Questions for the next step in TTC testing

Hi Ladies, need some help and advice.
I am 35 years and trying for baby #1. I have been off birth control pills for 8 months (6 cycles) and still no BFP so I am going back to my doctor for more test and questions. I want to go into my next appointment with as much information as possible so I have some questions.

I have PCOS tendencies like irregular periods and hormone imbalances (high T especially), but no insulin resistance. I was put on Metformin in June after blood work showed my hormones were wonky. I like it a lot and it has helped shorten my cycles and also they seem to be more regular now (average 35 days). Last cycle was my first cycle on clomid but still BFN. I just started AF so today is cd1 for me.

Doctor ordered an ultrasound for tomorrow, which I have never gotten before. I am eager to see what my insides look like and if that shows any issues. I am particular interested to see if I have cysts. (won't get results for a week- weird to me but whatever)

So my questions are this:

*Should I ask for the cd3 hormone test for FSH, inhibin B and other hormones to check my ovarian reserve? Would this test be thrown off because my last cycle I was on clomid and it might still be affecting my hormones? I am frustrated my doctor never checked this before, she only did 7dpo blood work.

*Can the ultrasound show my ovarian reserve as accurately as blood work? Will that be thrown off by my last clomid cycle too?

*Should I hold off on a second cycle on clomid until the results of my ultrasound and/or cd3 hormone test comes back? If I do go a second cycle, should it be at 50mg again or increase to 100mg?

*I got no noticeable EWCM this last cycle on clomid. I had moisture, but more watery not thick or EW. Could this have played a part in why I didn’t get my BFP this cycle? I have always gotten one day of EWCM on my non-clomid cycles. Is there something I can do on my next clomid cycle to improve my CM?

*Since being off BC, all my cycles AF has been very short and very light. I get spotting, then no more than 12 hours of actual real blood flow and then back to spotting for another half a day or so. From first notice of spotting to all is clean again and I don’t even need a pantiliner is no more than 48 hours. I have told doc this multiple times and she doesn’t seem to even care. Am I wrong to think this would indicate something wrong with my lining? What other reasons would lead to such little bleeding?

*How do I check for the health of my uterine lining and thickness? Is that by ultrasound and what cd? What improves uterine lining?

I am trying not to be impatient because I know 8 months is not that long compared to woman who try for years, but based on my PCOS tendencies and age I just want to do what tests I can now so I can feel confident moving forward. Hubby has appointment for a sperm analysis in two weeks too.

THANK YOU for listening and any guidance you can give.

What is your BMI? I think that is plenty of time TTC to seek help. Have they done a day 21 progesterone test and u/s to confirm you are ovulating? AMH test?

How long were you on birth control as a whole? And as for your CM issue on clomid I would use pre seed. I promise it's just as possible to get a girl with pre seed as it is a boy as my first cycle on clomid I used pre seed and got my wonderful DD3.

Your hormones would reveal a thinner than average uterine lining because estrogen is needed to build it up. If your T levels are high I do believe it's possible your body is converting too much estrogen into T and that could be a problem. I think however if your estrogen doesn't drop enough when it's already high that could also cause it to seem your lining is light and thin during a period when in reality it just didn't drop enough to bring on the heavy bleeding.

What's interesting to me is metaformin is usually specifically for insulin based PCOS. If it's helping I'd be more concerned maybe they missed something. No family history of diabetes? You had a fasting glucose test recently to confirm you have no insulin issues?

I am 125 pounds at 5'5" so BMI or about 20-21. I gained about 5 pounds the first few months off BC but then dropped that and dropped another 5 pounds since being on the LE diet and metformin.

I had blood work done at cd26, which for me was about 5dpo that cycle. Doc said my progesterone was okay, maybe a bit low but that she thought that I probably ovulated (but honestly I think my doctor is not all that wonderful so I don't trust her very much). On that test my estradiol was high and my testosterone was very high. That is when she put me on the metformin. I haven't had any more blood work to confirm if the met is working (but I think it is because I feel so much different and PMS is not nearly as bad as before).

I have not had the AMH test (never heard of it).

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Originally Posted by Burakoam

How long were you on birth control as a whole? And as for your CM issue on clomid I would use pre seed. I promise it's just as possible to get a girl with pre seed as it is a boy as my first cycle on clomid I used pre seed and got my wonderful DD3.

Your hormones would reveal a thinner than average uterine lining because estrogen is needed to build it up. If your T levels are high I do believe it's possible your body is converting too much estrogen into T and that could be a problem. I think however if your estrogen doesn't drop enough when it's already high that could also cause it to seem your lining is light and thin during a period when in reality it just didn't drop enough to bring on the heavy bleeding.

What's interesting to me is metaformin is usually specifically for insulin based PCOS. If it's helping I'd be more concerned maybe they missed something. No family history of diabetes? You had a fasting glucose test recently to confirm you have no insulin issues?

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Hi Burakoam- I was on the pill off and on for a year or two in early 20's, then consistently for about 7 years then got off it for a year to try a non hormonal IUD (that was the worst year of my life...), then got IUD out and was back on for 5 1/2 years before stopping in January 2016. So total...about 13 or 14 years out of the last 16 years.

I will definitely look into the pre-seed. Interesting about the estrogen and T levels and that I just might not be bleeding off the lining. Would that make my lining old and unhealthy if it is not being shed and replaced with new each month?

I just posted a response to nuthingbutpink that my estrogen and T levels were over the high limit on my last blood work. That same test they did a fasting glucose test and it all came back within normal range. I am not overweight either, but being on the BC so long that could have been controlling it. I know the metformin is usually for insulin resistance, but I was told that is because it changes your hormones which affect insulin so even if you don't have IR it can still help control hormones and balance things out. I am going to ask for another blood test 5-7dpo this cycle so I can compare the numbers with my last test that I took before I started on the met.

Dear GielieCat. You still have planty of time so don't worry, but it is good you adress your problem now and seek professionel help to reveal why your are not falling pregnant. Here in Denmark they always do bloodwork to see your hormonal status on bleeding day 1, 2 or 3. They take a variety of blood that (alongside with a scan) will tell you everything you need to know about ovarian reserve, your ability to produce sex hormone ect. I hope you get answers soon.


DS1 (9) ❤️ DS2 (8) [emoji173] DS3 (5) ❤️ DW (41) [emoji1326] DH (38) [emoji144] TTC'ing pink from May 2016

Is the day 26 tests the only test you have had? No day 3?

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Originally Posted by nuthinbutpink

Is the day 26 tests the only test you have had? No day 3?

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yes, the only blood draw was the cd26. I have not had a day 3 test yet, but I have a call into my doc to order that now since tomorrow is day 3. Will day 3 tests be thrown off since I was on clomid last cycle? I was on 50mg cd 3-7 of a 35 day cycle so it has been 30 days since I took the last pill.

Side note- AF is already gone completely. Total was less than 30 hours from spotting to fully clear, if you take out the spotting then I had actual flow for only about 12 hours. So frustrating.

Yes you need the blood work. I would call and ask them about the Clomid because they may instead prefer to do something called "Clomid Challenge test" which is actually more informative than the CD 3 test anyway and you would then take the Clomid this month and have the test done later in the month.

Ultrasound is not anywhere near as helpful as the blood work and that CAN be skewed by the Clomid. Do remind them when you go in for your results that you were on Clomid last month.

If you are not getting ultrasound monitoring to see how many eggs you make on Clomid, I do not recommend taking mroe than 50. It may make you conceive multiples.

I would recommend doing guanefesin instead of Preseed for your CM. Guanefesin affects your whole system even up inside where Preseed cannot go. Yes, a lack of CM can inhibit odds of conception.

Many of us notice short, light periods when swaying. I got my daughter the month after a period exactly like you describe. What you have to remember is that this month's period doesn't tell you about next month's lining. cAn you tell me more about your diet so I can advise you?? Drop fiber if you are taking it.

You would need ultrasound to check your lining. The best way to help your lining is supplemental estrogen given by your doctor. we do have some DIY methods but I don't think any of them even do much if anything.

Hi Atomic, thank you for responding to my questions. I had my ultrasound yesterday and my cd3 blood work today. I will have the results of both next week. It is probably too late for the clomid challenge this cycle but I will ask about that. I am pretty frustrated with this doctor and really don't like her. I don't know why she didn't order this cd3 blood work 6 months ago. I went to her a year ago before I ever stopped BC to talk about being prepared to TTC knowing I have hormone issues. Nothing I can do now about the past, but I am going to the RE if this weeks appointment with this normal OB goes bad.

I will look into the Guanefesin. What cycle days do I take it?

The light cycles can't just be from swaying because I have only been on LE for 11 weeks but my AF has been short and light every cycle for the whole 8 months I have been off birth control. Maybe LE is making it worse though because this cycle was the shortest and lightest by far. Would such small amount of blood mean the lining was thin? Or does it mean the hormones that should have triggers the bleed were not present as they should? (Maybe the ultrasound and blood work will answer that too).

I am really on a very simple sway. I am doing vegetarian, 1500-1800 calories, skipping breakfast, 2 meals a day- lunch and dinner- and occasionally a snack at night, I do not snack any other time, 1600 folate, 1000 Metformin, couch potato, and last cycle did e4d pattern. I lost some weight before I started swaying with this site and then a little more when I started LE diet but have been mindful to keep steady at my current weight the last 6 weeks since I am now at BMI of 20-21 and don't want to lose more.

Not having anything to do with TTC, I don't drink alcohol or coffee or any caffeine at all so I can't incorporate those into my sway.

Other than going vegetarian I basically eat the same foods I ate before swaying but just staying within limits. I am a very picky eater so my options are pretty limited. I have wondered if it matters if I eat wheat or white breads and white vs brown rice? I switch back and forth now and eat both. Also what kinds of milk or dairy? Some threads say low fat and other say whole milk so I am not sure which applies to my situation.

Thanks.

Guanefesin can be taken any time starting after AF ends and continuing thru 3 days past ovulation. I typically have people start it about 5 days before they expect O and continue till O day though just because it gets expensive and I've never seen any difference in results.

Both LE Diet and coming off the birth control pill can cause lower hormones. It's not unusual for women to take 9-12 months to regulate cycles after coming off the pill (especially having been on it a long time). So it may be that it was initially short from coming off the pill, and then this was exacerbated by LE. Also, something I've seen is that women's periods when on the pill OR their memory of their cycles when they were younger before the pill, were heavier than their normal cycles really are, so it seems like a lightening of the cycle. As an example when I was in high school my periods were 5-7 days long and cycles irregular, sometimes lasting months, and then I went onto the BCP and came off it and my cycles regulated at 28 days with much, much lighter periods. I conceived 5 kids with those lighter periods so it wasn't that anything was wrong, just that it had changed from what it was prior to the pill (and when I was younger).

The way the lining works is that estrogen causes it to grow until ovulation, then progesterone maintains it for about 7 days, and then more estrogen is released to sustain it another 7 days or so. So the most likely culprit is that you are lower in estrogen and not building a good lining and also then cannot make enough estrogen to sustain the lining another 7 days and thus may have or develop a shorter LP too.

Do not lose any more weight.

Why are you on Metformin?? Sorry if I should know this but I'm not spotting it in a quick scan of this page. I need to know this before I reply to your questions about white vs. whole grain.

I want you on full fat dairy ONLY. NO skim dairy for you.

I honestly can't recall much about my cycles before birth control except I know I was never regular and would go months between having periods in high school. But I am not really comparing to the past now, I just don't think it is normal to have a period that lasts only 1 day (actual blood for about 12 hours, rest spotting).

My LP hasn't been affected yet. I have consistently had about a 13-15 day LP. It has never been shorter than 13 since off birth control.

I am on the Metformin because doctor said it would help with my hormone imbalances and severe PMS moods. I did a fasting blood test and I did NOT should any signs of insulin resistance, but my T levels were very high and my estrogen was high (test was 5dpo).

She prescribed progesterone from O-AF too, but I didn't take it because you said it really doesn't help and I was afraid it would throw off my cycle even more. Doc said to take it from 2 days after my +OPK until AF comes but from what I read you won't get AF if you keep taking it. Is that true? Should I take the progesterone this next cycle? She RX that even before blood work and said it would help my extreme PMS because I thought I was going to lose my mind the first few months off BC. I hate how I feel being off the BC but it is much better now than the first three months.

Thank you for taking the time to respond. I really appreciate it!

Yes that was how I was too. Just completely unpredictable and that is normal for girls that age group.

I would have your lining checked to see how it is. I hesitate to comment on "normal" because there is a WIDE variety of normal.

If your T is high then you should be on Met and I recommend the alternate diet with whole grains for you.

I am not a fan of progesterone, but you gotta do what you feel comfortable with. Yes, the majority of people will not get AF till they stop prog which puts you in a limbo zone where you are not sure if you should stop it. The data indicates it does nothing to help anyone with a relatively normal LP, get or stay pregnant. But that's not my choice, it's yours to make of course. I am not convinced it does anything to help with PMS as mine is BAD when I'm higher in prog (from O through about a week after) and then incredibly improved after that and I also have PMS-type symptoms in pregnancy when my prog is thru the roof.

CD3 blood work came back and doc says everything looks good. Is she right? (I don't trust her very much)

TSH- 1.33
T4-free- 1.0
FSH- 6.5
Estradiol- 66

She is just an normal OBGYN so she didn't order some of the other numbers I am used to seeing in the pre-testing for IVF. Ultrasound showed cysts on my ovaries, but they said nothing too large and there is nothing they can do about them anyway. I just got the results over the phone and emailed to me so I didn't get to ask more questions.

I agree, everything looks good although it would have been nice to get AMH. My RE also did Antral Follicle Count, LH, and Prolactin. When do you get the sperm results?

FSH: In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate.
Estradiol: 25-75 is considered normal. Levels on the lower end tend to be better for stimulating.

Your numbers do look totally normal to me as well. The CD 3 tests are not as thorough as some but I'd be happy with those. :)