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.

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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**.

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*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