QuestionI have recently been seeing a private doctor who noticed I have a luteal phase defect, usually 8 or 9 days long. I was prescribed 5 Femara on day 3 of my cycle and 10 cyclogist(progesterone pesseries) to be taken 3 days after ovulation, I have also been put on LDN. This is my 2nd cycle on this, but due to money problems I can't continue the treatment after this month. I read on line the vitamin B6 %26 progesterone cream can help lengthen a luteal phase defect, is this true? I also wanted to know if I was taking 50mg vitamin B6 %26 got pregnant, would I continue to take it and for how long? I was told I have a high chance of miscarriage with a luteal phase defect and I am scared to do the wrong thing. Do you think the B6 and progesterone cream will be as effective as the other drugs I was on? Thank you.
AnswerHello Orla from Ireland,
I have to say that I am not an advocate of patient's self treating themselves, but that being said, I understand the financial limitations.
Luteal phase defect is where the "luteal phase" is out of sync. Usually it is too short. It should ordinarily be 14 days after ovulation. This defect is due to either an ovarian dysfunction or inadequate progesterone. If you are ovulating normally, then it could be a progesterone insufficiency. In that case, the treatment of choice is to use progesterone supplementation to lenghthen the luteal phase. Any form of progesterone will do as long as it is an adequate dosage and has adequate endometrial levels. For this reason, the two best ways to take progesterone are by injection or by vaginal suppositories. Progesterone cream and pills are available but in fertility testing, do not give adequate levels in the endometrium. I cannot advise on an appropriate dose because, in general and in my practice, I do not use the progesterone cream. If you become pregnant, you can continue this hormone until 12 weeks of the pregnancy to help with reducing the chances of miscarriage.
In term of Vit B6, I don't it offers any advantages. If you become pregnant, you should not continue supplementation with this medication but switch to prenatal vitamins. That way you will get the recommended dose of vitamins.
I hope that answers your questons.
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 facebook and twitter with me at @montereybayivf
