Infertility/Fertility/20 dpo with negative beta and surging progesterone -- 2 ovulations in 1 cycle?
Dear Dr. Ramirez,
I'm so glad you take questions, because I am at my wits end. I'm 20 dpo with negative betas and surging progesterone.
I typically have 8-10 day luteal phases with ovulation on day 14-16, for a total cycle of 24-26 days. I've been tracking my period since 2014 and this has remained constant regardless of season.
I'm 35. My RE says my progesterone is fine. My AMH in Jan was 2.23 with day 2 numbers of FSH 6.8; LH 4; Progesterone .3.
I did two cycles with clomid, one with timed intercourse and the other with a triggered IUI. Both failed.
This last cycle is the problem. I was put on tamoxifen for days 5-9. On day 11 my scan showed only 2 follicles, one at 15, the other at 13. My hormones were surging and on day 12 I was scanned and the follicles were at 18 and 15.
I had a trigger shot on day 12 at 11 pm and IUI at 11:30 on day 14. No other meds except prenatals.
I took a pregnancy test the day after the trigger and it was positive for HCG. I took multiple tests over the next week and they kept getting lighter until the line disappeared around 10dpo.
I had strange brown spotting, mixed with egg white cervical mucus on 12 & 13 dpo.
On 14dpo, I went in for a blood pregnancy test and I was told my beta was negative. My progesterone was less than 1. My period was expected within 3 days.
On 19dpo, still no period, my doctor said I probably had a cyst. She suggested a scan and more blood work. The ultrasound didn't show any cysts. My lining was 8.7 and my progesterone is now 16. Beta is still negative.
My RE says that it looks like I just ovulated again -- weeks after the trigger and without a period. Or she thinks that I've had multiple estrogen cysts that were forming and breaking and that's why I haven't had my period. Or maybe the trigger wasn't done correctly. She has also suggested that it's the weather, combined with 3 months of medicated cycles or stress (I insist that the last month was less stressful.) It feels like she's grasping at straws.
I am now on day 34, 20dpo and still no period although I've had copious amounts of 'wet' cervical fluid -- enough for multiple liners each day for more than a week. The RE thinks this liquid is the fluid from the cyst and that my period will come within 3-10 days.
Can you ovulate twice in one cycle, 20 days apart?
Can multiple cysts form, rupture and then disappear in one cycle (between day 12 and day 33)? Shouldn't the ultrasound show something?
I'm in NYC where we've gone from high 60s to mid-30s over the last 2 weeks. Can the weather add 10 days to your luteal phase?
Hello Amanda from the U.S. (New York),
The simple answer to your questions:
2. No and Yes
But, I'm sure that is not all that you want to hear. It is certainly unusual and very difficult to explain that you've not had a period despite a timed and triggered cycle and negative pregnancy test. My initial thought was that you had a retained cyst because you did not ovulate. But you stated that there was no cyst. My second thought was that you ovulated later than expected, which would make sense because the trigger shot was a little early in my opinion, in which case there would be no cyst but a pregnancy test would be positive. That is still a possibility so I would probably re-do a pregnancy test in a few days. Usually, I have my patients wait until CD#35 and if no period begins, then I check a pregnancy test, then if negative, treat with 5 days of provera to induce a withdrawal. In that type of case, the cycle became dysfunctional and so no endometrial withdrawal occurred.
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 http://womenshealthandfertility.blogspot.com
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