New Member, OPK/LH mystery

BenJay · October 2016

33 yo here on 1 year 6 months of TTC. I'm on my 3rd cycle with Clomid, with two "confirmed" ovulations. (Progesterone at 23+). Just waiting for a positive OPK to try IUI. And really disliking the easy weight gain side effect...

Has anyone else *never* gotten an lh surge? For the last couple months, I have tested 2x daily from Day 9 to Day 20 - first am urine (for scheduling the IUI treatment per dr's orders) and late afternoon (per internet wisdom and infertility RN's suggestion). I always cut my liquid intake in anticipation, wait at least 4 hours, and do a clean 'catch' for testing. No surge smiley face. Ever.

Advice is very welcome, if even it's good questions to ask the infertility nurses or OBGYN.

BenJay · October 2016

Sorry, I have been using OPKs for 6+ months but only 1x day from Day 11 to Day 16 or so. So not just two months without smiley faces.

lablover78 · October 2016

Hello! Yes this has happened to me. I think I just don't always ovulate on my own. During medicated cycles I always end up using a trigger shot. My current RE is adamant about using 2nd urine of the day to test which I've always been suspect of but my OPK did go from low to high today so maybe he's right.

BenJay · October 2016

Second A.M. urine?? Huh. I checked the IUI instructions and it looks like I have from 8am to 12pm day of positive to schedule a treatment. So, this could work. Thanks!

I'm pretty sure I wasn't ovulating for a long time because my thyroid was off. Not too hypothyroid to get meds but once I got an infertility consult, they were like "No wonder!" TSH was 4.08, they wanted under 2.5. If anything about this TTC journey, it's that thyroid meds have changed my life!

Bababatty · October 2016

My last couple of cycles before we started seeing the RE, I wasn't getting +OPKs. But I was also phoning it in in terms of tracking my cycle, so I played fast and loose with my test times.

My RE has me testing in the evenings. Why are doctors all over the map on this? He said OPKs are designed to be used then because the manufacturer assumes you would be having sex in the evening--after you test. But then the CB advanced ones (that have low, high, and peak) say explicitly to test with 1st am urine.

Anyway, I'm like @lablover78: I always end up using triggers during my medicated cycles.

@benjay Is your doc monitoring you with u/s before your IUI? My experience has been that the IUI is not dependent on the OPK. I go in for an u/s and based on the follicle growth, they determine what day I'll likely be ovulating and tell me which date to use the trigger by if I don't get a +OPK. Some ladies also do monitoring blood tests to check LH and estrogen, I understand. I'd call and ask your RE about it. You might risk missing your O date if you rely just on OPKs and you're not getting a +.

hoffmanr7 · October 2016

Hello, I am sorry you have to be here but glad you joined us. I hope your stay with us is short and sweet.

I usually use the OPK's that have the lines as opposed to smiley faces. The one time I did the smiley face ones, I never got a positive...but I normally get them with the line ones. Sorry, not sure if that helps or not.

BenJay · October 2016

I switched to the smiley faces at my infertility RNs insistence.

I had no idea that OPKs could be different effectiveness. Heck, I'm learning a lot from this whole TTC deal....

Thanks for the warm welcome!

BenJay · October 2016

No U/S monitoring yet. I go through an HMO so it's kind of 'hands off' treatment, imho. Maybe the big picture is that they assume that I just need time to get a normal cycle back after years of high TSH levels.

At the end of each cycle, I email the infertility RNs for next steps. I did get a fluoroscopy so things all check out (no blockage, abnormal uterus, etc). My husband checks out on sperm count. I seem to ovulate from my progesterone levels, so I can see that the waiting game might be just part of it.

@Bababatty - When did you start U/S? And what's this trigger you speak of?

Bababatty · October 2016

@BenJay In my enthusiasm to respond, I forgot to welcome you properly, so Welcome! I hope you join the weekly check-in and keep us updated on your progress. It's a great board to be on.

"Trigger" refers to ovidrel (in my case; there are other drugs that do the same thing), which doctors prescribe to force ovulation. You inject it ~36 hours before your IUI or timed intercourse. I think it's mostly used by people who don't ovulate on their own, or whose bodies are being slow to ovulate, or just to guarantee ovulation.

For my medicated cycles, I've usually had two u/s each cycle, which I think is fairly standard. A baseline one on CD2-5 and then another 7 days later to see how my follicles have responded to the Clomid or Letrozole. My first IUI cycle I actually had three the week before my IUI because the RE was concerned I would grow too many follies. Haven't had that issue since switching to letrozole.

Are you waiting to O so you can do IUI this cycle, or do they want you to start getting +OPKs before you do an IUI cycle?

I'm a little surprised your doc isn't monitoring you on Clomid. It's something I'd really encourage asking about. Clomid can cause a number of issues including large numbers of follies, which can lead to high order multiples (this is the fine line I was walking my first cycle); thinning your lining; cysts; etc. Most people here, I think, would strongly suggest getting at least baseline and monitoring ultrasounds. Unless you're already being monitored another way and I'm just rambling?

BenJay · October 2016

Thanks for the warm welcome, @Bababatty !

I haven't really been monitored at all on Clomid. Since my IUI consult, I have only emailed with my OBGYN and gotten two refills. I read the side effects of the meds, which are scary, but I have just experienced weight gain. First month, some breast tenderness and a little "hormonal" feeling, but since then, nothing. So maybe the dosage isn't right. Or maybe the drug isn't right.

The infertility clinic will only schedule after a positive OPK. But, perhaps protocol changes when I finally get enough cycles with no positive but a high Day 21 progesterone level. If I can trust my progesterone, I am ovulating and at about an average point in my cycle, Day 15/16.

So, I am pretty confused how I "most likely" ovulated but no LH surge. Like, is that a thing?

Bababatty · October 2016

I've heard that some women just never get a positive OPK but they do still ovulate. I'm not sure why--maybe it's a really short surge and they miss their window? Do you track your temp and such? A temp shift will confirm O after the fact--although I'm sure you can also trust your blood tests--so maybe if you can chart for a few months and show obvious ovulation through temping, that will be enough for them? Obviously you shouldn't schedule your IUI based on temp, since by the time a shift is confirmed, you'll have missed your O date.

BenJay · October 2016

I haven't tracked temp because it's just one more thing for me to worry over.

I don't know about other folks, but I am feeling like a science experiment lately. TTC is not as magically romantic as I had envisioned!

I've opted for intercourse every other day during what might be my "fertility window". I started OPKs only because of my dr's recommendation. I was feeling so anxious about it all, because twice a day, I had (and still have) a reminder of that big goal. I'm feeling better about it this cycle, for sure.

seethosestars · October 2016

Hello and welcome! I am on letrozole with timed intercourse and no monitoring (where I'm from this is standard, although I understand in the USA there is often ultrasound monitoring). I too have really struggled with OPKs but am hopeful that this time, with the letrozole I will be able to get a positive!

I think the trick is to test multiple times a day (at least twice) as the surge may come and go before you got a chance to see it. I agree with the temperature thing - it doesn't take a lot of extra effort to check when you first wake up (use an app like Fertility Friend so you don't even have to interpret it!). If you haven't gotten the crosshairs for ovulation based on temps I would keep testing. Perhaps your O date is later than you think.

BenJay · October 2016

I just cannot imagine peeing on a stick more than 2x a day. Am I the only one that finds holding my bladder for 4 hours to be difficult and only possible with mild voluntary dehydration?

Ok, I am beginning to think temping isn't the worst idea...

Bababatty · October 2016

Honestly, I don't hold it for that long. It takes me about 1.5 hours to get home, and that's usually when I test. And in the mornings it's just when I wake up, so no discomfort. :-) Dont make yourself suffer or give yourself a bladder infection.

BenJay · October 2016

Most afternoons, I am so busy with work that 4 hours is a breeze. It's trying to not wake up in the middle of the night!

It sounds like second A.M. urine might be the trick, so I might switch up my tactics. Day 12 so I mix it up.

lablover78 · October 2016

@Bababatty your first post made me crack up

BenJay · October 2016

Most afternoons, I am so busy with work that 4 hours is a breeze. It's trying to not wake up in the middle of the night!

It sounds like second A.M. urine might be the trick, so I might switch up my tactics. Day 12 so I mix it up.

BenJay · October 2016

Well, it seems like the very same thing happened this cycle that it has for the last two: I get a faint line for 3 or 4 tests and then it's gone. The darkest line I get is about 36 hours from when my app estimates I should ovulate. But no smiley face and really, no answers.

What gives?

BWhitta · October 2016

I never got a positive OPK until I had medicated cycles (I have PCOS and I've heard that can happen) it's so frustrating!!!!!

BenJay · October 2016

It's super frustrating! I haven't been diagnosed with PCOS, but I just dying to know the science behind this missing LH surge with ovulation.

I feel like I'm peeing my money away. Thanks, Clear Blue.

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