Are There Any Options for Me Besides IVF?
Question
My husband and I have been trying to conceive since August. We have run into some “roadblocks”, and obviously at this point I’m getting kind of despondent.
To start, my history: I am 37 years old with two children, neither of which gave me any problems in terms of conception (to be honest, they were both unexpected). For the past three or so years my cycles have been erratic, and were only 23 or so days in length. In January my cycle suddenly went to 45 days and then I started to spot. I thought I might be miscarrying, but after an ultrasound they found an 8cm cystadenofibroma that they thought was on my left ovary. Surgery was scheduled, and it turned out that it was actually on my left fallopian tube. I lost that tube but kept the ovary.
About two months later my OB/GYN re-evaluated me since she knew we were ttc. I was put on Femara for days 5-9. First month was 5mg, but since my progesterone levels were still low they bumped me to 10mg for the 2nd month (they wanted me over 10, and the 10mg had me at 12.3). My cycles then went to 28 days like clockwork. After four months total, I missed a period, and on about day 40 I started to spot. Again, they found a cyst, this time a 2cm simple, and took me off the Femara (she said a cyst should not have developed if the Femara was working).
My OB/GYN had suggested getting a test done on my husband as well, but since there were so many problems that were on my end, we never did those tests. However, two months ago my husband and I found out that he was taking a medication that caused low sperm count, so he went off of it and we decided to try again. I still had two refills of the Femara left and I chose to risk the cyst and start the regimen again. I informed my GYN of this on the second month and had my 23-day tests done this past Tuesday. This time even after two months my progesterone was only at 2.9.
I know this is a little run-on, but I wanted to give all the background first before I asked my questions…
My questions are as follows:
1. What would cause the Femara to work fine on the progesterone levels the first round, but not at all on the second?
2. I know I don’t have PCOS, so what could be causing these low progesterone levels? (I never had any problems getting pregnant with my two children).
3. Are there any options available to me other than resorting to something like IVF?
I meet with my GYN again on the 30th, but was hoping someone here could give me a little hope in advance…
Ayara
Answer
Last Updated: May 2, 2022
The Femara will primarily raise your follicular phase (pre-peak) estradiol levels. If your luteal phase (post-peak) progesterone levels are low then HCG injections on post-peak days 3, 5, 7 and 9 would be a better treatment.
The low progesterone levels could be a result of an age-related luteal phase defect. The cysts are not necessarily a good indicator that the Femara was or was not working.
I suggest that you get a comprehensive NaProTechnology evaluation. Go to www.naprotechnology.com for more information. Go to http://www.fertilitycare.org/mclocations/usa.htm to find a NaProTechnology physician.
NaProTechnology seeks to identify defects in the reproductive system and then treat those defects. Its approach respects the integrity of the design of the natural reproductive system, never impeding, destroying or circumventing it.
In health,
George Delgado, M.D., F.A.A.F.P.
Answered By:
