Fertility Workup Needed?

Question

Dear Expert,
I am having such difficulty finding information about my symptons and possible treatment. I am 36 years old and have been on the pill pretty much since my early twenties but with a four year break in my early thirties.

I have now been desperately trying to start a family for a year. During the last year I have used ovulation predictor kits to monitor my cycle and have timed intercourse accordingly. During the period 1. My cycle has always been between 28 and 32 days long 2. 3 times I have seen full follicular development on the scan 3. The womb lining appears thick and normal on the scan 4. I have a definite LH surge showing up on the ovulation predictor stick between days 14 and 16 5. I seem to have fertile cervical mucus prior to detecting the LH surge but by the time I detect the LH surge, the mucus seems quite dry and tacky.
6. In the three cycles where I have seen follicular development and detected the subsequent LH surge my day 21 progesterone tests were 8.5, 11.1 and 14. On one of these cycles a later phase scan showed the ruptured follicle.

Am I ovulating?

Could a follicle develop without an egg? Why?

Does it mean I don’t have any viable eggs left?

What kind of treatment could I expect to try?

I would be so grateful if you could give me a reply. I just don’t understand what’s going on.

Answer

Last Updated: June 14, 2013
Since you have been trying to get pregnant for a year, you could benefit from a full fertility workup including a semen analysis for your husband, checking to see if your fallopian tubes are open, checking for the presence of endometriosis, and thyroid and other hormonal tests, such as day 3 FSH and estradiol. It seems from what you are describing that you are ovulating. The day 21 progesterone is less accurate than obtaining a more complete series of values for estradiol and progesterone 5, 7, and 9 days after ovulation, as determined by the LH test. It is possible you have a minor degree of follicular dysfunction, or perhaps your ovaries are functioning well and the progesterone levels were drawn too late or to early to detect the peak progesterone. It is possible for a follicle to develop without an egg or to not rupture. This occurs with minor degrees of PCOS or perimenopuase, as well as with endometriosis or luteal phases insufficiency.

In the interim, supplements may help ovarian function, such as Optivite and flax oil capsules 1-3 grams daily. I would have intercourse both at the time of maximal mucus and within 24 hours of the LH surge for now.

Dr. Mary Davenport

Answered By:

Mary Davenport, MD, MS
Mary Davenport, MD, FACOG, an obstetrician/gynecologist from the Oakland Region of California, offers telehealth services over MyCatholicDoctor.com She graduated from Tufts University School of Medicine and completed her residency at UC San Diego. Dr. Davenport is a Fellow of the American College of Obstetrics and Gynecology, and serves on the Advisory Board of the California Association of Natural Family Planning.

Read more related questions

Panic About Fertility

I’m having a complete panic about my fertility. I’m 30 years old and stopped taking the pill a few months ago after being on it…

Trying to Conceive for First Time

I am a 38 year old woman, trying to conceive for the first time. I am using the Clearblue Fertility Monitor and it showed high…

Could Polyp Be Causing Miscarriage?

Could you please help me as I don’t know who I can ask? I am 43 years old (have had no children before) and within…

Breastfeeding and Miscarriage

I am a 38 year old woman with three children who has also had five miscarriages. I am currently four weeks pregnant (six weeks after…

Conflicting Advice on Progesterone and Infertility

I am 27 years old and my husband and I have been trying for our first child for five months. I have been charting since…

Low Estradiol on Day Three of Cycle

I am 26. I have had four miscarriages. Recently I had cycle day three labs done. The results are as follows: FSH 5.5 TSH 1.33…

How Long Should I Wait to Conceive After Weaning

I had a miscarriage a few weeks ago, and I believe that it is very possible it was due to low hormone levels. I had…

Is My Premenstrual Spotting Related to My Miscarriages

I am 40 years old, with an almost-three-year-old daughter. My husband and I have been married for eight and a half years. We went through…

New Normal After Stillbirth?

My first child (a beautiful baby girl) was stillborn in February of this year (40 weeks gestation with no known cause). My husband and I…

Poor Cervical Mucus and Now Miscarried

I am 37 years old, with two children ages six and three and a half. I have been trying to conceive for one year using…

Still Think Something is Just Not Right

I am 26 years old and my husband and I have been practicing NFP since we married two years ago. Right after getting married, I…

What is Normal TSH?

I was having a difficult time becoming pregnant. I finally got pregnant, but then miscarried. This was unusual for me because I quickly became pregnant…

Create An Account

This is not a membership, this is an account for our CANFP website. If you decide you would like to sign up for one of our memberships later, you can do so with or without this account.

First Name *
Last Name *
E-mail *
Username *
Password *
Confirm Password *
Edit Profile
Information
Subscriptions
Payments
Order History
Downloads
Shipping and Billing
Donations
Settings
Login Information
Notification Settings
Notification Subscriptions
Profile

CANFP conducts varied outreach programs to the community at large, in addition to serving our members (NFP users, teachers, and advocates).

CANFP provides education programs tailored to the audience, not only on Natural Family Planning, but on the wide variety of topics related to it.

Programs can be continuing education for NFP Professionals, introductory information for a lay audience of youth or adults new to the topic, or specifically tailored to the interests of a professional audience, such as educators, physicians, or clergy. Content is faith based or secular, whichever is suitable for situation.

CANFP offers a variety of resources for those just discovering Natural Family Planning, as well as to meet the varied needs of our CANFP Members. Most resources are available to any visitors to our site. Some resources do ask you to register as a site user in order to access them, others are available only to CANFP Members.

CANFP statewide conferences, regional events offered in collaboration with local partners, events featuring CANFP speakers, or exhbit, as well as other events throughout the state of interest to our NFP community.  Come meet one of our experts at one of these events or book a speaker for your own upcoming event.

CANFP depends on the gifts, talents, and generosity of our members and supporters. The success of our mission depends on the collaboration of our members. Please consider contributing your time treasure and talent through CANFP to share the good news of NFP with the world! Both volunteer and contracted positions available.

Stay informed by joining our email list

* indicates required
Which role(s) best describes you?