Normal FSH and LH but low progesterone

[Amyflood246]

Is it possible to have normal FSH and LH but not ovulate? I have had regular progesterone tests throughout my cycle (irregular periods) and they all show no ovulation but my doctor said that because my FSH and LH are normal I must still be ovulating. Is this correct? Thank you

[IvfStruggler]

I had low progesterone but normal FSH and LH. And I did ovulate as this could be seen when I was scanned. But this is not necessarily true. You may have PCOS in which case you may not ovulate. But there are also other reasons for low progesterone. If you have hidden endometriosis you may have low levels due to progesterone resistance. It could also be caused by chronic stress (your body will use progesterone to make cortisol) and problems with your thyroid. I never worked out what caused my low progesterone and I think it may have led to embryos failing to implant and sticking around. Taking extra progesterone supplements didn't help but I did become pregnant with a course of Hcg injections (during IVF treatment). They help to keep your ovaries pumping out more progesterone instead. I really had to push doctors to recognise the problem. I hope all is fine in your case. Good luck!

[Amyflood246 in reply to IvfStruggler]

Hi! Thank you for your reply, so say I had low levels due to hidden endometriosis would I still be likely ovulating but my progesterone isn’t rising or would I not be ovulating? I don’t think I have PCOS because my other hormone levels were ok and I had an ultrasound which was clear

[IvfStruggler in reply to Amyflood246]

Yes that could be possible but it's difficult to say for sure. When you had an ultrasound could they see a dominant follicle? Or could they see a corpus luteum? How irregular are your cycles? Long or short? My cycles were shortish- around 23 days and I would have problems with spotting. Sometimes 5 days before my period would start. Is it similar for you? And you had your progesterone levels tested for just this cycle or also others? How low were your levels? X

[Amyflood246 in reply to IvfStruggler]

They didn’t say anything about a dominant follicle or a corpus luteum so I’m not sure they just said it didn’t look like I had polycystic ovaries! My cycle is everywhere sometimes they are really short other times I can totally skip a month. I’ve tested my progesterone levels over 2 cycles. So would you say it’s possible to have normal FSH and LH but not ovulate? X

[Riri88 in reply to IvfStruggler]

Hi hun, I hope you don’t mind me jumping in here. Just curious if you tried solving the low progesteron issue at all outside of TTC as in to sort your cycles out in a natural way? I am asking as I always thought my progesteron is low. I ovulate generally late (around day 20) but I would start spotting 3 days later for 8 days or so and then get a period and generally the luteal phase is short. All my hormones always come back as normal, thyroid is normal, no signs of PCOS and I had a laparoscopy and no signs of endometriosis so overall no reason to why the spotting. But when trying naturally I had multiple chemicals and 2 ectopics which I think are all due to low progesteron as the tubes were clear before the ectopics and the pregnancy never sticks past week 5. Now going through IVF it is really interesting that the moment I am on progesteron pessaries I have zero spotting, like it works brilliant. But if IVF doesn’t work I would still like to sort my own cycles out without a doctor saying ‘just go back on the pill’. Sorry long message but just always looking at ideas of how to improve this and it sounds like you had done quite a bit of research on it. So wanted to pick your brain…

[Thedazzlinsun in reply to Riri88]

Hi Riri88, I was interested in your reply because I think I am exactly the same. Usually ovulate around day 20 but then have a really short luteal phase with spotting for about 8 days. Thyroid supposedly normal, I definitely don't have PCOS since I have low egg reserve (I am 32 so was not prepared for this when they told me). I also think the problem with my cycles is too low progesterone, which in my case might be caused by my low reserve, my ovaries not producing enough. I am now going through an IVF cycle for egg freezing but after that I want to try to sort out my cycle naturally. I was on the pill before for many years so basically did not realise what my body was telling me. Any insight welcome..

[IvfStruggler in reply to Thedazzlinsun]

It's really difficult. I have a really bad hormone imbalances which means I have high-ish estrogen and low progesterone. This means that in addition to lots of spotting during my cycle, I have ridiculously heavy (and painful) periods. Now that I'm pregnant, it's the first time of my life that I'm not massively iron or B12 deficient. I may have hidden endometriosis but doctors advice me against having surgery because of scarring making things worse.

What seems to have helped me with finding a bit more hormonal balance is loosing weight (no idea why) and eating lots of seeds. Every morning I will have a bowl of yogurt, nuts, blueberries and then chia seeds, flaxseeds, pumpkin seeds and I think most importantly sesame seeds. I got it from a website and some forums. I really like research and this is absolutely not scientifically backed but it seemed to help me, have less painful periods, less spotting and more regular and longer cycles.

But I was wondering if you respond well to progesterone medication you could get your doctor to prescribe you some to take each month. I have read about women that will start taking progesterone 5 days after their ovulation peak until their period or positive pregnancy test (after which they would continue). You may have to argue with your GP or fertility doctor but I'm sure that this is a protocol and works for many women.

I probably go back on the pill as I don't seem to respond to medication. I was on 3 lubion shots and 2 pessaries and I still didn't have a half decent level. But other than IVF I have absolutely 0 chance of getting pregnant.

Hope this helps a bit. Good luck with your cycles- the both of you!

Xxx

[Riri88 in reply to IvfStruggler]

Hi IVfStruggler, thank you so much for the tips regarding seeds etc! I did look into seed cycling and tried acupuncture which maybe helped a little bit but not completely. I hope I can get a GP indeed to trial progesteron during my cycles but this will be after IVF is over. Just about to start my 3rd FET with my last frostie so I hope that will stick! I hope you will be successful in the end with your IVF journey!

And Thedazzlinsun , yes that sounds very similar! Same here, 16yrs on the pill without issue’s so never knew something wasn’t right. Came off, took 9 months to even get a period, since then irregular and spotting. Then fell pregnant naturally 4x in 1 year yet all chemicals or ectopics and one ruptured a tube and strong advice from doctors not to try naturally any more hence the IVF now. But all the test are all ‘normal’ and even the tubes before the ectopics were clear so I either have really really bad luck or something just isn’t right and my gut feeling is that it is all to do with the progesteron. Just so hard to ‘proof’… good luck with the stimulation and I hope you get good quality eggs!

[IvfStruggler in reply to Riri88]

I really hope your frostie sticks! Keeping everything crossed for you. You probably already have but did you look into Lupus or hidden endometriosis? They can lead to low progesterone and reoccurring miscarriages. I'm so sorry to hear you went through so much. I hope your doctor allows you to supplement in case your IVF doesn't work out. There's a link on Tommy's website about progesterone in pregnancy that also includes information for clinicians who need to be convinced: tommys.org/about-us/charity....

But hopefully this is not necessary as your IVF will work! Good luck xx

[soccerkt6 in reply to Thedazzlinsun]

Hi Riri88 and Thedazzlinsun

What IVFStruggler is describing with eating seeds is a form of "seed cycling" and it's worth a try to see if it helps balance your hormones. You can find tons of information online if you google 'seed cycling', but the basics of it are that you eat particular seeds during the first and second half of your cycle to promote certain hormone production. It looks like this:

Days 1-14 of you cycle (or menstruation to ovulation)

1-2 tablespoons ground flax seeds

1-2 tablespoons ground pumpkin seeds

(Why: Both seeds are rich in phytoestrogens, a naturally-occurring form of estrogen.)

Days 15-28 of your cycle (or ovulation to menstruation)

1-2 tablespoons ground sunflower seeds

1-2 tablespoons ground sesame seeds

(Why: High levels of zinc in sesame seeds and vitamin E in sunflower seeds promote progesterone production.)

There's also been research that women who take vitamin B6 and 750 mg of Vitamin C daily have significantly higher levels of progesterone. Magnesium is also really important in hormone production and it's difficult to get enough from food, so supplementing with 400-500 mg daily can help.

If the mid-cycle spotting continues, you may also want to get tested for infections as that can sometimes be a cause.

Best of luck xxx

[IvfStruggler in reply to soccerkt6]

Yes this is it- seed cycling. I looked at it and thought what's the harm but then wasn't motivated enough to stick to the real deal 😁I think the vitamins are also a really good point but don't go overboard with vitamin B6 supplements. When I did my research that was one of the vitamins were they said to be careful. I also agree about the mid-cycle spotting. When I had this it turned out I had a cervical polyp (although with you they would have noticed this with all the ultrasound scans). x

[soccerkt6 in reply to IvfStruggler]

Yeah, excellent point about the supplements. If someone is taking a multi-vitamin it likely already includes these vitamins and minerals, so just have a look at the quantities and make sure you're not taking too much.

My final suggestion regarding hormones (and then I'll stop, I feel like I'm spamming this thread!) is that sulforaphane and DIM both have research demonstrating their ability to help balance estrogen and correct estrogen dominance. I haven't tried DIM myself, but I started taking BrocElite (a sulforaphane supplement) 6 months ago and that same month my breasts ceased being sore during my luteal phase. For the past several years they would be sore from about 2dpo until my period. This is a common sign of estrogen dominance and it just completely went away after I started sulforaphane. I was kind of amazed xx

[IvfStruggler in reply to soccerkt6]

I have the exact same problem with my breasts. At times they would feel like they were going to explode. One of my depressing moments dealing with this stuff was when I sat in front of the doctor in tears and he was so unimpressed- he said it wasn't cancer because it hurt so probably just runners nipple. I will try the sulforaphane. Sounds good! X

[soccerkt6 in reply to IvfStruggler]

Oh you poor thing, that sounds absolutely horrendous. What a doctor – imagine looking at a woman crying because of painfully sore breasts and concluding she must just have a bit of nipple chafing. 😒

Unfortunately, there's no data yet on sulforaphane in pregnancy. (Congratulations, by the way!) It does also boost your liver function and can help detox stuff that has built up in your body, so I'd wait to take it until you're not pregnant or breastfeeding. There are loads of sulforaphane supplements on the market but I've only come across two that contain the active, stabilised form of sulforaphane rather than just the precursors (which don't convert well to active sulforaphane) - these are Prostaphane and BrocElite. Though only the latter contains other compounds that work synergistically with the sulforaphane. xx

[IvfStruggler in reply to soccerkt6]

Thank you for the info and congratulations. I'm still so scared of another loss. I would definitely wait with taking any new meds. The weird thing is that pregnancy seems to have helped all my symptoms: good iron and B12, no breast pain, less IBS symptoms, my mood is so much better, no greasy skin and normal hair. It makes me even sadder about how these kind of problems are dismissed and covered up by getting women to just go on the pill. I get really angry about how women with fertility problems are treated according to such standardised protocols that don't take into account individual causes. It caused me so much grief for so many years but no one listened. Thanks again! Xxx

[Riri88 in reply to IvfStruggler]

Thank you both IvfStruggler and soccerkt6 for all those tips! Will definitely look further into the seed cycling. I am already on the pre conception vitamines and take on top of that extra vit D, magnesium, Vit C and iron enriched water so not sure how much more vitamines to take haha. I did read things about chasteberry to try to re balance hormones but of course don’t want to start that during IVF. Thankfully I don’t really get much PMS symptoms or breast pain so that is for me not so much the issue. Did notice hair quality going down etc after stopping the pill yet things improving while on IVF meds so there is definitely something to explore.

I did also thought for a moment about lupus because I can have achy joints and do have rheumatic disorders running in my family but sometimes I wonder if I am turning into a hypochondriac and really I am just seeing things that aren’t there. Been all cleared for cysts and infections etc. Generally every test so far always comes back normal so maybe it is all in my head. Trying to stay relaxed for the next IVF cycle and hope for the best! Already part of me is accepting the fact that we might go adoption if this fails but trying not to think to far ahead and go with the flow… sadly I am a bit of a control freak so finding it hard haha.

I really appreciate the tips and advice though and it sort of is comforting knowing I am not the only one with these symptoms although of course sad to know there are more women with issue’s if you get what I mean.

[Thedazzlinsun in reply to Riri88]

Thank you all, Riri88 IvfStruggler soccerkt6 about all the advice and info on supplements, I'm definitely going to try this out after I clean myself a bit from all the meds and go back to my normal cycles. Similarly to Riri, I was on the pill for many years and that masks all the problems, I'm going to go natural now to at least be able to understand what goes on in my body naturally.I was already taking vit D, iron, selenium and vit E, but going to look into the seeds and everything else.

I have my extraction today so will update with how many eggs etc. I've got low reserve so not expecting anything crazy.

Thanks a lot again,

x

[IvfStruggler]

It is possible that you have normal FSH and LH and not ovulate (although this is not common). An anovulatory cycle could happen to all women- not just those with PCOS. When you skip a month it might mean that you haven't ovulated at all. During the short cycles it is possible that you have ovulated but your progesterone doesn't rise enough.

I'm so sorry I can't give a definite answer. It is possible that you have normal FSH and LH and ovulate- it's also possible that you don't ovulate (but not as likely).

With hidden endometriosis (or similar conditions) it's possible that you have ovulated but your progesterone just doesn't rise to normal levels.

I think the only way is to do more ultrasounds. Did you ever use a ovulation test to track your LH to see if you have a peak? When I did my research I did find some evidence that some women do get positive tests but don't actually release an egg. But this is quite rare. You could use one of the fancy ones that have flashing smiles as they will have certain thresholds for levels of LH. So you avoid measuring just a rise (when the strip gets darker) but a real peak with levels high enough to release an egg.

Sorry for not being more helpful x

[Amyflood246]

Aww no you have been fab! Thank you so much for all of your help and taking the time to reply to me I’m just baffled as to what the issue can be x

[IvfStruggler in reply to Amyflood246]

I can really understand- it's so difficult. And I've sat in front of doctors who told me things which I just had read about in research papers and knew they were not true. Of everything IVF and infertility I always found progesterone the most confusing. There are such different opinions between doctors and consultants and some research and knowledge is simply missing. I hope you can find out a reason for your low progesterone and solve the issue as soon as possible. X

[Amyflood246 in reply to IvfStruggler]

I’ve just looked at my reports from my ultra sound scans and one of them it says there was a 3.5 hemorrhagic cyst. Could this be anything? X

[IvfStruggler in reply to Amyflood246]

At which cycle day did you have the scan? Did they not discuss this after your scan? If it was in de latter part of your cycle- the cyst has been formed by some bleeding into the corpus luteum which would mean you have released an egg. But from what I understand- you can't be sure the cyst has been formed during this cycle or a previous one. It's only a small cyst so should not really an issue but I would still want to discuss it with a fertility consultant in light of your other issues. Did you have another scan after to see if it was still there? x

[Amyflood246 in reply to IvfStruggler]

I had a scan about 6 months later and it was gone x

[IvfStruggler in reply to Amyflood246]

That's good then! Although 6 months is a long time. Did they write anything about dominant follicles or a corpus luteum in the follow up scan? I find it weird they have not been clearer. I would assume that there was evidence of you ovulating otherwise they would have said- right? But I would want to be sure. My scan reports always mention dominant follicles (I always got them done in the beginning of the month). x

[IvfStruggler in reply to IvfStruggler]

This gives a bit of information about hemorrhagic cysts: newsnetwork.mayoclinic.org/...

[Amyflood246 in reply to IvfStruggler]

Thank you for the link I will have a read, this might sound stupid but do you know whether ultrasounds are recorded so they can be looked at again at a later date or is it just the report that remains? X

[IvfStruggler in reply to Amyflood246]

It's not a stupid question but I'm not sure of the answer. At our fertility clinic (which was based at a hospital and did both NHS and private treatment) they did because when I moved I had to request my files and I found it contained the pictures of every scan. But I'm not sure this is standard practice. You can always try. Good luck! x

[Amyflood246 in reply to IvfStruggler]

Ah ok that’s good to know! I will check thank you so much x

[soccerkt6]

Hi lovely

I just want to second IvfStrugger's suggestions to have additional scans to help determine if you're ovulating. The first scan would take place in the first 8-12 days of your cycle and the clinic will be looking to make sure you have a lead follicle on one of your ovaries. Meanwhile, you would be using the Clearblue ovulation kits to track your LH surge and once it's detected, you'd contact the clinic again to have another scan 2-4 days later. At that point, the clinic will be looking for a corpus luteum (what remains of a follicle once it's released an egg) to confirm successful ovulation.

Unfortunately, ultrasounds are really the only way to definitively confirm ovulation. Hormone tests can give a good indication but they're not exact.

Good luck! xx

[Amyflood246 in reply to soccerkt6]

Hi! And thank you for your reply, yes I will definitely book a scan! Have you ever heard of normal fsh and lh but no ovulation? X

[soccerkt6 in reply to Amyflood246]

It's definitely possible, I think your doctor is mistaken. 🤭 FSH doesn't have anything to do with ovulation, it more indicates how high your ovarian reserve is. And though an abnormal LH result can indicate irregular ovulation, a normal result is also no guarantee that you're definitely ovulating each month. In you're talking about hormone tests, progesterone is the more accurate hormone to measure since it's released after ovulation. If your progesterone is low 6-9 days after your LH surge, that's a likely indicator that ovulation didn't occur.

Do you track your ovulation with Clearblue sticks? xx

[Amyflood246 in reply to soccerkt6]

That’s what I thought too! I was doing but I never seemed to get any positives so I gave up. But I’ve just been looking at my ultrasound reports and it says I had a 3.5cm haemorrhagic cyst so could this be the corpus luteum? X

[soccerkt6 in reply to Amyflood246]

Ohh, I don't know. I think the sonographer would probably be able to differentiate between a corpus luteum and a cyst, but I'm not sure. There is such a thing as a 'corpus luteum cyst' which is maybe what is was?

Have you been given a reason for your irregular cycles? It's a bit suspect that you weren't ever getting positives on OPKs. xx

[Amyflood246 in reply to soccerkt6]

No they said from my blood tests and ultrasound that it didn’t look like I had PCOS so I’m really confused! I have no clue what’s going on x

[soccerkt6 in reply to Amyflood246]

Personally, I would start taking a myo-inositol product like Inofolic Alpha and see if anything changes. PCOS is tricky to diagnose - there's no definitive diagnosis so they just look at several different criteria and make a judgement call - so it's possible that you have a mild form of it and no one has spotted it. The myo-inositol won't hurt anything if you don't have PCOS, but it should help regulate your cycle and prompt ovulation if you do have it. Might be worth a try xx

[Amyflood246 in reply to soccerkt6]

I didn’t realise PCOS was so tricky to diagnose? That’s good to know so that’s a possibility! Aww thank you for all of your help x

[soccerkt6 in reply to Amyflood246]

Yeah. Granted, if someone has irregular cycles and polycystic ovaries and irregular androgen results, then it’s an easy diagnosis! But if you only have one symptom, you may not meet the official criteria for diagnosis but it doesn’t mean you don’t have it. Good luck! xx