Low progesterone party. Please give me advice?

virginiaorjohn

Ladies, I am really feeling like I need some advice, but this is a long post full of backstory. No hard feelings if you don't want to deal with this now, here's a puppy/kitten combo for your click-troubles.

I've mentioned here and there from the start (see my intro post here) that I have had short LPs, and a month ago I went in for 7DPO bloodwork to test prolactin, TSH, and progesterone. Prolactin and TSH were normal, progesterone was 4.9ng/mL. They told me to wait a month and come back for repeat 7DPO bloodwork to confirm, and it came back even lower at 1.8ng/mL. From what I've read, the ranges for low progesterone are: 

<3ng indicates no ovulation

3 to 10ng indicates "weak" ovulation, and 

>10ng is healthy/normal ovulation

I have been charting for two months (see charts here) so I don't have a ton of temps to go on. But here's my first question: am I wrong to say that my charts indicate that I AM ovulating even though my progesterone indicates that I might have "weak" ovulation or be anovulatory? 

Unrelated to the actual bloodwork, my old OBGYN left my practice for family issues, so I got assigned to a new OBGYN this week. I talked to the new OB's nurse on the phone just now, and she gave me (as I expected) the spiel about "oh, we can try Clomid next cycle" after they do some tests. Well, I knew she would say that and that's NOT going to happen at the OB's office (all my love for teaching me that, you guys are awesome.) I have an appointment scheduled with the new OB on Monday since we've never met, and she also wants to do an ultrasound (I guess just for general troubleshooting? I really don't know.) 

We have only been TTC for 9 months so far, and our insurance will not cover an RE until 12 months of TTC. And I don't want to do Clomid until I'm with an RE, obviously. So here's my second question: does it make sense for me to ask to try progesterone suppositories for a few months until we hit the 12 month mark, or is that jumping the gun? If I continue with no progesterone meds, am I right to assume there is very little chance that I will conceive on my own, thus basically benching myself for 3 months until I can see an RE? (And that's assuming I can even get in to see the RE quickly when my coverage kicks in.) I don't know what this new OB will say, but I do want to be prepared and knowledgable about my options outside of Clomid.

Feel free to give me all the advice, because at this point I trust you guys to keep it real. Flame me if I'm crazypants. 

TL;DR - If you have low progesterone with 3 months to spare until you see an RE, would you ask for progesterone suppositories for those 3 months? (Wow, I probably should have just gone with that.)

barackollama

I would not. My ob put me on progesterone. Fast forward to my RE appointment and it actually hurt my chances of conceiving based on ob's instructions. I wish I would have gone straight to the RE at my year mark. My ob is awesome but there's a reason specialists exist.

divinemsbee

I don't have a ton of experience with progesterone as part of treatment, I know that my RE (and from what I've read lots of REs) will put me on progesterone suppositories, but only after a BFP.

I think the thing I'd worry about if you were put on them in the TWW by an OB is whether they would be timed appropriately. If you started the progesterone too soon in your cycle it could prevent you from O-ing entirely.

Does you insurance require a year even if there are other diagnosed issues at play? If so, I'd probably just keep doing what you're doing and charting so that you have more to take to the RE when you can see them. Also, can you call around to RE offices and see what the wait time is on getting a first appointment? That way, if it's 4 weeks or so, I'd just call and schedule it that far out.

ETA: One of the reasons they could be suggesting Clomid is that it can help women who have a weaker ovulation (I occasionally do) to have a stronger one which can up the progesterone levels on the 7DPO blood work. So I don't think Clomid in general is a bad idea or an off suggestion, but you are right to want  to do it with a proper doc and proper monitoring.

AnonymousNurse

Others might have better insight into this, but your low progesterone is more likely a symptom of another problem and not a solitary issue in and of itself.  Therefore, just trying to slap a bandaid on the problem by taking progesterone supplements is not likely to do anything.  I would avoid seeking any further treatment with your OB and just wait until you see the RE.

I was just shy of a real year of TTC when I made my first RE appointment.  Some insurances specify that if there is a known issue, you can see a specialist sooner.  I asked my RE's office about this and they told me to just put 12 months on my history just to cover myself.  If I were you I would call and make an appointment now - you will likely be at or near the year mark by the time you're able to get a consult, anyway.  I'm not advocating impatience, but you have a known issue and you are so close anyways.  

virginiaorjohn

divinemsbee said:

I don't have a ton of experience with progesterone as part of treatment, I know that my RE (and from what I've read lots of REs) will put me on progesterone suppositories, but only after a BFP.

I think the thing I'd worry about if you were put on them in the TWW by an OB is whether they would be timed appropriately. If you started the progesterone too soon in your cycle it could prevent you from O-ing entirely.

Does you insurance require a year even if there are other diagnosed issues at play? If so, I'd probably just keep doing what you're doing and charting so that you have more to take to the RE when you can see them. Also, can you call around to RE offices and see what the wait time is on getting a first appointment? That way, if it's 4 weeks or so, I'd just call and schedule it that far out.

ETA: One of the reasons they could be suggesting Clomid is that it can help women who have a weaker ovulation (I occasionally do) to have a stronger one which can up the progesterone levels on the 7DPO blood work. So I don't think Clomid in general is a bad idea or an off suggestion, but you are right to want  to do it with a proper doc and proper monitoring.

Regarding Clomid, I wonder if weak ovulation is my problem, and if that's the case then I think progesterone would be putting a bandaid on a bullet hole, so to speak. But if I have weak ovulation, is that indicated in my charts? I have no idea. I have a sustained temp shift, but maybe the shift isn't great enough, I don't know. I hadn't thought about whether an RE would be covered earlier with this diagnosed issue. I will call them tomorrow to ask. And the calling early to get an idea of wait times is a great idea, especially given that a friend of mine had a great experience with one guy and I might try to see him in the long run.

virginiaorjohn

mbrookeRN said:

Others might have better insight into this, but your low progesterone is more likely a symptom of another problem and not a solitary issue in and of itself.  Therefore, just trying to slap a bandaid on the problem by taking progesterone supplements is not likely to do anything.  I would avoid seeking any further treatment with your OB and just wait until you see the RE.

I was just shy of a real year of TTC when I made my first RE appointment.  Some insurances specify that if there is a known issue, you can see a specialist sooner.  I asked my RE's office about this and they told me to just put 12 months on my history just to cover myself.  If I were you I would call and make an appointment now - you will likely be at or near the year mark by the time you're able to get a consult, anyway.  I'm not advocating impatience, but you have a known issue and you are so close anyways.  

Agreed, if I have a bigger problem like weak ovulation then progesterone won't work. I'm still confused as to whether my temps show weak ovulation or not, but my charting experience is still limited right now.

I also don't feel impatient to go see an RE, but yet also, if my chances are 0% while unmedicated then I guess there's no reason to delay if insurance will cover it. I'll definitely be calling my insurance to see whether coverage kicks in early for broken utes. Thanks so much for the help.

sister13

I took a look at your charts and it does look like you are ovulating.  With only two months of data, I would trust that the ranges you reference are a guide only, not necessarily absolutes in any given month when the numbers are conflicting with your temps. 

You have to use the data and experience available to you, which shows that you have consistently short LPs, and now you have some more data that indicates a problem.  

As for the treatment with prog supplements and/or Clomid, I've got nothing, but I'll page @DorothyZbornak97 in because I believe her situation was somewhat similar, and I think the prog supplements appear to have worked in her case, just shy of 12 months TTC.  (Hi DZ!)  

kelle017

When I was trying for dd I had two c/p's (cycles 2 &3) which my ob believed to be a result of low progesterone.

  

As a result I started suppositories after ovulation was confirmed and even after that once I got pregnant with her (cycle 6) it was still low (numbers in siggy I think)

So going into this round I already have a prescription ready to go for progesterone.

typo31

Hi there! Lurking from 3T.

I, too had clear ovulation temp shifts but then short LPs (7-8 days spotting all the while) during my unsuccessful year of trying. Several times I thought about asking my OB about progesterone but never worked up the guts to do it.  

Fast forward to the beginning of my RE testing, and it was conclusive - mild PCOS that was causing "weak" ovulation with basically no hope of implantation. My progesterone was low but it all started in the beginning of my cycle, when the PCOS affected hormones that then failed to trigger other hormones, etc. etc. So, just taking the suppositories wouldn't have made a difference, and my PCOS would have gone undiagnosed.

TL;DR - it sucks when insurance gets in the way, but I wouldn't mess around with hormones of any sort without direction from an RE.

Good luck!

bfonz619

I don't have any insight to offer, but just wanted to wish you the best.

nittanyllama

I haven't been around much lately but I'll make an appearance for this. I am in almost an identical situation. I've been charting since March and I see temp shifts, although it's a slow rise and short LPs (9-11 days). Saw my OB who offered clomid (no thanks) and told me progesterone supplements wouldn't do any good. My level at 7dpo was 3.3.

I decided to wait and see what the RE has to say, our appt is end of this month. I'm under the assumption that I have weak ovulation and that with P4 levels that low, I feel like I've given up on "trying" right now because in my mind it's pointless. But I feel like I will hopefully have a better picture of the situation after seeing the RE. 

I'm sorry that your results look crummy. I'd wait for the RE if I were you but I know that sucks and I'm really very sorry.

bosco213

Lurking, but can I ask what "weak" ovulation actually is and how you could tell it was an issue? Aside from seeing your doctor/blood work.

typo31

@bosco213 My RE explained it as: ovulating (and seeing a clear ovulatory pattern on your chart), but due to insulin/androgen levels being wacky the egg is poor quality and the lining has not built up appropriately. This can result in a lot of mid-cycle and LP spotting/very short LPs.

virginiaorjohn

This is all great advice, guys. I'm calling insurance tomorrow, and some REs to get an idea of wait times for consults. Thank you for your time and help!

URMySunshine77

I also want to wish you luck and hope that you get a firm plan forward soon.

LG2793

Good luck! I'm in the same boat, so I'm interested to see what you find out.

virginiaorjohn

Additional info is never late, @dorothyzbornak97‌

I called my insurance and they said with the diagnosis of low pg, I don't need to wait the official 12 months, but the earliest appt I could get with an RE (that a friend had success with) is late November, which will put me at 11 months anyways. I will talk to my OBGYN on Monday, and see what she says regarding progesterone supplements, since there seem to be some in 

@dorothyzbornak97, do you remember how your progesterone was prescribed? I know you shouldn't take before O, so was it a daily after confirmed O until you got your BFP?

Also, @PrincessPetunias‌, when you say taking the pg hurt your chances of conceiving, do you mean it messed up your cycle while you took it with no long-term effects, or do you mean your RE wished you hadn't taken the progesterone because it affected your long-term fertility?

virginiaorjohn

MeatandBandP said:

As long as you are taking progesterone at the right time in you cycle it can have no negative side effects on conception. PP probably took progesterone based on a certain cycle day without confirming O, and yes in that case, it would hurt your chances.

You would start the progesterone on the day after O. 

Thanks, @MeatandBandP‌ that's what I figured but thank you for confirming! Lord, this new OB is either going to think I'm so crazy for being informed or that I'm awesome for being informed. I hope it's the latter...

katie0919

Do you spot after ovulation and before your period? I have been TTC since December and am 35, so I sought out help from an RE in July since after I had a chemical pregnancy in March, my cycles have been off, and I began to spot starting around 5 DPO through CD 1. Turns out, I have low progesterone, BUT she said that is caused by a weaker ovulation. When she asked me if I used OPK's (yes), she asked if they were clearly positive. I said, no, they got to ALMOST as dark or as dark as the control line, but never darker than the control line. I asked about supplementing with just progesterone and she told me literally what you said - that is just masking a bigger issue.

That is when she diagnosed me with weak ovulation (even though my charts clearly indicate ovulation), she said that didn't matter and it just was too weak.

I took 50mg Clomid (monitored), trigger shot, and timed intercourse with progesterone supplements post O and low and behold - I got KU. Now, as you can see by my signature, that didn't end wll. BUT, I believe she diagnosed me properly. It sounds like you could possibly have a similar problem on your hands. FX for you! 

virginiaorjohn

katie0919 said:

Do you spot after ovulation and before your period? I have been TTC since December and am 35, so I sought out help from an RE in July since after I had a chemical pregnancy in March, my cycles have been off, and I began to spot starting around 5 DPO through CD 1. Turns out, I have low progesterone, BUT she said that is caused by a weaker ovulation. When she asked me if I used OPK's (yes), she asked if they were clearly positive. I said, no, they got to ALMOST as dark or as dark as the control line, but never darker than the control line. I asked about supplementing with just progesterone and she told me literally what you said - that is just masking a bigger issue.

That is when she diagnosed me with weak ovulation (even though my charts clearly indicate ovulation), she said that didn't matter and it just was too weak.

I took 50mg Clomid (monitored), trigger shot, and timed intercourse with progesterone supplements post O and low and behold - I got KU. Now, as you can see by my signature, that didn't end wll. BUT, I believe she diagnosed me properly. It sounds like you could possibly have a similar problem on your hands. FX for you! 

Yes, i feel like there's no way to know whether it's a weak ovulation problem or a low progesterone problem without further testing (I want to say testing for FSH on CD3 would help, but maybe I'm wrong on that.) 

In the past I have have not spotted at ovulation, but I generally spot consistently 2 days before I get my period around 9DPO. I haven't used OPKs since my first two months of TTC; at the time I had so much trouble figuring out if I had a positive or not (probably for the same reason as you) and so at month 4, I switched to using the ClearBlue fertility monitor because it gave me a clear low/high/peak answer. I think I'll try OPKs this cycle so I can say for sure what they look like when I know I'm ovulating, per the fertility monitor and temping.

I'm really glad I have the RE to look forward to because if weak ovulation is the problem (and it very well may be) then I know Clomid is a good bet, and I want to do it the right way at an RE. In the meantime, it sounds like taking progesterone suppositories may not hurt me, but they might not do anything either. 

tessajdhSMC

I am "ovulatory PCOS". I tested 3.7 progesterone level 7dpo. I tried progesterone supplements (vaginal suppositories) and would use them at 7dpo and continue through a negative test. Did that for 3 months. No luck. RE said I was definitely ovulating. 

Do you have any other symptoms of PCOS? (hair in unwanted places, acne, bloating in the stomach area, etc) You could have your testosterone levels checked to see if you're in the PCO range.

You may want to look into trying myo-inositol. There have been some really great results from that in the PCOS community. I take 4g (about a tsp) in the morning before eating anything. One of the things it is supposed to do is increase progesterone after ovulation. (and help those who aren't ovulating at all to actually ovulate) 

I've only been on it for a couple of weeks, so I can't say what it's doing to my cycles just yet, but I know other ladies who have had great success with it.

Good luck!

virginiaorjohn

tessajdhSMC said:

I am "ovulatory PCOS". I tested 3.7 progesterone level 7dpo. I tried progesterone supplements (vaginal suppositories) and would use them at 7dpo and continue through a negative test. Did that for 3 months. No luck. RE said I was definitely ovulating. 

Do you have any other symptoms of PCOS? (hair in unwanted places, acne, bloating in the stomach area, etc) You could have your testosterone levels checked to see if you're in the PCO range.

You may want to look into trying myo-inositol. There have been some really great results from that in the PCOS community. I take 4g (about a tsp) in the morning before eating anything. One of the things it is supposed to do is increase progesterone after ovulation. (and help those who aren't ovulating at all to actually ovulate) 

I've only been on it for a couple of weeks, so I can't say what it's doing to my cycles just yet, but I know other ladies who have had great success with it.

Good luck!

I'll have to look more into PCOS and ovulatory PCOS... I am about 30 pounds overweight carrying it all over, but not hairy beyond the usual legs and underarms, and the occasional acne. I will absolutely encourage the RE to do any and all testing, though. I'll also educate myself on myo-inositol. Thanks for the new info @tessajdhSMC‌!

julymommy12

Thank you so much for starting this thread. My 7dpo progesterone was 6.9 ng and my lp is 9 days. I also have a clear shift on my charts but nothing is happening. I am seeing an RE next week about this.

jesselayne8

I am currently taking progesterone supplements because I had an 8 day LP every cycle. I am pretty sure it's just a bandaid and my real problem is weak ovulation because my LP is only 10-11 days with the supplement. I have a diagnosis of PCOS.