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Hormone Testing Series

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MellieC Posted: Wed, Feb 8 2017 11:21 AM

Hello all!

   Background:  We are on our 17th cycle TTC w/ no BFPs and I have spotting starting between 3 and 7 days after ovulation (and have since coming off BCP in December 2014).  My progesterone has tested okay (10-15 ng/ml on 7dpo), but taking Crinone (progesterone) in the luteal phase stops the spotting.  

   My NaPro doctor ordered a hormone series of testing every other day for most of the cycle and I have all the results back!  I have an appointment to discuss with my RE and also my NaPro doctor on 2/21.  There are definitely some things that give me concern, but I'm curious to hear (1) what all oddities do you see and/or (2) what do you think could be the cause?  Note:  O dates below are based on temperatures.

Thank you!!!

 

1/17/17 (O minus 8):  E2 - 82 pg/ml

1/19/17 (O minus 6):  E2 - 150 pg/ml

1/21/17 (O minus 4):  E2 - 271 pg/ml

1/23/17 (O minus 2):  E2 - 359 pg/ml

1/25/17 (O):  E2 - 59 pg/ml; progesterone - 2.4 ng/ml

1/28/17 (O plus 3):  E2 - 124 pg/ml; progesterone - 11.0 ng/ml

1/30/17 (O plus 5):  E2 - 160 pg/ml; progesterone - 16.9 ng/ml

2/1/17 (O plus 7):  E2 - 260 pg/ml; progesterone - 14.0 ng/ml

2/3/17 (O plus 9):  E2 - 158 pg/ml; progesterone - 8.2 ng/ml

2/4/17 (O plus 10):  E2 - 83 pg/ml; progesterone - 2.5 ng/ml 

 

lab reference range:

Progesterone:

  Follicular Phase     < 1.0
  Luteal Phase      2.6-21.5

Estradiol

 Follicular Phase:    19-144
 Mid-Cycle:             64-357
 Luteal Phase:        56-214

Me (Mel): 33  DH: 36

Charting since 1/14, TTC #1 since 11/15!!  

6/16 - working with RE due to spotting throughout the LP

2/17 - stage I endometriosis dx and removed; also removed uterine polyp

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dj rayne replied on Thu, Feb 9 2017 9:20 AM

I really don't see anything odd. Levels are where I would expect them to be for the days tested and with the range of normal. Estrogen rises with development of follies. It peaks and triggers LH and then falls prior to O.I would put O at later on 1/24 which is in keeping with what is considered within norm (O is possible within +/- 24 hours of most likely which is what is marked on your chart). Progesterone starts to rise at O as granulosa cells convert and those levels are as expected and also fit with a late 1/24 O. Estrogen begins to rise along with progesterone and follows what is expected with a pek mid LP and then falling levels as there is no pregnancy. Progesterone peaks within the normal range for days and is still adequate at 7DPO. The CL would be rescued by a pregnancy if there was one at this point and though you may see a liitle more dip a pregnancy would then result in a rise where no pregnancy would mean the CL would begin to decline and head toward resolution. progesterone shows a characteristic bell curve. It will be interesting to see what the NaPro says. Let us know how your visit goes. Estrogen and progesterone would continue to fall through the first days of AF. E levels may be a bit higher than expected at 10DPO. I am surprised for that he did not do at least one more draw.

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MellieC replied on Thu, Feb 9 2017 9:40 AM

DJ, thank you so much for your response!  I thought my follicular phase looked fine too, but in the luteal phase I had been concerned that it looked like (1) progesterone peaked too early and (2) that estrogen had such a pronounced bell curve that went so high (out of the lab reference range).  Sounds like you think that is within the broader range of okay though - yippee!  

  This cycle my spotting started at the late end (for me) on 7dpo, which looks right when estrogen is peaking and progesterone is falling.  Interesting.  

  My NaPro dr actually instructed me to stop at 9dpo.  (I told him I wanted 11 too, and he said that was fine.)  Unfortunately 11 dpo was a Sunday so labs were closed and by Monday AF had started.  

  I will definitely update with what he says when I hear from him!  (I have it on my list to update my NaPro experience thread too after I complete all of this testing he suggested).  

Me (Mel): 33  DH: 36

Charting since 1/14, TTC #1 since 11/15!!  

6/16 - working with RE due to spotting throughout the LP

2/17 - stage I endometriosis dx and removed; also removed uterine polyp

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MellieC replied on Thu, Feb 9 2017 9:44 AM

Oh also, I didn't add it to my original post (didn't want to make it confusing), but I started this hormone series the cycle before too; but was foiled by a really early O and had to start over.  However, that series did show a really high estrogen number pre O:

12/27/16 (O minus ~2):  E2 - 462 pg/ml

That was well over the lab's reference range.  This cycle didn't peak nearly as high.  

Me (Mel): 33  DH: 36

Charting since 1/14, TTC #1 since 11/15!!  

6/16 - working with RE due to spotting throughout the LP

2/17 - stage I endometriosis dx and removed; also removed uterine polyp

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dj rayne replied on Thu, Feb 9 2017 10:19 AM

I really hate the reference ranges labs use when hormones have a daily range of norm based on CD not block (FP, mid cycle, LP). Ranges are also dependent on number of follies at the given stages o development and CL stage. Spotting is usually estrogen related and the ratio between E and P can be a factor  but spotting does not necessarily mean that there is a fertility issue and for many has no impact on pregnancy.

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dj rayne replied on Thu, Feb 9 2017 10:21 AM

MellieC:
12/27/16 (O minus ~2):  E2 - 462 pg/ml
That suggests more than one dominant follie and with a ratio of E:P that high then overbuilt lining would cause spotting.

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MellieC replied on Thu, Feb 9 2017 10:55 AM

DJ:  that is fascinating!  I had no idea overbuilt lining could be a thing and certainly not that it could cause spotting.  Yes, in that cycle of really high pre O E2 I had spotting starting at 3dpo.  

Thank you so much, you have given me so much to think about!

Me (Mel): 33  DH: 36

Charting since 1/14, TTC #1 since 11/15!!  

6/16 - working with RE due to spotting throughout the LP

2/17 - stage I endometriosis dx and removed; also removed uterine polyp

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dj rayne replied on Thu, Feb 9 2017 1:18 PM

Simplistic way of thinking but consider an ice cream cone you continue to pack ice cream into/onto. It not only melts but you risk the ice cream falling off....

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AlaskanWife replied on Wed, Feb 15 2017 12:24 AM

Forgive me for jumping in but - an "overbuilt lining" would be what happens with breakthrough bleeding, right? The lining builds up but there is no O, so spotting occurs. 

Me (30, PCOS, annovulatory, chronic pelvic pain) and DH (31, good health)
Surprise pregnancy June '15, mmc at 6 wks. TTC our Rainbow 

Jan-April - trying natural, all annovulatory
May-Jan - 5 failed round of Femara (only ovulated on 2/5)

Starting in March, trying natural for a few months
Vitamins + supplements, CycleSyncing diet, fertility massage, yoga 


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dj rayne replied on Fri, Feb 17 2017 6:39 AM

As your lining builds so does the blood supply. The lining is fragile and with all of the other chemical changes going on the capillaries bleed. What most women never really grasp is that the amount of lining is actually very small and most of what is happening is this blood supply bleeding as opposed to lining shedding which only happens at AF. Spotting and breakthrough bleeds are blood from weakened cell walls and fluid from the lining not the lining itself though the dead cells shed are also present.

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MellieC replied on Fri, Feb 24 2017 12:12 PM

Hello all!  This is just an update post of what my NaPro dr said about the initial results I posted for anyone's future reference.  The NaPro group has done hormone testing across lots of women, so they have these charts of what is ideal and what is within the normal range for estrogen/progesterone every day of the cycle.  

Pre O - My doctor said my pre O measurements were all a-okay (although they ended higher than the chart suggested).

Post O Progesterone - he was not worried about the progesterone peaking a little early, but he was concerned that it went down so dramatically at the end (his chart indicated 10/11 dpo should still be testing around 8 ng/ml).  

Post O Estrogen - My post O estrogen was literally off his charts.  I was just a little high until the 2/1/17 result when it sky rocketed to 260 pg/ml.  The charts indicated it should be around 120 pg/ml.  Also, my estrogen showed more of a dramatic curve (like a steep mountain), whereas the charts indicated it should go up to 120 around 3/4 dpo and stayed around that level until 10/11 dpo (like a plateau).  

His suggestion for both of the Post O results was to supplement with progesterone in the luteal phase.   

I tried to get a copy of his guideline charts to post for everyone's reference, but sadly I was not successful.  

Flowers

Me (Mel): 33  DH: 36

Charting since 1/14, TTC #1 since 11/15!!  

6/16 - working with RE due to spotting throughout the LP

2/17 - stage I endometriosis dx and removed; also removed uterine polyp

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dj rayne replied on Tue, Feb 28 2017 7:04 AM

They are very protective of their information. I had access to earlier research findings but not most recent. I don't think much has changed though.

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dj rayne replied on Tue, Feb 28 2017 7:08 AM

Alaskan Wife I meant to add that you can still have an overbuilt lining with O. It is all dependent on estrogen levels.

Mellie perhaps adding the progesterone will bring the ratio of E:P into better balance and correct why E is spiking. I would suspect out of phase follie development.

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MellieC replied on Tue, Feb 28 2017 8:32 AM

DJ:  Yes, I think that is what they are hoping for (that the progesterone will balance things out).  I guess since the crinone in the past has stopped the spotting - maybe it does?  

What is out of phase follie development?  Like my body is trying to make them in the luteal phase or something?  

Me (Mel): 33  DH: 36

Charting since 1/14, TTC #1 since 11/15!!  

6/16 - working with RE due to spotting throughout the LP

2/17 - stage I endometriosis dx and removed; also removed uterine polyp

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dj rayne replied on Tue, Feb 28 2017 3:54 PM

Your body always has follies on track and developing but sometimes recruitment starts earlier than it should because of imbalances. Women with PCOS and/or that have taken/take infertility meds are the ones I find most often with higher than normal estrogen levels in the LP. Rarely if ever are there US to see what is happening. The estrogen has to come from somewhere. It could be more than one follie released or something coming along when it isn't supposed to.

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MellieC replied on Tue, Feb 28 2017 3:57 PM

DJ you have just blown my mind!!!  So, I should see if I can get an ultrasound around 7dpo (when my estrogen spiked last cycle) to see what is going on?  

Me (Mel): 33  DH: 36

Charting since 1/14, TTC #1 since 11/15!!  

6/16 - working with RE due to spotting throughout the LP

2/17 - stage I endometriosis dx and removed; also removed uterine polyp

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dj rayne replied on Tue, Feb 28 2017 4:03 PM

I would ask. Maybe it is just how you are wired but having all the pieces can make the big picture change. This is from a past reply. I did not edit anything out. I added it for the refresher on how long it takes for a follie to develop. And this goes on continuously. Until we have hit menopause this is what is happening on a continuing basis.

Keep in mind two things 1) it can take a normal healthy couple with perfect timing a year , some take a little longer, some not so long. 2) Our bodies are continuously in the process of preparing eggs for the moment of ovulation.

This from the Wiki definition on PCOS:

  •  
    •  In PCOS, there is a so called "follicular arrest", i.e., several follicles develop to a size of 5–7 mm, but not further. No single follicle reaches the preovulatory size (16 mm or more). According to the Rotterdam criteria, 12 or more small follicles should be seen in an ovary on ultrasound examination. The follicles may be oriented in the periphery, giving the appearance of a 'string of pearls'. The numerous follicles contribute to the increased size of the ovaries, that is, 1.5 to 3 times larger than normal. 

This from a prior post. I edited my answer as all did not apply here. This is what happens over the course of several months and you may see many follies that are visible that will be reabsorbed. The issue with PCOS is that the reabsorbtion process is circumvented along with the dominant follie not reaching maturity. Any woman that went in for an ultrasound at the right time would see this but maybe not to the extreme. In a normal cycle the dominant would continue to develop to maturity (with around 5 following close behind and several in the preceding state) and many would never make it to that stage and be reabsorbed. I always had 15-30 spread over both ovaries when I was being monitored. I had absolutely no problems getting PG, just staying that way. As long as they all are behaving as they should no problem. With LUFS you typically have one very oversized (post mature follie) that converts to a fluid filled corpus luteal cyst.

 

Most common belief is that we are born with all of our eggs; there are studies now that speculate that we can actually produce more eggs later from certain cells in our ovary. I'd love to see the new research on this but haven't found it yet. In any case this is an egg's route to maturity. Each month several follicles(each with one egg) begins to mature. Usually only one egg completes the process. Your system runs off of the different levels of hormones you produce in an endless feedback loop. After AF,GnRH, estrogen, FSH and LH are the key hormones. Once GnRH and FSH kick off the monthly activities estrogen is produced by the developing follicles and as the level increases it causes the endometrium to get thicker. The higher the estrogen the lower FSH drops while causing a sharp rise in LH. Once LH peaks it triggers the mature follicle to release the egg. All of the other follicles(eggs) that reached this point are reabsorbed by the body. They disintegrate. Which is one reason we have so many. For the super tech minded there is some truth in the three month to maturation process. It takes 290 days for an egg to go from a primordial state to a primary state(called recruitment- hundreds of eggs are at some point in developing at any given time). Most die during this process. It takes 90 days to complete this primary transformation once there( so at 1 year) basically an average of 5-7 make it to a level that allows them to compete to complete the cycle any given month(so add at least another 15 days). These compete for FSH during the follicular phase she who collects the most FSH wins and completes the process. So technically 375 days from dormant(primordial) to primary mature follicle.

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