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Infertility/Fertility/No LH surge but temperature increased

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Question
I was wondering what it means when you do not get an LH surge detected when using an ovulation test kit from a pharmacy but your temperature goes up.  

I have been through all the usual fertility tests with the doctors and they say everything is good and no reason why I shouldn't conceive and my husband's sperm count is apparently fine too according to the dr and gynaecologist (although we have also been to see a Chinese Fertility expert in London and she said it was very bad).  I have been taking my temperature in the mornings for the past two years and have found it to be generally low in the beginning part of the cycle and high in the later part although it can be variable; for instance, this month temp was generally between 97 and 97.3 but on a couple of occasions as high as 97.6 in the first half of the cycle but then went up to 98 before back down to 97.6 the next day and today back to 98 today.  I don't know why I would get a reading like 97.6 in the later part of the cycle and also the start of the cycle - shouldn't it just stay high?  In addition, one reading in the first half of the cycle was just 96.8 so not even on the chart they give you for BBT.  I've read in a few places that several readings of less than 97.5 could mean I have low thyroid but it didn't come up on any of the tests I took for hormones with the doctors last year.  In the meantime, no LH surge has been detected on any of the test strips which I've done each day since day 6 of my cycle.  I used to have a 28 days cycle - so I thought - but once I've monitored it more closely, it can vary and is usually either 28 or 31 days and only once more than that in the last year that when it was 37 days - although could have been anxiety related.

I would be grateful to know what this could mean as I'm finding it almost impossible to determine when I am ovulating (again, Dr's test said I was) each month and we are both finding it very frustrating.

Answer
Hello Emma from the U.K.

I am afraid I cannot tell you why your OPK's are malfunctioning.  There is no physiologic explanation that would explain this, if in fact you are ovulating.  If you have regular menstrual cycles and your doctor has done mid-luteal phase progesterone levels that were above 10, then these indicate that you are ovulating.  Your question regarding the OPK's probably need to be directed to the manufacturer.

The temperature elevation as detected with the BBT is due to the rise in progesterone.  This rise is also detectable by the mid-luteal phase progesterone level and both indicate that ovulation is occurring.  Using the BBT only, the point of beginning intercourse is when the temperature rises.  You should have intercourse daily for four consecutive days at this point.

In terms of the Chinese doctor's analysis of the semen analysis, I have to comment that I am a Western trained medical doctor, so can only interpret based on that knowledge.  I know that Chinese medicine doctors have lots of different ways of interpreting things, but what I tell my patients about them and other non-medical practitioners such as naturopaths and acupuncturists, is if they are so correct and have the right answers, why isn't medical practice all Chinese medicine, Naturopathic or Acupuncture instead of the way that it is?  The reason why Western scientific medicine is the dominant form of health care is because it is the most correct.

The other method that you can use to time your intercourse is the simple calendar method since your cycles are fairly regular.  Since the average cycle is 30 days, I would count based on that number so that ovulation would occur 14 days prior i.e. cycle day #16.  So mark your calendar on the day your period starts, which is cycle day #1 and then count each day.  When you reach CD#14, begin intercourse daily, once per day and only one ejaculation per episode, for five consecutive days (CD#14-18#.  This will make sure you have fresh sperm on the day that you ovulate.  The only other way to time intercourse is to use ultrasound surveillance so that the pre-ovulatory follicle can be detected before it ovulates #generally when the follicle size is 20-22 mms).

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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