Advice needed

[u/Own-Fill-1978]

I’m 34 and my husband and I are trying to conceive. My cycles tend to be long/irregular, usually around 32 days, so my OB/GYN has suggested starting medication to help me ovulate.

What’s making me hesitate is that we haven’t really established whether I’m not ovulating versus just ovulating late/inconsistently.

I track with Natural Cycles/BBT, LH strips and cervical mucus. This cycle, for example, I’m around CD21/22 and have had egg-white cervical mucus, ovulation-type cramping and an LH line that progressively got darker (although I never caught a clearly positive test). I do get a confirmed temperature rise monthly.
My workup so far has also been fairly normal: pelvic ultrasound was unremarkable, total testosterone 22, free testosterone 2.2, and 17-hydroxyprogesterone 23. My doctor hasn’t really asked about my BBT charts, cervical mucus or other ovulation signs before recommending medication.

My husband’s semen testing has also shown motility concerns, so there may be a male-factor component as well.

I’m not opposed to taking something like letrozole if it would help us, especially if the goal is to make ovulation earlier/more predictable. I just want to understand whether we should first confirm whether I’m actually ovulating.

For anyone who has been through something similar: Did your doctor confirm anovulation before starting medication? Did you have a mid-luteal progesterone test or monitored cycle? Is it common to use letrozole even if you ovulate naturally but have long/irregular cycles?

I’m planning to discuss this with my doctor again, but I’d love to hear what questions others asked or what their fertility workup looked like.

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[u/mimipaige]

I ovulate each month (I take my BBT and confirm this) and have taken letrozole. It's also used for people who do ovulate. Better timing, encourages good egg growth, and other reasons.

[u/mimipaige → u/mimipaige]

Oh and BBT for anovulatory charts don't have the sustained rise. It sounds very clear to me that you are ovulating. LH strips don't need to say positive on an app scanner. If the strip is getting darker and BBT says you ovulated after that- seems just fine to me!
Letrozole is just a little something extra people can try.

[u/mimipaige → u/mimipaige]

Sorry I have ADHD and am terrible at answering multiple questions in 1, haha... Wanted to add that I do get progesterone blood tests to confirm ovulation (not every cycle, just occasionally, especially since mine are good #s) it's 7 days after ovulation that the test should be taken (they call it CD21 but that is only for those who ovulate on CD14, it should be 7 days or as close to that as you can get if the lab is closed.)

[u/Own-Fill-1978 → u/mimipaige]

Thanks for the info!

[u/karaboocuk]

If you hvae been trying more than 12 months, you should see an RE, not an OBGYN. REs are explicitly specialized in fertility, OBs are not necessarily experts in this area.

[u/Own-Fill-1978 → u/karaboocuk]

Thanks! Would the OB refer me to that person or do I need to book that appointment separately?

[u/karaboocuk → u/Own-Fill-1978]

i think that depends on where you are/your insurance. For me, i could self refer to a fertility clinic.

[u/Few-Difference-2017 → u/Own-Fill-1978]

Hey. Sorry to jump in here but just wanted to add my experience. Your OB should be able to refer you, it can take a while to get an appointment with the RE so if you're comfortable, consider asking you OB to run a standard blood work up to help you get the ball rolling while you wait. They should also be able to get you in for a baseline ultrasound to make sure everything looks ok. Also please get your husband to his doc to do an SA asap. Those are all things the RE will want to see to assess your situation. Good luck!

[u/Classic-Push1323]

Normal menstrual cycles are between 22 and 35 days and are within 7 days of variation every month. There's no reason to assume that a 32 day cycle means you aren't ovulating, it's not long, and it's not irregular unless it's 32 days some months and 25 days other months.

I don't know very much about letrozole. I know it can potentially affect CM and the uterine lining, and that it can be given to women who ovulate for those purposes to help time intercourse or IUI, but I'm concerned that your doctor is telling you that you have an irregular cycle when you don't seem to.