QuestionHi,
My husband and I just started trying to have a baby in June 2010. I have PCOS and was worried that I would have problems getting pregnant. We had no problems getting pregnant, but I have not been able to maintain a pregnancy. I have miscarried twice. The first time in August and the second time in November. Needless to say I am heartbroken.
After the first miscarriage I was diagnosed with MTHFR which causes problems with folic acid usage in the body. My doctor started me on Mentax to increase my levels. With the second pregnancy my doctor closely monitored my progesterone levels. My levels seemed fine at first, but dropped at my fifth week.
My doctor noticed that hCg levels indicated that a week behind where I should have been in my pregnancy. My doctor did an biopsy of my endometrium yesterday. We talked about possible treatments. My question is what treatment do you recommend for LPD? Should I be supplementing my progesterone? If so, how? Starting when? Some of the information that I have read says that it should be taken at ovulation, what is the best way to determine that? Should I take clomid?
Thank you,
Nicole from Maryland
AnswerHello Nicole from the U.S.,
If the doctor you are seeing is a fertility specialist (a real one), then this is a very simple question for him or her to answer and he/she should be answering it for you.
But since you asked, progesterone is a very easy hormone to use and I use it with all my fertility treatments. Of course, you were able to get pregnant on your own (I presume) so I would not have automatically prescribed it, but now that you have miscarriage twice, it would be indicated. In addition to the Folate, I would add low dose aspirin 81 mg per day and progesterone. I use either Crinone 8% or Endometrin 100 mg, both used vaginally. Crinone is used only once per day (each morning) whereas Endometrin is used twice per day. Both are started right after ovulation (if detected by ultrasound monitoring) or on cycle day #16 if using the calendar method. Because you may not have a period using supplemental progesterone, a pregnancy test will need to be done around cycle day #28 and the progesterone should not be stopped unless the test is negative. If positive, it should be continued until you are 10 weeks gestational age.
There is no way to know exactly when ovulation occurs. The OPK that you can buy only gives you a heads up that it will occur within 3-4 days so that you can start having intercourse. Ultrasound surveillance of the developing ovulatory follicle is a little more accurate and can time within 24-36 hrs. But, neither of these can determine exactly when it occurs.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
