See a Gyno/OB or time for RE?

[cab50]

I've always had irregular periods when not on birth control pills (cycles might go as long as two months sometimes) and I am currently having major cycle delay. I am turning 30 in a few months. I've been about 10-30lbs overweight most of my life but lost the extra weight in 2013 and now in BMI is about 24.

History: I did not have my period for three months in 2008 and was prescribed BCP without any diagnosis re cause besides stress. I went off BCP in May 2014 and used withdrawal method for BC until December 2014.

Cycles days off BCP: 35, 32, 27, 28, 27, 44, 33, a month of BCP (27), 18, 18, 86
The first three cycles off BCP, I noticed gel like CM around the two weeks before my period (it was a LOT during the first cycle then less each cycle until I stopped noticing any stretchy CM but could still feel additional wetness). I started doing basal body tempting in July to make sure I was ovulating correctly and saw temperature shifts each cycle about two weeks before having a period.

I went to my GP in November for a physical and a pap smear, while I was in the middle of the 33 day cycle and still had not ovulated yet. I mentioned I was a little concerned about my last 44 day cycle and the delay this cycle due to my history before BCP. She did some blood work which were normal and then prescribed a month of BCP to be started after I start my period which she hoped would cause me to have regular cycles after stopping.

We have been actively trying to conceive since finishing the cycle of BCP in Jan of this year. However, instead of regular periods, I spotted/bleed on day 18 after my BCP period (had a few drops of blood for 2 or 3 days that barely required a pantyliner) and then the same thing in another 18 days. I did not see any temperature shift.

I got worried and saw a gyno/ob in February shortly after the two weird 18 day cycles. We went over my history without a physical exam or blood work as I showed him the labs from my GP. He was not concerned and said the BCP might have just messed up my hormones for a bit. I asked if I may have PCOS and he said I did not "look" like a PCOS patient. He said to wait and see what happens, use a OPK and he would prescribe Clomid if I didn't ovulate every 6 weeks or so. From Jan to March I had horrible chin/jawline acne which now still pops up once in a while but is mostly resolved.

I started using ovulation predictor strips in Feb. I did not see the DR again and nothing happened until late April when I finally got a positive on my LH strip and had a temperature shift. Timed intercourse but did not get pregnant and had my period about two weeks after the temperature shift.

This current cycle I got a positive on my LH strip on day 20 with some gel like CM and so I thought I was definitely ovulating. But I ended up getting sick the same night with a stomach issue and had a low fever for two days. After that, my bbt went back down to my normal pre-ovulation levels so I think I did not actually ovulate. I've gotten over my stomach bug/virus and I'm continuing to test LH but so far on day 27 and nothing.

I'm ready to go see another doctor and I am just wondering if I need to go to a RE for additional testing for an actual diagnosis on the cause of my ovulation problems or if I should try clomid with a ob/gyn first since they are much closer to my work and more convenient.

Thanks for reading such a long post.

[Dr. Wisot]

This is an easy one. You need to see an RE. An RE should be able to diagnose the problem and get you started on the right track. It does not sound like the two previous doctors you saw had a clue on what to do.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California