Infertility/Fertility/spotting before period


Thank you for taking the time to answer questions on All Experts! I am writing to you from Seattle, Washington. My husband (40 y.o.) and I (33 y.o.) have been trying, unsuccessfully, to conceive for almost two years. Ever since I quit taking birth control pills, which I was on for three years, I have been experiencing spotting before my period, and my cycles are slightly irregular (ranging from 24 to 29 days in length). I did not have irregular cycles or spotting before my period prior to being on birth control. The spotting has ranged from two to six days before the start of my period. My luteal phase averages between 12 and 15 days. My temperatures always indicate that I ovulate each cycle, and my temperatures remain high until the start of my period. I have seen a naturopath and an acupuncturist. My lab values are the following: estradiol 69.2 (cycle day three), FSH 4.8 (cycle day three), anti-mullerian hormone 4.43. Progesterone 14.84 (seven days post ovulation). TSH 2.3. Vitamin D 36.5. I am on prenatal vitamins and am taking 5000IU vitamin D daily. My question is, could the premenstrual spotting and sometimes short luteal phase be a factor in the difficulty conceiving? Do you have any recommendations of physicians to see in the Seattle area? Do you have any other suggestions based on this limited information? Additionally, my BMI is on the low side, as I am 5'4" and 107 lbs. Might this play a role? Thank you again. I appreciate your time.

Hello Aerin from the U.S.(Washington),

I think it is time that you see an infertility specialist.  I have a good colleague near Seattle, Dr. Jerry Letterie.  I've forgotten the name of his clinic but if you look up the name, you should be able to find him.  Drop the Naturopath and Acupuncturist for now, at least until you have had a thorough evaluation.  Something is causing your infertility and it needs to be identified so that an appropriate treatment can be applied (the treatment depends on the problems).

What we know so far is that you have good ovarian function with evidence of ovulation (MLP of 14.84).  Your thyroid is normal and your AMH is adequate #although of no consequence at this time in your life and was probably not necessary.  I can't explain the spotting but it may or may not be a luteal phase defect.  This diagnosis is made by an end of cycle (CD#27 or 28) endometrial biopsy, but if you are going to undergo infertility treatment any way, we usually will cover this by using supplemental progesterone so the testing is not absolutely necessary.  Your husband will need to undergo some testing as well.

Good Luck,

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

Monterey, California, U.S.A.

for additional information check out my blog at 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


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.


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.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

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

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

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