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What causes delayed periods?

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Posted on Mon, 28 Jul 2014
Question: Doctor

I consulted you in March this year , I have another query today please help
I am going though stimulation as advised by my gynecologist (taking 3-4 injections ) after that I go through Follicle study in my every cycle .
My last LMP was 27th May'2014
I took injections on d3 , d5,d6,d7 and then started my follicle on 9th day .
I had good follicles and got ruptured on its own on 10th -11th XXXXXXX . I was advised next 2-3 days as productive days and we had intercourse on these days

My Gynae and Ultrosound doc were hopeful in this cycle . But till now I have not got my periods , I took Urine and BHCG Test in my 9th day of missed period which was 5th july and that was negative.

I visited my Gynae and I was not too convinced by her answer this time . I asked why are my periods delay ? I have a regular 28-30 days cycle and after confirmation of rupture was also there

My question to you is on my stage right now... I have read on net that If ovulation has happened it results into pregnancy or periods . Where am I right now ? Is there any chances of pregnancy in this cycle as my Gynae has advised me to wait for one more week and get BHCG done again if I dont get my periods .

Kindly advise what could be the reason of delayed periods if Ovulation has happened ? My Husband and I are trying for baby since 1 year , all our reports are normal, tubes are fine and also I had one missed abortion just after my honeymoon last year in XXXXXXX .

I am unable to find is there a reason of no period , no pregnancy after Ovulation is confirmed .
What should I do now?
Where are we going wrong ?

Kindly advise if I have a chance of pregnancy in this cycle and also what could go wrong If my ovulation is happening with good eggs every month .

Thanks
Bhavna
doctor
Answered by Dr. S Patra (2 hours later)
Brief Answer:
DETAILS ARE GIVEN BELOW.

Detailed Answer:
Hello XXXXXXX

Thanks for your query. I understand your concern and current situation.

1) I suggest you to repeat blood beta-hCG after 1 week in absence of period to rule out late conception though there is quite LOW chance.

2) Female body hormones are regulated by Hypothalamus- Pituitary- Ovarian Axis (HPO Axis) and it can be affected by mental stress, psychological factor, fertility medicine or external hormone, high prolactin level etc.

Women are fertile for about 24–48 hours around the time of ovulation and you have confirmed your ovulation or follicle rupture through Serial Follicular Study. However, high progesterone level is the reason of NOT getting period in spite of your ovulation.

Progesterone levels remain high unless the egg goes unfertilized, in which case the egg is re-absorbed and progesterone levels fall. In this event, progesterone levels continue to fall until day 28, when progesterone reaches its lowest level, menstruation occurs, and the cycle repeats. However, menstrual cycle varies from women to women from 21 days to 40 days due to disturbance of HPO axis.

3) In my point of view, it is MOST likely physiological phenomena. You should wait for upcoming cycle up to ONE week and repeat pregnancy test. Another thing, you can undergo Serum prolactin level and LH/ FSH test to determine underlying cause. Kindly, consult with your doctor following above tests.

Hope, it helps to understand clearly. Kindly, close the discussion if you don't have any other query.

Wish your good health and take care yourself.

Regards,
Dr Soumen

For future query, you can directly approach me through

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=63326
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S Patra (18 hours later)
Thanks Doctor for your reply
I am slightly confused , why has the progestrone increased in my body ? Is there a treatment for this ? I must be facing this only every month I assume coz follicle confims ovulation every time .

Can you suggest why is this happening as the reasons that are mentioned (
affected by mental stress, psychological factor, fertility medicine or external hormone, high prolactin level etc.) does not exist in my case .

Please suggest the treatment for this and Also If you could tell me when should I get these tests done- LH/ FSH

Also do you recommend stimulation in every cycle and how long ?

As I am trying since 1 year along with medicines and treatment do you feel I need to take further steps like IUI etc ?

Thanks and Regards
XXXX
doctor
Answered by Dr. S Patra (2 hours later)
Brief Answer:
DETAILS ARE GIVEN BELOW.

Detailed Answer:
Hello,

Thanks for follow up query. Followings are my comments:

1) Luteal Phase Defect or progesterone deficiency and High Progesterone level (mostly due to hCG injection) are to be ruled out in this context. It is related to the disturbance of Hypothalamus- Pituitary- Ovarian axis as a result of repeated stimulation in each cycle. It can lead to period disturbance certainly.

2) I suggest you to repeat pregnancy test first and undergo some tests like LH, FSH, Serum progesterone, Estradiol & pelvic ultrasound scan for current cycle. You can do those tests ANYTIME after pregnancy test.

3) Proper treatment depends on diagnosis of the case. Progesterone supplement or estrogen therapy (to combat high progesterone effect) may be required to induce period. Other supportive treatment may be given as per test reports.

4) HCG injection can be given for 4 to 6 cycles initially within therapeutic doses and it can be repeated according to next plan of treatment.

Repeated hCG injection stimulation for triggering oocyte release may lead to Ovarian Hyper-Stimulation Syndrome (in small percentage) and it should be cautioned as it is MOST dreaded complication.

5) You should know that around 10% causes of infertility remain UNEXPLAINED where all test reports are NORMAL including physical examination.

In that case, we suggest our couples to proceed ART (Assisted Reproductive Technology) following consultation with Infertility Specialist. It includes IVF (In Vitro Fertilization), GIFT, IUI etc.

Hope, I have answered your queries. Kindly, close the discussion.

Good luck and all the best.

Regards,
Dr Soumen
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. S Patra (23 hours later)
Hi Doc

As advised will get the BetaHCG test day after which will be 14th day of missed periods . Please confirm what is the first step for me incase it comes negative , should I have 5 days medicine to get periods ? Have been reading on net that lot of people came to know about their pregnancy in 4-6 weeks of missed period , Is that true and positive ?
1.Please confirm If I should have 5 days medicine to withdraw (have periods)
2.Also it was very scary for me to read about IVI treatment and unexplained fertility , Am I at that stage or there could be more treatment for me to conceive as my all tests are normal .

Regards
XXXX
doctor
Answered by Dr. S Patra (43 minutes later)
Brief Answer:
DETAILS ARE GIVEN BELOW.

Detailed Answer:
Hello,

Thanks for additional query.

1) YES, you would take Progesterone pill as prescribed by your doctor to induce period in case of NEGATIVE blood test for beta-hCG.

Another thing, you can undergo above mentioned tests following pregnancy test to rule out underlying cause before taking 5 days medicine.

2) Late conception may be detected slight lately, even 1-2 weeks after missed period. Blood test for beta-hCG is more accurate test to rule out pregnancy at this stage. It will be more informative and worthwhile.

3) You would try for pregnancy naturally or with fertility treatment. Assisted Reproductive Technology (like IVF, IUI etc) is the LAST option for couple with Unexplained Infertility. You should consult with Infertility Specialist regarding this for proper management.

Wish your good health and good luck. Kindly, close the discussion.

Regards,
Dr Soumen
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. S Patra

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What causes delayed periods?

Brief Answer: DETAILS ARE GIVEN BELOW. Detailed Answer: Hello XXXXXXX Thanks for your query. I understand your concern and current situation. 1) I suggest you to repeat blood beta-hCG after 1 week in absence of period to rule out late conception though there is quite LOW chance. 2) Female body hormones are regulated by Hypothalamus- Pituitary- Ovarian Axis (HPO Axis) and it can be affected by mental stress, psychological factor, fertility medicine or external hormone, high prolactin level etc. Women are fertile for about 24–48 hours around the time of ovulation and you have confirmed your ovulation or follicle rupture through Serial Follicular Study. However, high progesterone level is the reason of NOT getting period in spite of your ovulation. Progesterone levels remain high unless the egg goes unfertilized, in which case the egg is re-absorbed and progesterone levels fall. In this event, progesterone levels continue to fall until day 28, when progesterone reaches its lowest level, menstruation occurs, and the cycle repeats. However, menstrual cycle varies from women to women from 21 days to 40 days due to disturbance of HPO axis. 3) In my point of view, it is MOST likely physiological phenomena. You should wait for upcoming cycle up to ONE week and repeat pregnancy test. Another thing, you can undergo Serum prolactin level and LH/ FSH test to determine underlying cause. Kindly, consult with your doctor following above tests. Hope, it helps to understand clearly. Kindly, close the discussion if you don't have any other query. Wish your good health and take care yourself. Regards, Dr Soumen For future query, you can directly approach me through http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=63326