QuestionI am 37 years old with 2 children (6 and 4) who were conceived very easily. At age 36 we began trying for our 3rd child, became pregnant naturally and miscarried at 8 weeks. We tried for 6 months after the miscarriage and then talked with our ob-gyn. I have very regular 27-29 day cycles and in the last year usually have mid-cycle pain. A day 14 ultrasound showed very small follicles and so he thought I may not even ovulate and a day 21 progesterone level of 12. Husband and I still had intercourse periodically days 12-17. Well, I left town on day 18 of my cycle but then showed a positive preg. test 1 day after my period was to start, but then started bleeding 4 days later. My doctor said to start clomid (as was discussed the month before) 50mg days 2-7. Ulatrsound on day 13 showed several small cysts, largest one measuring 10mm, next ultrasound day 17 one follicle 18mm. I was given an HCG shot (10,000), and my progesterone level on day 24 was only a 7.2.
I am worried that my progesterone is simply not high enough to help with implantation and maintaining a healthy pregnancy, yet my Dr said only to begin progeserone pills on the 1st day of a positive pregnancy test. What are your feelings on this advice and is there any harm in taking a vitamin B6 supplement while on clomid and HCG shot? I heard it may help with prog. levels. Is there any other blood work that may be helpful. Does a 7.2 progesterone result this cylcle mean I have little chance of conceiving?
I am sorry this is so long, but any comments would be helpful.
Thanks so much,
Sherrie
AnswerDear Sherrie,
In reviewing your question, let me explain some basic concepts first. It sounds like the ultrasound you had on day 14 missed ovulation, and that you indeed ovulated because your day # 21 ultrasound was greater than 10 (an indication of ovulation). With the subsequent cycle, where you had a slightly late period, positive pregnancy test then bleeding, it is possible that you had a chemical pregnancy. However, without having checked a blood pregnancy test, we can't know for sure.
In terms of Progesterone supplementation, what you are eluding to is a disorder called "Luteal Phase defect". This is where the ovary does not produce adequate progesterone levels after ovulation, in which case either impplantation is impaired or a miscarriage ensues. Because of this, I place ALL my Clomid or infertility patients on progesterone supplementation starting immediately after ovulation (day#16). If pregnancy occurs, then this is continued until 10-12 weeks gestational age. This may or may not be your problem, but you could certainly given it a try. B6 supplementation does not work.
The main reason, that you my be having more difficulty getting pregnant, and even miscarrying is age related. As a woman ages, her chances of spontaneous pregnancy declines significantly, especially after 35. This decline is also because there is an increase in miscarriages caused by genetic abnormalities. What you need to keep in mind is that it is harder to get pregnant at your age, but not impossible. You'll need to be more patient and expect more similar episodes. In general, infertility subspecialists recommend that you see an infertility specialist after the age of 35.
As an aside, based on what you have told me, I'm not sure your OB/GYN doctor is the best person to be seeing at this point. I would strongly recommend that you see an infertility subspecialist. How do you know who to see, since many OB/GYN's advertise that they do infertility? Just ask if they provide IVF. If they don't, then they are not a subspeciality clinic.
I hope this answers your questions.
Sincerely,
Edward J. Ramirez, M.D.
Medical Director
The Fertiltiy and Gynecology Center-
Monterey Bay IVF
www.montereybayivf.com
