Inga Heese

This is the case of a 31-year old woman trying to conceive. She had been trying for one year to get pregnant. She had a laparoscopy two weeks ago and was diagnosed with ‘mild endometriosis’. She was tired and depressed. I asked her to do a BBT chart to monitor her body temperature (The body temperature reflects very well how the ovaries work: in the first oestrogenic phase the body is much cooler than after ovulation, in the progesterone phase.)

We saw that her temperature after her period (follicular phase) was 36.7, this being too high and giving an indication that something was going on that prevented her temperature to reduce fully. On reading her laparoscopy and scan reports we could see that the report showed an endometrioma on the right ovary which had been removed, and she had adhesions on the right fallopian tube which had twisted though it remained open. Most striking was that she had severe adenomyosis with a bulky and distorted uterus. I also noted that she had an antral follicle count of 24 with a FSH reading of 5 and LH reading of 6.7, so the FSH/ LH ratio wasn’t right. Her progesterone test was 37 on day 21, so on the low side. She also had acne. Her main clinical symptom was bad abdominal cramping in the second phase of the cycle.

This patient had an endometrioma, so it is very likely that she had a Grade III endometriosis, as well as adenomyosis. She also had polycystic ovaries (PCO): an antral follicle count of 24 is good in fertility terms, but it is quite high, indicative of PCO; the FSH /LH ratio wasn’t right, and she also had acne, possibly indicating PCO Syndrome. She also had a luteal phase defect: from her temperature chart we could see her luteal phase had collapsed on day 21: her body temperature had reduced to 35.5, the biggest decline I have ever seen in clinic. This was a complex case. We had to make her ovulate more efficiently to strengthen her luteal phase, whilst treating the underlying reason for her endometriosis and adenomyosis. This patient was on three different prescriptions depending on her stage of her cycle. Her premenstrual symptoms improved and her temperature in the luteal phase became more stable. She became pregnant after four months and had a healthy baby boy.