I've been getting a few hits from people googling about their luteal phases, and I must admit I don't have as many answers as I'd like myself. So I thought I might try something - an informal survey to see what others' experiences have been.

In order to participate in this survey you must:

• have completed an IVF cycle.
  
• have experienced three menstrual cycles after IVF which did not result in pregnancy, and which occurred prior to a successful pregnancy. Do not include treatment cycles except completely natural FETs without luteal phase support.
  
• have accurately charted cervical mucous/spotting for at least three cycles before IVF, as well as those three cycles after IVF.
  
• be able to accurately pinpoint ovulation for those six (or more) cycles, by means of either a blood test to detect LH surge or basal body temperature charting.

So if that's you, please take the survey now and we'll see what we see. I'll update this post periodically to include results.

--
28/6/07
Phew! Well, that was a long time between updates.
Basically, a small number of respondants indicate no change to their luteal phase post-IVF. Must be just me then.

I'm going to go out on a limb here. There may be Something Up with my luteal phase.

Back in December when fertility friend gave me a coverline which concurred with my OPKs and secondary fertility signs, I confidently started marking off the days. Thirteen or fourteen of these, I thought, and Bob's my uncle. Which, as you all know, would have made Flo my aunt.

On the thirteenth day post ovulation - right, I thought, on cue - I started with the merest, tiniest bit of spotting. By the end of day sixteen I was almost ready to go out and buy a HPT, despite my FS's claims that if I got pregnant without either IVF or committing adultery I would be entitled - nay, obliged - to start my own religious cult. My dipping temperatures and lack of pregnancy-related signs kept my foundless hopes in check, although I did start to get excited about the possibility of cycling in January. Which I would have been able to do if my period had arrived tomorrow, instead of today. Thank goodness it didn't arrive several days ago though, or I wouldn't have been likely to completely miss my parents when I go back in February*. Perfect timing, I'd say.

Turns out I've been wasting my energy on Dr Google, because it's not polyps, or endometriosis, or an imbalance in the hypothalamic-pituitary-ovarian axis. It's just my reproductive system's idea of a great, big, fun, practical joke. Well I hope it's having a good laugh - next month, it'll get a taste of what's coming to it**.

---
*Just to clarify, because there were an awful lot of negatives in that sentence, this means I will probably NOT see my parents in February. If my cycle had ended several days ago, like I thought it was going to, I would probably have had a day or two with them. So yes, either yesterday or tomorrow would have been better. But hey! Anything could happen. Let's not call it til... March.

**Pu.re.gon. Bit anticlimactic, really.

---
Also - go play the mind game. It's not that it's fun, exactly, but it is interesting.

My luteal phase was thirteen days. Which is... ok I guess. Actually, thirteen days is fine. Good, even. Also, my cycle was a normal length - 35 days. Which is fine. Except.

Except.

My temperature dipped dramatically at 10dpo. That night I started spotting lightly. Days 11, 12 and 13po saw bright red spotting for the first half of the day. And cramps! It was one step shy of "light menses". I checked back through my notes from this year. My spotting has started at 9-10dpo every cycle I know the ovulation date for. Not as dramatically when I've had the help of progesterone, but nonetheless. At 9-10dpo. And I know a lot of people experience spotting and I know it's not impossible to get pregnant on one of these cycles, except.

Except.

The chemical pregnancies. Three of. And I know there are other reasons for a chemical, and it could still be the quality of eggs gained from an OHSS cycle, or one of "those things" and I know prior to IVF I had two completely normal luteal phases, with maybe the teensiest bit of brown spotting at 13 and 14dpo so maybe this is all just a drug-induced fuck-up that will sort itself out much like the luteal phases of breast feeding women who've said they were fine once baby was weaned, except.

Except.

Those AIH cycles were atypical for me - shorter, by several days, and with much more obvious signs of ovulation than usual. What if this is my normal cycle? What if I only get two or three good ones in a normal year? I also know that even a ten day luteal phase is considered fine by many, and that implantation will mostly have happened by then, and that even if it is on the short side it's treatable except.

Except.

We have been treating it - with OI (FSH) and LP support and it hasn't solved the problem, and don't they say frozen embryos are sometimes a little slower? And what's the deal with my progesterone levels being normal - in fact, great - during my luteal phase even whilst the spotting is going on? Normal progesterone levels and an abnormal response of the lining? How do you fix that? And I know we're still young and if we keep throwing shit at the wall someday something will stick and maybe it'll be cycle six, or sixteen, or even twenty-three but fuck it we can't even conceive without IVF and I don't know if I want to keep going that long and I'm not sure it's worth it and I'm starting to feel like I could do something else with my life and still feel it was all worthwhile and maybe we'd even be happy and maybe people would come to respect that and maybe I'd come to see this whole exercise as nothing more than blind worshipping at the false idol of parenthood and not something I ever had a good reason to pursue because some days I forget why we're here and I wonder what's keeping us going except.

Except.

I think I should try one more time.

It's my post-lap cycle. Bound to be screwy, right? And the others - they were post-progesterone-support cycles. Bound to be screwy, right? Right? I mean, it's all still under control. Isn't it? And we haven't exhausted FS's list of FET protocols. One of those will probably work fine. Right? And if we don't try everything we'll regret it one day, right? Won't we?

I asked Mr Bea how many cycles he thought was "reasonable". He said he thought any number of cycles was reasonable. So I asked him, with some irritation, how many he thought we would do, before giving up. He blinked. He said we've only been doing IVF for a year. Only a year.

He said at four to six transfers a year he doesn't think it's logical to give up and move on until we've got three or four years under our belt. But he understands I might want to stop sooner. And he's happy for now to say let's use up our frosties and do a second fresh cycle then see where we're at.

I'm tired. Because apparently when I said I'd take a few months off to see if my body would reset without the drugs, what I secretly meant was I wanted to take the rest of the year off and go back in January, confident that half our problems were solved, and we were simply looking for the "right" embryo. But it's going to take longer than that, if it happens at all, and if the next FET doesn't work, we - what? Take another several cycles off so my body can reset so we can do another FET that doesn't work and then take another break of several cycles...? How many years would we go on for at two to three transfers a year? "Logically" speaking?

I'm losing faith. I feel like pursuing something else - something I can have faith in - except.

Except.

Not quite yet.

From my most recent conversation with FS:

---
"...so just call me when you want to do another cycle. Although you'll probably go off to Singapore and call me saying you got pregnant all by yourself and don't need another cycle!"

"Really?"

"No. I'll see you next year." O...kay. "Til then, have a good Christmas and just forget about it."

Right.
---

Today is cycle day one. Or "CD1" as we in the biz like to call it. And guess what I didn't have during this luteal phase? Anyone? (Clue - look at the labels down the bottom. Hint - I did have the lap/hyst/dye, and I'm still on break).

Also - I appeared to ovulate around CD13. I have done that exactly once before, that I know of. I'm a 16-19 day gal. This year, it's been anything in the twenties, and only then with help from our friends the injectables, except for that last cycle where I started injecting on day 8 (or was it 9?) and ended up ovulating on day 17. So - unaided, day 13. I wasn't expecting that.

Now I know what you're thinking. Did I really ovulate that early, or did I have a strange and stunted luteal phase? And I'd be thinking the same thing, except... on CD12 of the cycle in question I suddenly thought, "Fuck! I think I'm ovulating!" and I marked the day down on my little fertility friend chart, and predicted that today... that's right, today... would be CD1. Which it is. So.

Now, I did have a little spotting on the day after the lap/hyst/dye, so it hasn't been completely spot-free, but I'm ignoring that because hell, if you can't spot for 24 hours after a lap/hyst/dye when can you spot?

So.

So...

Several theories come to mind.

1. It's a coincidence. See what happens next cycle and this time, buy a bloody OPK to give yourself some credibility.

2. The physical handling of your uterus during transfer is causing the spotting. Well, it was pretty firmly handled during the lap, so why didn't I spot like crazy because of that? The dye cleaned things out? Maybe? And what about that first cycle - you only got a little spotting and that was at about the time your period was due? Lots of holes in this argument, I'm afraid. At any rate - no transfer, no pregnancy so even if this is the reason, there's no solution.

3. The luteal phase hormones he's given you are causing the spotting. But the spotting wasn't worse with higher doses of hormones. And those hormones are supposed to prevent spotting, so this would be a really perverse thing for your body to do. If this is the case, over the next few (rest) cycles you should get a normal luteal phase length with no spotting. Easily tested. And then I guess we can discuss completely natural cycles, and see what happens.

4. That durrned embryo is causing the spotting. The amount of spotting seems to have been more or less inversely proportional to your hCG reading on beta day. You spotted the most with the BFN, and the least with the first cycle, which produced the highest beta. Although, to be honest, there were less spotting days with the BFN than with the next cycle, even though the spotting was heavier, and... I just think you're being dodgy, that's all. At any rate, what are you going to do about it? Monitor, OPK, record, gather more data, try to achieve some statistical significance.

5. The mental stress of cycling was causing the spotting. Relax and it will happen! (Hahaha - gotcha.) Alternatively - it's the power of springtime! Lucky I'm moving somewhere equatorial then, isn't it?

In any case, what I have to do seems pretty clear. OPK, record, monitor. See what happens. Mull. Draw shaky conclusions.

And he told me to forget about it!

No endometriosis. No endometriomas. No suggestions of cancerous or pre-cancerous tissue. No hyperplasia. No fibroids, no infection, no tubal blockages. No funny looking fluid. No adhesions or septae. No weird and unusual congenital abnormalities. No polyps. No curette, in the end, because he decided he could only make things worse from here.

("Told you so," he said. I was hoping he'd say that.)

There's no cysts, no polycystic ovarian syndrome. No systemic disease of any kind - not with my thyroid, my liver, my kidneys, my adrenals, or my glucose metabolism. No hormonal inbalances. No clotting disorders. No immunological problems, or at least not any he believes worth testing for. No visible problems with our eggs, or the embryos that make it to transfer, and nothing wrong with our sperm that can't be solved using ICSI.

I have no pain (only a little discomfort, but ask me again tomorrow). No explanation for the mysterious spotting or the chemical pregnancies.

Oh, and no baby.


---
An aside on my mother, the dear: she teared up (but fought back bravely) in front of the admissions nurse because she couldn't shake her deep and abiding fear that the comic films I'd borrowed on DVD for my recovery would cause me to laugh too hard and break my wounds open. She chooses the most bizarre things to worry about (shut up, I am not).

Hearing her worry like this has a profoundly calming effect. I toyed with the idea of taking her to all my procedures from now on for this reason, but I really don't think she could stand the stress.

1. There may or may not be an identifiable explanation for spotting during the luteal phase.

2. Specialists argue about whether or not it affects your fertility.

3. Plenty of people (including your Great-Aunt's friend's coworker) have spotted heavily during their luteal phases, in some cases losing up to 15L of blood in one day and requiring multiple transfusions, and have soon afterwards found out they were pregnant and gone on to deliver a healthy baby. Even though multiple doctors had told her she would never be able to conceive on account of having no ovaries, plus she hadn't had sex in about six years and in fact had been living as a hermit-nun on a deserted island since her husband died five years ago, and in THOSE days we didn't have access to all these fancy assisted reproduction technologies, we had to make our own fun.

4. Here is a somewhat random list of terms for you to ask Dr Google about, and later regret doing so:

• anovulatory spotting (fixable by inducing ovulation)
  
• ovulatory spotting (more mysterious and complicated)
  
• coagulopathies
  
• structural lesions
  
• hypothyroidism
  
• inflammatory lesion
  
• dysfunctional uterine bleeding owing to immaturity of the hypothalamic-pituitary-ovarian axis* (to which I would add thoroughly-confused-by-infertility-drugs hypothalamic-pituitary-ovarian axis)
  *reproductive hormone system, in plain English.
  
• endocrinologic causes (hormonal problems) vs organic causes (non-hormonal problems)
  
• organ dysfunction, such as liver or renal disease
  
• endometrial hyperplasia
  
• infection
  
• iatrogenic causes (caused by medical intervention), such as chemotherapy, anticoagulants, steroid therapy, and use of IUD
  
• anatomic causes, which include uterine leiomyoma, endometrial polyps
  
• endometriosis
  

5. Tests:

• hormone tests - luteal phase progesterone, serum prolactin, hell, haven't we all had enough hormone tests done to cover this bit?
  
• hysteroscopy/hysterosalpingogram/sonohystogram
  
• thyroid tests
  
• adrenal function tests
  
• laparoscopy
  
• endometrial biopsy
  
• coagulation profile
  

If you have not read my last post I beg, beg, beg you to do so now and reply with anything you can think of. Assvice/secret hope stories and whatever else you are wondering whether or not you should post as a comment because you think maybe it will sound really irritating and so no, actually, let's not post that well please please scrub that thought and actually post it because I promise I won't get mad.

I've written a novella on this subject for Mr Bea, but I'm going to give you the summary. (No, trust me - it's seriously long and tedious.) What it boils down to is this:

Either there is an explanation as to what's going on, or there isn't.

So I think the best thing is to spend October investigating thoroughly and treating any problems as best we can. And if it turns out, after exhausting all our tests, that there just isn't an explanation (which is unfortunately likely) then I should blame the IVF and take a break from it, just in case that helps. And if that doesn't help, well, I guess we're no worse off for trying. Hopefully no worse off.

I still need a full list of possibilities so we can be thorough in our investigation. Therefore - please keep sending me lots of assvice about luteal phase problems. Also, I'm thinking of gathering a second opinion just so we don't miss anything.

***Thankyou to those who have already replied to the last post - your comments helped immensely. At the end of the day, I guess I just want to know that what we're doing isn't completely pointless. At the moment that's the feeling I'm drowning in.

***Cervical Mucous Update***
PART ONE
No spotting last 22 hours. Good, except now, of course, I am completely re-evaluating my whole plan, and I had just got it looking like I wanted, too. Keep sending me info and advice. There's more of this debating what should be done if this, if that, before we're through. I'm ok though, just hungry for information.

I just got an email from Mr Bea (I asked him to google me stuff too). He asks if it's worth trying clomid. I think he may have a steep learning curve ahead of him.

PART TWO
Crap. Spoke too soon.

The only thing different is it's taken two less weeks for everything to go to shit. Which I admit is nice. *Update - actually I checked my maths. Better make that one less week.*

The spotting started six days post transfer/eight days post ovulation, on day 25 of my cycle. A hCG injection did nothing but make it difficult to sit down. Now he's advising more progesterone, and trying to tell me to be less upset because this one patient? this one time? had two days of bleeding (when her period was due) but she was actually pregnant and went on to have a beautiful baby. On her very first IVF transfer, too!

Which is almost exactly like my situation.

Don't you think?

Hysteroscopy is back on. Forgive me if I just don't see how this is fucking ever going to fucking work.

***I need help***

I don't need hugs and I don't need to know you're thinking of me. Ok, well, maybe I need that too. But mostly I need to know what is going wrong, why, and how to fix it. Please, please, please give me any thoughts you, your assvice-loving neighbour or your superfertile hairdresser may come up with.

The Story For Those Just Catching Up

Prior to February I was considered to be a perfectly fertile woman, married to an unfortunately infertile man. Bloods and ultrasounds - all normal, at all times. Cycle - only irregular under periods of duress (jetlag/night shift). Luteal phase - perfect 14 days.

Feb - IVF/ISCI #1, ET was cancelled due to OHSS and I spent 10 days in hospital.

March/April - rest cycle, 46 days.

May - FET#1 - natural cycle with LP support.
No follicle growth whatsoever on scan, and E2 levels rock bottom until about day 17. Then the ovaries seemed to wake up and go about their business as usual.
Ovulated day 25, transfer day 27.
LP support - pessaries twice daily, hCG injections 4dpt (day 31) and 8dpt (day 35).
Some spotting day 38 (11dpt, 13dpo).
Low positive beta day 42.
Beta levels dropping day 46.
AF arrived day 48.

June - FET #2 - natural cycle with LP support.
Normal follicle growth and hormone levels on day 12 (10mm follicle).
No further growth by day 17 (still a 10mm follicle). Slight growth by day 20.
Ovulated day 24, transfer day 26.
LP support 2 pessaries daily, hCG 4dpt and 8dpt as before.
Spotting started day 33 (7dpt, 9dpo). Continued on and off til AF arrived day 43.

August - FET #3 - OI cycle with LP support.
Normal follicle growth and hormone levels on day 12 (as for FET#2).
Interminably slow growth between days 12 and 19 - started FSH once follicle properly "dominant".
Ovulated day 25, transfer day 27.
Pessaries twice daily, hCG 4, 6 and 8dpt, IM this time.
Spotting started day 32 (5dpt, 7dpo). Continued daily until AF arrived day 44.
Low positive beta day 41.
PROGESTERONE LEVELS NORMAL THROUGHOUT LUTEAL PHASE (high 80's, where normal range is anything above 40-ish).

September - FET#4 - OI cycle with LP support.
No follicle growth yet day 8.
Started FSH day 9, ovulated single follicle day 17 (yes, I thought it was 16 too, but apparently I was wrong) - hormone levels normal throughout. Transfer day 19.
LP support one pessary daily, hCG 4, 8dpt.
Spotting started day 25 (6dpt, 8dpo).
Extra hCG given day 26. Pessaries increased to three per day.
Spotting continues unabated, appears to be worsening.
6 days til beta.

Why why why?

*Update*
There is something wrong with me.
But they don't know what.

Dr flips backwards and forwards through my paperwork with a worried frown slapped across his face, until eventually his expression crumples under the strain and he rubs his eyes and temples in frustration.

Blood tests this morning, more jabs, and he says he wants to book me for a hysteroscopy and/or curette before the next transfer. He also wants to run more tests on Mr Bea's sperm. Yes, more than 30% of our embryos should be making it through the thaw. He's stopped talking about our "family in the freezer" and has begun alluding to our next EPU.

Then there is an awkward pause, and he adds, almost guiltily, "Unless this round works, of course."

Of course.

But his words lack the force of belief.

*Update Ends*
---
I need to write some things down. Feedback is welcome.

Item One

Eleven days til beta, and it looks like I'm getting my period. That's right - 5 days post 3 day transfer. This happened last time. Yes, I've tried to call the clinic - no-one is in at this time on a Sunday. If I leave it alone, the progesterone/hCG injections will keep things down to a light spotting for the next eleven days, and then we'll get our negative. I don't have time for this shit. I am going in tomorrow.

These embryos - crappy and excellent alike - are not even getting a chance. What's wrong with me?

Item Two

Yesterday was the official opening of the Adoption Talks. Mr Bea thinks we're being premature, but the fact is we're planning a move to Singapore. We currently live in the anti-adoption capital of the world. Expressions of interest open intermittently each few years, and from there it takes another three or so years for baby to arrive - providing you go with the faster inter-country option. Couples have been told (I read it in the newspaper) by the relevant state department, that if they're serious about adoption they should consider relocating outside Queensland.

We're moving to Singapore. There we have the opportunity to adopt within 6-12 months. I have announced my resolution to return home (to live, visits don't count) with a child. One way or the other.

Item Three

Mr Bea has just started trying to work through the ethical issues associated with adoption. In contrast to his opinion of eight months ago, he no longer sees this as "option two" above sperm donation. He talks about his sperm quality in tones of acceptance. It's beautiful.

I don't expect to commence any adoption procedings until at least 2008. Talks about embryo/sperm donation are scheduled, but have not yet begun.

Item Four

We ended with another game of hypotheticals. I asked Mr Bea if he'd donate his sperm. He said yes immediately, in a tone which suggested he hadn't thought very seriously about it because he wasn't really expecting anyone to ask.

But the fact is, he does have sperm. And donors are so rare, people are using IVF anyway. Ok, so you'd have to add ISCI, and there's the whole issue of passing on male infertility. On the other hand, he has many outstanding qualities, and a clean medical bill otherwise. Heck, I find his sperm not only acceptable, but actually desirable.

The hypothetical finished there, unresolved. I'd given myself a hCG injection and fell asleep pretty much mid-sentence on the couch. When I woke up, I was bleeding, and I couldn't contact the clinic.

But then I read Richard's latest post and the question re-emerged... is an infertile donor better than none? Or not?

Hypothetically speaking?