Dear Alicia,
I am sorry that you are meeting such difficulties but it is wonderful that you are charting because this gives a physician excellent information to target testing and interpret results. Charting also helps a couple participate in rather than be incidental to their fertility investigation. Additionally, the goal is to find the reason for the difficulty and restore health. Because of these things, a charting couple is usually considered infertile or sub fertile after six months of fertility-focused intercourse.
The testing of your hormones is a good start; however, it is better to draw the blood in relation to the peak day (the last day of any peak type mucus) and not necessarily on Day 21. Physiologic markers such as cervical mucus are accurate markers of biologic function and blood tests and ultrasounds etc help to fine tune that information especially when coordinated with the chart.
Peak type mucus is a result of increasing estrogen levels from the egg follicle on the cervical crypts. Estrogen causes the mucus to be elastic (stretchy), slippery (lubricative), and /or clear and it has been shown that most ovulation occurs on peak day. Right after ovulation, the remaining follicle produces progesterone which is needed for endometrial development and sustaining a pregnancy. If the progesterone amounts are too low, not sustained, or drop off too early, cycles are irregular and miscarriages are more likely. Other hormones factor into healthy cycles such as thyroid, testosterone, DHEA, etc.
You describe symptoms of low progesterone levels, irregular ovulation, and anovulatory cycles (no ovulation). It is quite possible that you have follicular cysts that are prolonging your cycle and delaying ovulation. Additionally, the follicle that develops may not be sufficient in producing enough progesterone in the normal rise and fall pattern of the luteal phase. Also it is possible that though the follicle enlarges, the egg never ruptures out so you have the appearance of fairly regular cycles but without actual ovulation.
If this is the case as it is for many women with irregular cycles, progesterone is used with excellent results. Creams, vaginal suppositories, injections, and oral routes are used during post peak only, following ovulation, from the third day after your peak through the 12th day after your peak. This helps to normalize the cycle. The use of bio-identical progesterone (exactly what your body makes) is typically used by myself and colleagues and has been found to be safe in all three trimesters of pregnancy as well. A study is soon to be published that reviews the data regarding the use of bio-identical progesterone over forty years via the Pope Paul VI Institute. The data shows that bio-identical progesterone can be used safely in all three trimesters of pregnancy.
Additionally, 17- hydroxyprogesterone caproate has been used since the 1950’s as Delalutin to help reduce miscarriage. It was taken off the market and then returned to market after a NIH study showed its effectiveness and safety. It was remarketed in 2011 as Makena and the cost was artificially elevated. After a firestorm of criticism, the company reduced the price. What your Ob/Gyn may have been commenting on was that Delatutin/Makena have not been studied in all three trimesters. IM Progesterone just had a labeling change for use in the first trimester whereas the creams and oral preparations never had a first trimester warning. This all may contribute to the varying conclusions that physicians have regarding progesterone.
Nutrition is always important for fertility and general health. Physicians are becoming more knowledgeable about this area and how it impacts fertility. There is a good basic book called “Fertility, Cycles, & Nutrition” by Marilynn Shannon which you may find helpful. Additionally adequate restorative sleep, sensible exercise, and maintaining a healthy weight are vital.
I hope that this information helps you.
Gretchen V. Marsh, D.O.