Luteal Phase & Conception

[adgal]

Hi Dr.

I am a 39 year old relatively healthy women, trying to have our first child.  I have a low body weight for my height, but no eating disorders or anything like that. Also, no drugs, medications beyond occasional tylenol.  Social drinker only.  I am an on and off again smoker, but almost off them completely. Just really thin, and always have been.  I experienced a miscarriage that began Jan 5th of this year, and ended in an emergency D&C with a fair amount of blood loss on Feb. 3.  During that month, I never did stop bleeding, and my hemeglobins got just below 70. It was a very nasty experience.  Prior to that my cycles were 28 days like clockwork.

We are trying to conceive again, and I am using an OPK.  I got my positive for LH surge day before yesterday (day 11) which is fairly normal I understand.  However there have been times I have not gotten it until day 16, and still menstruated day 28.   My understanding is you don't actually ovulate for 12-48 hours after a positive surge.  Will the fact that I sometimes have a shortened luteal phase impact my chances for natural conception?  Is there anything I can be doing to regulate it?  I see my OBGYN (who is also a fertility specialist) next week, is there anything specific you think I should be asking him about or to test for?

Thanks for your time.

[John H. Kim, M.D.]

Yes, I agree with you. There may be something wrong with your luteal phase. This can be monitored with ultrasound and by checking a Progesterone level 7 days after you ovulate. Fertility treatments usually corrects this luteal problem. For example taking Clomiphene citrate or injectable forms of fertility drugs like gonadotropins usually fix this shortened luteal phase. In addition, one can take Progesterone supplements to boost the luteal phase. All these are potential options by your fertility specialist.

[pjbjd1007]

My husband and I are both mid 20's.  We have been TTC for 3 months. During my preconception visit my doctor told me to return for an appt if I didnt get pregnant within 9 months.  After our first month of TTC, we started using OPKs.  Both OPKs didnt show a positive result until day 22 of my 29 day cycle which would make my luteal phase only 7 days.  I have googled shortened luteal phases and it suggests over the counter options of B6 or Vitex (Chasteberry).  Should I begin taking this without consulting my doctor first?  Or should I make an appt even though I haven't been TTC for 9 months yet??  Thank you for any help!

[John H. Kim, M.D.]

Please see your doctor first. I do not suggest Vitex or B6 for luteal phase defect if indeed that is what you have. I do think that seeing a reputable practioner of acupuncture and herbal medicine with a speciaty in fertility can be helpful but first see your doctor.