Irregular Cycles

by May

Hi Amelia,
I am 30 years old and have irregular cycles. I have been trying to conceive for 8 months. I have a young child who was conceived naturally after about two months. All of my fertility labwork has been completely normal, including all of the day 3 labwork (FSH, estradiol), a thyroid panel, DHEA and prolactin, and I think maybe a few other hormonal tests that I don't recall.

My cycles are irregular and range in duration from about 29 to about 45 days, typically around 35 days. My cycles have been lengthy and irregular since I first got my period at age 13. I have been doing OPKs and temping for the past 4 cycles, and have confirmed ovulation for 3 of the 4 cycles. Ovulation has happened as late as day 33. OPKs have been a little tricky and I've had definite LH surges when I didn't go on to ovulate.

This has made me suspicious of PCOS, but I haven't suffered from any metabolic consequences, such as altered glucose or elevated cholesterol levels. Physician did not think it was necessary to do a vaginal ultrasound. My progesterone at 6 dpo has ranged from 4-6.8. Husband's semen analysis was normal. I don't find that I have particularly EWCM, although it gets more slippery for a day or two during ovulation.

Where do you suggest I go from here? Do you think that it's possible to conceive with progesterone levels as above? Do you see any benefit to an ultrasound? I have held off on doing HSG testing, but will likely go ahead to rule out tube blockages as well. I've not tried acupuncture yet, but it is something that I am interested in.

Thank you,

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Irregular Cycles
by: Amelia Hirota

Hi May,
Irregular cycles are the hallmark of PCOS. Even though you don't have overt metabolic syndrome or elevated glucose, you can have PCOS, or what I refer to as sub clinical PCOS. This would be PCOS that isn't visible on an ultrasound.

I suspect that you've had PCOS since you first started menstruating. It wasn't bad enough to affect the quality of the follicles in your first pregnancy, so you conceived easily. Following pregnancy, women often experience a downward spiral in terms of hormonal imbalance and this might have happened with you after your pregnancy. That may be why it's taking longer this time around.

The irregular cycles, lengthy cycles, erratic ovulation and tricky OPKs all point to some degree of PCOS. Also, the relatively low 6 DPO progesterone level of 4 - 6.8 tells us that the dominant follicle isn't making a strong corpus luteum. This is another characteristic of PCOS. I like to see progesterone levels on a blood test be at least 10, in order to support a pregnancy.

I would strongly recommend that you come in to the clinic for an initial consultation. The testing that we do would tell us if we're dealing with PCOS and what exactly is going on with your hormones.

I always think that it's a good idea to have a saline ultrasound to rule out polyps and fibroids in the uterus. You could do an HSG, but because you have a young child it's unlikely you have blocked tubes. However, if you're not averse to doing the test and your insurance covers it, it might be good to be sure that your tubes are open.

If you want to learn more about your hormones and PCOS before coming in to the clinic, I recommend that you watch Webinar #1, "Your Hormones are the Driver Behind Your Fertility" and Webinar #9, "PCOS: The Hidden Culprit in Sub-Clinical Fertility Cases."

Don't feel too discouraged. You have many good things going for you, including your age, the fact that you conceived easily before and carried your baby to term, your cycles are biphasic, and you're getting started early to address your particular issues. I wish you luck!

Sending Babydust Your Way,
Amelia Hirota, D.Ac.

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