Luteal Phase Defect and Infertility

Like many women in their late 20s and early 30s, I discontinued birth control pills and expected to get pregnant within a few months, a year at the most. As it turned out, it was not that easy. I started tracking my basal body temperature every morning (for more information on this, I highly recommend Taking Charge of Your Fertility, below) to determine when I ovulated each cycle. Based on my temperature shifts, I was definitely ovulating. However, after ovulating, my temperature would only stay elevated for 9 or 10 days before I started spotting for a couple of days, and then I would get my period. My periods after going off the pill were also lighter than they were before I went on the pill. From what I read in Taking Charge of Your Fertility, I had a luteal phase defect, which is common after discontinuing birth control pills.

A quick review: the first half of the cycle, called the follicular phase, begins with the first day of your period and ends with ovulation. The second half of your cycle, begins the day after ovulation (1 DPO, for example, refers to the 1st day past ovulation) and ends the day before you get your period. According to Taking Charge of Your Fertility, a luteal phase of less than 10 days qualifies as a luteal phase defect. Essentially, even if your egg had become fertilized, there would not be enough time or your endometrium would not be of sufficient quality for the embryo to implant. The hormone responsible for keeping your temperature elevated, among other things, is progesterone.

So luteal phase defect could be thought of as simply a problem of low progesterone. But it's not as simple as that, and simply taking progesterone in the luteal phase apparently doesn't solve the problem. From what I've read, the problem can be traced back to the follicular phase. In a nutshell, a poor ovulation can lead to insufficient progesterone which manifests itself as luteal phase defect. Based on this, doctors prescribe Clomid during the follicular phase to try to improve the quality of ovulation, and this also corrects the luteal phase problem.

Update: Upon visiting my Ob/Gyn after a year of trying unsucessfully to get pregnant, I showed the doctor my BBT charts and she agreed that my Luteal Phases were on the short side. So she prescribed 200 mg of natural progesterone (Prometrium), to be inserted vaginally, starting at 3 DPO. At 14 DPO, I am supposed to take a pregnancy test, and if it is negative, I will stop the progesterone and get my period. If the pregnancy test is positive, I am supposed to continue with the progesterone until 10 weeks into the pregnancy.

Another update: I have begun seeing a practitioner of Traditional Chinese Medicine (TCM) after reading the book The Infertility Cure. Every week, I go in for acupuncture treatments, and also take Chinese herbs (in capsule form, or raw form, depending on where in my cycle I am.) So far, I have been seeing her for two months, and each month I have ovulated 4-5 days earlier than my normal CD 18-19.

Yet another update: Acupuncture didn't get me pregnant, after trying it for 6 months. Now, I'm seeing a Reproductive Endocrinologist (RE), who's putting me through a battery of tests -- HSG, FSH/LH/Estradiol/Prolactin blood tests, ultrasound, etc -- and has determined that I have 'ovulatory dysfunction.' My first cycle of Clomid 50mg + IUI (intrauterine insemination) - in additional to being very painful - failed. I will be doing 2 more cycles on this, before moving on to IVF.

Pregnant!: The third and final cycle of Clomid (100mg) + IUI worked! I also did Acupuncture and took Chinese herbs this cycle.  At 14dpo I had a HCG of 450 and two days later it was 799. Next is the 6 week ultrasound, at which a heartbeat should be detectable if all is normal. After two long years, I never thought I'd be pregnant, so I am still in disbelief. I hope it sticks!

Please feel free to leave comments about your experience with infertility. I know it helped me to find other women's stories on the internet, so I thought I'd contribute mine as well.