My Medical Care Providers Over the Past Three Years

Before having to deal with infertility I had the unfortunate luck to have been injured in a car accident back in 2000. Through that experience I realized that my healthcare providers didn't have my best interests at heart, they wouldn't let me know to come in for a follow-up appointment, sometimes I was referred to lame care providers. I came to understand that the only one fully vested in my recovery and well being was me. That helped set the stage for the adventure that started when we got into TTC.

September 2002 -- Internist diagnoses fibroid (dump internist due to issues with getting appointments and information from her in the couple of years in her care -- I had to wait a week for an appointment when my neck went out and I was in constant pain and couldn't turn my head).

October 2002-March 2003 -- worked with a naturopathic doc who helped me gain better balance in my diet and lifestyle but also wanted me on a ton of supplements. She asked me if I had considered adoption and how long I intended to cut back on alcohol and taking prenatal vits in a way that wasn't entirely supportive so I stopped going there.

February 2003-May 2003 -- Met with RE#1 who I liked and she did an okay job but she left the State and clinic after a few months. She told me I should have my fibroid out after my HSG but to find a new surgeon. Even though my basel temps charts showed that I had regular cycles and temp rises consistent with ovulation she dismissed them after saying "yes you ovulate" and then told us we should do the HSG and then move onto IUI with Clomid and that she could "make me ovulate" which I didn't like the sound of at all.

June 2003-Nov 2003 -- Met with RE#2 to try to figure out if I needed to have fibroid surgery or not. He decided to give me a fertility work-up (just blood work) and wasn't a good listener. He told us that my partner had anti-sperm antibodies almost certainly and we would need ICSI to conceive (you won't be able to conceive on your own he said). While he knew his stuff I really didn't like him and his arrogance so I left him after one last consult in Nov to review my pooled progesterone results and to see if he would provide care if I had a fibroid embolization instead of abdominal surgery for my fibroid. It ended with a strong conversation about fibroid embolization.

July 2003-Sept 2003 -- Gyn #1 who I was scheduled to have my fibroid surgery with but I got such a bad feeling from her that I cancelled the surgery 10 days before and decided to pursue other options.

November 2003 -- consulted with an interventional radiologist about having my fibroid embolized (they block the blood flow using small particles through the uterine arteries). He was nice but I wasn't sure and couldn't find a gyn to provide support to this procedure.

Dec 2003 -- met with Gyn #2 who was all right but a little young and I cried in her office and she just looked at me, offered no consolation or anything. Her office was hard to book appts with so I decided to bag them.

Jan 2004-May 2005 -- started working with acupuncturist #1 after prompting by a couple of friend in alternative medicine. He was very nice

April 2004-current -- fell down the stairs and reactivated my back injury from a car accident in 2000 prompted a visit to chiropractor #2 (chiro #1 took bad care of me after my car accident)

Jan 2004-July 2004 -- met with RE#3 who was very nice and a good listener. We were going to try clomid/IUI under his care in July but we got pg on our own in May. He did my first d&c but left the clinic the following week; he told the nurse that I didn't need to have my beta checked post procedure which was wrong. I had continued bleeding for weeks afterwards due to retained tissue and had to see RE #4.

August 2004-current -- RE#4 took care of me after my m/c showed to be incomplete. We decided to wait it out rather than try methotrexate to avoid doing a repeat d&c so soon after the first one. With my enlarged fibroid not decreasing and the retained tissue not resolving on its own she was the one who did my surgery on both in November.

June 2005-current -- acupuncturists #2/3 work together in a practice that specializes in fertility. I went to see them first the week of my miscarriage as I was in so much pain.

Sept 2005 -- gyn #3 was very sympathetic, but gave signs of being a little conservative such as 37 week c-section due to my myo though he did say that they would take good care of me on a subsequent pg.

I'm not really a problem person but I wasn't really to take standard b$ care from my docs, especially after seeing how lame they were 5 years ago after the car accident --- you have to look out for yourself.

Report from the ob/gyn visit today

My appointment went well but I was really upset by the end of it, having to explain about all I've been through. The doctor was very nice though and when he saw that I was getting upset he switched over and started saying lots of consoling, positive things which was what I needed. We talked about a c-section delivery and how he would do that and I learned some about their practice. He was a little confused as to why I was seeing an RE without having fertility treatment but finally I think he got it, just circumstantial that we hadn't yet gotten to any fertility treatments. I feel like Annie in the musical, "I think I'm gonna like it here."

I dropped by my RE's office which is now on the next floor down to say hi the office staff who know me pretty well now. Still feeling upset, I decided that I wasn't ready to go in to the office so I went home and took a nap for an hour and a half (I did get up at 5:30 this morning) and then felt tired and icky after I woke up. I cooked lunch and made some passionflower tea to calm my nerves (good stuff) and realized that I was holding my muscles related to my uterus. I've been feeling crampiness like after my HSG. I think it was the PAP that set it off, probably brought back pain memories as well.

I finally got into work after 2pm. C'est la vie right?

Stuff about Crohn's Disease and Ulcerative Colitis

[I'm always searching out weird topics so I thought I would share this recent post]

I met the author of the book Eating for IBS once a few years ago and thought she had an interesting perspective on how to manage IBS and other diseases of the bowels using diet. You can visit her site here:

HelpforIBS.com

I don't have this condition but it's totally plausible to me that diet/lifestyle/medications were contributory causes. It isn't a normal, healthy, homeostasis condition. Here are some other links that you might find interesting:

small-bowel bacterial overgrowth(SBBO)

Bacterial Overgrowth Syndrome

Breaking the Vicious Cycle - The Specific Carbohydrate Diet

Cultured Cabbage Juice - Make the Best Lactobacteria

I've also found reference to birth control pills sometimes being a factor -- making the condition worse or better, which seems to indicate a hormonal contribution as well. Knowing that progesterone relaxes smooth muscle tissue and changes the way our bodies deal with blood sugar levels, it isn't so far fetched that hormones coud affect all aspect of our system.

Crohn's Disease and UC came up while I was searching for information on Chronic Fatigue Syndrome as well. Do a search for more information though, the terms "crohn's disease chronic fatigue" turned up a bunch of interesting results.

Gyn Appt

I posted a couple places today about looking for a good Seattle ob/gyn and someone on Babycenter's fibroid board gave me her docs name. I called over there to speak with them and let them know my story: 35, TTC, 2 m/cs, fibroid surgery, RE, etc. and also about how lame my other ob/gyn's office was and asked if they could do better. They had an opening tomorrow so I set up an appointment for a pelvic exam -- with a doc whose name had been given to me by a friend a while back -- she switched her ob in the 8th month of her pg to this guy. I'm a bit nervous as I hate having to deal with allopathic doctors and their myopic view of medicine, but I still keep hope that he's going to be nice to work with.

I'll have to go through the medical records I have at home tonight and bring along copies with me to the appointment. Oh and they told me not to insert anything vaginally for 48 hours prior to the appointment. I mentioned the prog supps and the person on the phone said not to use them. I'm mid LP though. What should I do? Use one tonight and not in the AM? It would be dissolved by then. It probably has to do with the PAP though I doubt it will interfere in a measurable way -- who knows.

I have checked my temp during the night as my partner keeps coming to bed after 1am (grumble) and waking me up. I haven't yet had a sustained high temp overnight. When I was pg the first time my temp was 98.6 in the middle of the night as well as when I woke up. I also don't have an itchy forearm which happened both times I was pg. I tested yesterday with my last FM stick and it just showed a little LH as it did last cycle around this time. The curiosity got the best of me this AM and I used one FRE (I so want to be one of those gals who goes in for a beta on CD9 and has a raging great result) and it came back negative as anything. It's still early though and the cycle I got pg last I tested negative on CD9 and ended up getting a BFP on CD13 so perhaps there's hope yet.

It could have been me

Last night I went to a community BBQ and brought along my SIL and my baby niece and nephew. I watched the baby while my SIL followed round her son as he played on the playground equipment at the park we were at. There were lots of people there I know from around the neighborhood, due to my community activism. Almost all of them came over to ask me if my niece was mine.

Yes, I don't see these people all of the time, mostly only in email and at occasional meetings. Yes, I was holding a baby with dark hair like mine. But really folks, an 8 month old infant doesn't come out of thin air and most of them have seen me within the past year when I would have looked pregnant. Many of them knew I had abdominal surgery last year as well, though not what kind of surgery and I suppose that still didn't exclude me from having a kid now.

So, it was a mixed thing. A little fantasy about what it would be like if I had a baby, this baby that I held that was born the same week as my first [a] was due. There was also the stupidity of it all, the frustration as well. Of course I want a baby, no this isn't my baby but it could have been -- at least in an alternate reality. I guess I should be thankful that no one asks why I don't have children yet. As if there is any easy answer to that question, because even I don't know why we don't have children now.

(P.S. I'm at 10dpo and no sign of anything vaguely pregant with me yet. Two things I'm looking for are an elevated basel temp in the middle of the night and an itchy right forearm -- my symptoms that are particular to when I've been pg)

Types of Iron

There are two kinds of iron, heme (heem) and non-heme. Heme is found in animal sources of food (red meat, liver, clams, salmon, eggs, etc.) and non-heme is found in vegetables (spinach, raisins, kidney beans, lentils etc.) Heme iron is easier for your body to absorb, though in what I've read your body can absorb more non-heme iron in the presence of heme iron.

So you want to have some spinach with your lamb curry and then you'll have your bases covered. As an anemic gal trying to build her iron stores I've been eating like that (by the way indian and ethiopian are great ways to get good iron in your diet from plant and animal sources) and taking my prenatals plus my chewable iron as well.

Bowling and Babies

We had a company bowling event last night and in addition to my niece being there one of our employees bought along his wife and baby. The baby was 5-6 months and babies that age just remind me of my first m/c and make me really uncomfortable (that could have been me, ya know?) I didn't even say hi to the woman, I'm sure she thought I was cold. Other people from our company were carrying the babies around and the like but I just feel like babies are a loaded subject for me. I could see the wife of another employee staring at the babies as I know they are interested in starting TTC. It just made me think of how much heartache TTC has brought me and as I fell asleep last night I kept thinking to myself that maybe I would be better off just not having babies.

An update on the dysmenorrhea

I had a stomach virus or something. It was connected to a different virus I caught weeks ago with a temperature and everything -- the connection was the stomachache that lasted for weeks. It's possible it was some sort of micro-organism as in the end several of the symptoms were similar to when I had salmonella, though the timing was spread out and the symptoms didn't happen all at once. I felt like I needed to throw up two weeks ago, and also like I was going to have diarrhea. I made mention of it to my acupuncturist. The following Sunday I woke up and felt really ill and proceeded to empty my digestive tract over and over for several hours. That seems to be the end of it though my acupuncturist today noted still some disturbance in my stomach channel.

Pretending

Lately I've been feeling like it's all just pretend. I'm pretending that eventually I am going to have a baby. I'm pretending that this is something that will happen to me. Like looking at some Hollywood actress or rock star and thinking that I could do that (don't we all have those moments?) Since its been so darn long I just feel like I've been pretending for a long time, that small piece of hope left seems almost a little silly.

The other side of it is that I worry that I'm just getting too comfortable in my own life (not such a bad thing) and that I'll not be able to adjust to sharing my world with a wee one. That I should even be so lucky. It's been an ongoing worry of mine, though feeling comfortable is a newer addition.

But then here I am in the 2ww again (2dpo) and that little piece of hope (and distraction) lifts its head and says "what if..." If it wasn't so sad it would be aggravating.

We went camping over the weekend and I brought along my digital basal thermometer to temp with. Of course it was freezing at night (38 degrees) and so I slept with a hat on and a wool blanket over my head but who knows if my temps are what they would have been otherwise. It was challenging getting one BD session in with our friends there with us. We had one session Saturday morning before we left and then one on Sunday afternoon and then I ovulated on Monday. Not as much as we usually try to get in but maybe the timing was good enough.

I had acupuncture today and it was very relaxing. I'm on a luteal phase herbal formula that tastes okay though a little smokey. Fingers crossed pleased that we catch another eggie.

Unbelievable indeed.

Last week I got an email from an old boyfriend announcing his engagement. We've stayed friendly all these years, it was only a little thing we ever had, so I was happy for him. This morning however he follows up with an email blast to all his friends announcing that he's expecting a kid next March. WTF? It sounds like they weren't even trying though if she's due in March then they have known for a while now.

It's nice how he phrases it:

Unbelievable really as we were always told it would take ages once you were in your thirties etc, etc and hey presto wham bam, first time trying ! Always knew I'd be super fertile ;-)

This guy has said for years that he would never get married and never wanted kids. Uh, yeah right.

Feeling poorly

I'm on cycle day three of my 38th cycle charting. I've been feeling so poorly these past couple of days that I finally looked up dysmenorrhea (painful periods) and I fit the definition to a T this cycle. What's up with that? I've got stomach pain, lower GI discomfort, headaches, I'm not sleeping well. Its actually not a normal pattern for me. I've also still got symptoms from that virus that's been going around the office, others have the same symptoms -- sore back, sinus congestion, faint numbness in hands and feet. One of my employees saw her doc about it today and was told it was indeed a virus and that it might take another 2 weeks for the symptoms to clear out.

I had an acupuncture treatment this afternoon and she treated me for blood stasis in my abdomen that was causing me a lot of menstrual pain, as well as my immune system and also to help stimulate follicle development. They told me to take a break from the herbs for a wee while and see how my body does. I told her about how when I was younger and stressed out my stomach would hurt me (I spent many hours in the nurse's office in 6th grade with stomach aches when my parents were fighting constantly and close to divorce and I wasn't doing my homework), and sometimes if the emotional stress was intense I would get diarrhea (first bad breakup I couldn't eat for a month and when I did I had diarrhea -- I lost 10 lbs). Certain types of really bad stress would even cause me to have mid-cycle bleeds, but never annovulation, I never missed a cycle. She said that it fit in with what she knew already that I have an overactive liver but that normal Western testing wouldn't show any dysfunction and it ties in with my other complaints as well. In TCM the liver is associated with emotions and I'm such a freaking sensitive person and a bit neurotic as well (but I'm sure you noticed that by now). Its just who I am and while I've made lots of changes I don't know how much more I can do. To think that sometimes just being can be the thing that throws you off. I don't even want to know about it. I fell asleep during the treatment at any rate, for a good 40 minutes, which felt good.

While sweeping our back porch the other day I was thinking to myself about what someone on the boards wrote to me after my first loss; she said "God must really love you to put you through so much." I too know that I'm stronger in some ways, maybe more wise to the ways of the Universe and my connection to the world around me. My losses are a part of who I am now.

Sometimes lately I've been thinking of just getting used to the idea that we won't have kids. It's been such a very long road so far. At least I'm needed at work and I'm getting to do more consulting work. I don't know what the future holds and I talked to my great-aunt about it when I was in New York. There are places for all kinds of mothers in the world, and not all of them are biological. You don't even have to be an "adoptive" mother to make a difference. You know I've heard that for troubled children even a 15 minute positive encounter can build esteem enough to help that child find hope and change direction. Maybe there's a place for me there in the world. I just don't know yet.

Tonight I did a brief liver qi cleanse as I missed my qigong class for the second week in a row. This time because I wasn't feeling well, last week was due to traffic and class just not being at the park where they were supposed to be.

Call back from the nurse

The RN asked me if the RE had planned on any more bloodwork since my recent panel came back normal except for ferritin being dead low.

She said there is a lot that can cause nightsweats but w/o having blood work to show what's going on it's hard to know what the deal is. I noticed as well in doing some searches and looking at my reproductive endocrinology textbook last night that estradiol levels in the late luteal phase is not really something that is covered a lot; it isn't interesting or something.

She mentioned that Clomid might be an option, that the goal was to get me to have a healthy egg and a healthy pregnancy. I totally agree. I told her that the only reason I'm being such a spaz about trying to figure out if there's something we've missed is that I really really really don't want to have another m/c; if I can do anything at all to help prevent it then I will.

I've only been able to try 4 cycles since my fibroid surgery, one of those cycle I got pg and the last one was my first try after my m/c so my stats aren't really that bad again...yet...

Honestly I'm on a much better course of health than I was when I started TTC. I don't have a large fibroid any more, I'm working on building my iron stores, I'm much more relaxed, I eat better and more regularly, I'm not spotting when I ovulate, I don't have BV. That's how I was when I started out. What a winnner eh?

I've had the night sweats for years, I remember them as early as when I first moved to Seattle when I was 23 so it's not a peri-menopausal thing for me.

I'm waiting for the NP to call me back now as my RE is in surgery today. I'll let you know if I find anything out. I'll also bring it up with my acu next Tuesday and find out what her perspective is.

Chinese Herbs I'm Taking

I just looked up the herbs I'm taking from my acu, the ones I haven't been great about taking lately and if I did they might help out with this. Anyway they contain:

White Peony
quote:

Traditional Chinese applications: Blood deficiency affecting the uterus, with irregular menstruation, dysmenorrhea, or excessive bleeding; spontaneous sweating and night sweating; abdominal pain or spasm; pain of the hands or feet; headache and vertigo due to preponderance of liver yang

Dong Quai (or Dang Gui)
quote:

Traditional Chinese applications: Blood deficiency syndromes; irregular menstruation, amenorrhea, and dysmenorrhea due to deficiency and stagnation of blood; abdominal pain due to deficiency and cold; pain due to stagnation of blood; traumatic injury; pain and numbness in muscles and joints; boils and carbuncles; constipation due to deficient blood and dry intestines

(carbuncles?)

Some of my symptoms are cumulative over many years, some over the past few years with my stupid fibroid, and then some very recently with my 2 m/cs and fibroid surgery. Boy it seems like I'm getting worse instead of better as I go down this infertility path. It's a good thing that I'm doing what I can to reduce stress, eat better and drink more water or else I would be a complete wreck.

I'm probably going to call and mention my luteal phase night sweats and my weird results with the FM test sticks to my RE's office since when we talked a few weeks ago she said that some women's body reacted more strongly to the drop in estrogen but my pee test shows it was actually an estrogen surge and not a drop.

Stupid Hot Flash or Something

I had a night sweat two nights ago and a hot flash yesterday evening that lasted quite a while. I did a FM test which showed really strong estrogen, stronger than the previous 5 days (mid-LP) which I was testing for just to see if there was any LH or reason to use a HPT (we can all have dreams right).

I read on a menopause site that some women have hot flashes even with elevated estrogen levels. I guess that would be me. But why is my estrogen peaking this late in my cycle (cd10?)(maybe its normal -- see hormonal chart on this page -- but why does it give me hot flashes and night sweats?)

I feel like I'm such a hormonal mess and I don't know if its genetic, environmental or what but for all the acu and herbs I've done (not too many herbs) why is my body still such a freak. I feel broken.

And since my mother's hormonal pattern was really similar to mine and she's recently been dx with breast cancer its even more concerning ya know?

I just came across this page about CFS and some of my symptoms/pattern are there, particularly the kidney yang/spleen qi and kidney qi deficiency. I want to be balanced, not deficient.

The Patron Saint of Fibroids (in Pregnancy?)

I just came across this and I'm fascinated because I know so many women here and elsewhere on the Net who have been through similar trials and yet haven't been beatified. But, at any rate, I guess we have a patron saint.

Gianna Beretta Molla (1922-1962)

"In September 1961 towards the end of the second month of pregnancy, she was touched by suffering and the mystery of pain; she had developed a fibroma in her uterus. Before the required surgical operation, and conscious of the risk that her continued pregnancy brought, she pleaded with the surgeon to save the life of the child she was carrying, and entrusted herself to prayer and Providence. The life was saved, for which she thanked the Lord. She spent the seven months remaining until the birth of the child in incomparable strength of spirit and unrelenting dedication to her tasks as mother and doctor. She worried that the baby in her womb might be born in pain, and she asked God to prevent that."

There's also a web site for The Society of Blessed Gianna Beretta Molla
(http://www.gianna.org/). Where you can learn more about her condition during her last pregnancy.

Crash and burn.

I think something may have been trying to gain a hold but then it didn't work for some reason as my temps the past two days have been down. Last night I had my typical luteal phase night sweat as well.

Here are my temps:

cd9 -- 97.5
cd10 -- 97.5
cd11 -- 97.5
cd12 -- 97.5
cd13 -- 97.5
cd14 -- 97.5 (Ovulation)
cd15 -- 98.1 / 1dpo
cd16 -- 98.1 / 2dpo
cd17 -- 98.0 / 3dpo (NPC)
cd18 -- 98.4 / 4dpo (NPC)
cd19 -- 98.1 / 5dpo (NPC)
cd 20 -- 98.1 / 6dpo (50 mg Rx Prog)
cd 21 -- 97.8 / 7dpo (50 mg Rx Prog) (dip to CL)
cd 22 -- 98.6 / 8dpo (50 mg Rx Prog)
cd 23 -- 98.7 / 9dpo (50 mg Rx Prog)
cd 24 -- 98.0 / 10dpo (50 mg Rx Prog)
cd 25 -- 98.1 / 11dpo

Sigh. Someday we'll figure this out. I wish I knew how to get my body and pregnancies to work together in a friendly long-term fashion.

AF is due on Sunday. It will be good to be done with this cycle so I can work more on building my blood stores.

Less is less.

So I don't think there's going to be any good news from me this time and here's why. I used some fertility monitor tests over the weekend (starting Friday I think) and the first one I did was darker for LH than the next two and the one I did this AM showed no LH at all. I also woke up early this morning so my temp isn't good but I still think that if there was something going on this cycle that it ended already.

I know, it sounds depressing and I'll wait it out until the end but I really now don't think anything more will happen for me this cycle.

Maybe it was an early chemical pregnancy.

Obsessing, Of Course

Who wouldn't obsess with a dip to the coverline (97.8) on my basal chart yesterday followed by a spike (98.6) this morning at 4am (I woke up early due to an uninspired dream that annoyed me). I'm on 8DPO now and I started using my prescription progesterone on Friday evening, after using natural progesterone cream at least once a week since Monday. My experiment on myself this cycle is to see if I can help influence for the better the development of a pregnancy by supplementing sooner since last time with supplementation in my luteal phase the pregnancy developed further along.

I did go down the street this morning to pick up an early pregnancy test* and knowing full well that last cycle when I got pregnant that the day of my temp spike that I tested negative but it was worth a shot. So I tested and it came back negative. Still, that means nothing yet. I'm hoping that my cycle charting program will give me a triphasic message in a couple days and that testing again in a couple of days will give me a positive pregnancy test.

I feel determined to get pregnant this cycle. Our fertility has certainly improved and I'm relatively healthy really. Also, since this is our first cycle trying since the last pregnancy I'm hoping to draft that cycle's hormonal adjustments which should likely have improved my hormonal balance some.

If this cycle doesn't work then I'm tempted to try a few months of progesterone shut-down of my ovaries to help counterbalance my estrogen levels. But I'm hoping it won't be necessary.

Send sticky thoughts.

* When I went to buy the pregnancy test I was one of the first people in the drugstore this morning. I had thought I would pick up a few things but we don't really need anything right now. I thought I might buy a pair of rubber gloves for cleaning but they didn't have any. Instead I decided to buy an electric fan on sale. So I went up to the register with a pregnancy test box and a fan. Trying to make the pregnancy test seem like something that I'm all nonchalant about. But I'm not, so very not as it's been such a journey and these tests represent so much hope and can give so much pain and pleasure. I think that probably there is a story behind every test that is sold and each one is attached to hopes and dreams for better or worse.

Progesterone Levels in Early Pregnancy

In the event that the serum progesterone level is 5-25 ng/mL, further testing using US, additional hormonal assays, or serial examinations is warranted to establish the viability of the pregnancy.
from: Pregnancy Diagnosis

Among women who present with a history of infertility, approximately 3-5% of those with infertility have a true luteal phase defect, with repeated cycles lacking adequate luteal support. The incidence of luteinizing hormone deficiency is higher (10-15%) in subsets of patients who are infertile and have had [repeated miscarriages].
From: Luteinizing Hormone Deficiency

...a quantitative serum progesterone level of more than 25 ng per mL (80 nmol per L) proved 99 percent accurate in predicting a living intrauterine pregnancy. Sixty percent of the patients with progesterone values below 25 ng per mL had abnormal pregnancies.
from: Advances in the diagnosis of first-trimester pregnancy problems

Fourteen infertile women and two women with recurrent abortions were suspected of having luteal phase defect (LPD) by BBT charts. In these patients, the midluteal phase serum progesterone (P) levels were determined together with histological examination by the late luteal endometrial biopsies during the same cycle. The diagnostic criteria for LPD was BBT of luteal phase < or = eleven days, mean P level of 3 blood samples taken on three days during midluteal phase was less than 48 nmol/L (15 ng/ml) and the histological dating of endometrium was two or more days behind. The results showed that histological abnormality and low P level were 6.3% and 31.3%, respectively. When histological abnormality combined with lowered P level at the same cycle, the diagnosis of LPD increased to 87.5%. The author suggests that both midluteal phase P level and late luteal endometrial histological examination should be assessed at the same cycle in the diagnosis of LPD. BBT should also be assessed.
from: Diagnosis of basal body temperature, serum progesterone and endometrial biopsy for luteal phase defect

More about Progesterone Testing and the Value of Pooled Progesterone Testing for Luteal Phase Defect

"Single or multiple pooled serum progesterone values have been used between 21-24 days into the menstrual cycle. A progesterone level greater than 10 ng/mL may represent adequate progesterone support from the corpus luteum. Most authors now agree that a single mid luteal phase progesterone level is not sufficient to evaluate the adequacy of the luteal phase."
From: Lutenizing Hormone Deficiency

"Among women who present with a history of infertility, approximately 3-5% of those with infertility have a true luteal phase defect, with repeated cycles lacking adequate luteal support. The incidence of luteinizing hormone deficiency is higher (10-15%) in subsets of patients who are infertile and have had [repeated miscarriages]."
From: Lutenizing Hormone Deficiency

"As with many hormones, progesterone levels fluctuate hour to hour and day to day, so that a single level is not always an accurate reflection of ovarian function. Also, it is important that progesterone levels are sufficiently elevated for an adequate number of days after ovulation. For these reasons, it is ideal to check more than one blood progesterone level during the time in your cycle when progesterone levels are the highest, approximately 5 to 9 days after the LH surge. In the pooled progesterone test, blood is drawn on three days between the 5th and 9th days of the luteal phase. Blood samples will be "pooled" together, and a single progesterone level will be determined, representing an average of your progesterone levels."
From Pooled Progesterone Test (PDF)

"The results suggest that the most sensitive and specific prediction of low integrated progesterone (and therefore of LPD) was a value of <30 ng/mL for the sum of three (midluteal) serum progesterone measurements (100% sensitivity, 80% specificity).

Even a single (midluteal) progesterone result of <10 ng/mL was highly predictive of LPD (84% sensitivity, 82% specificity). However, a diagnosis based on a single progesterone determination continues to be controversial. Progesterone is secreted in a pulsatile manner, and serial samples obtained over a 24-hour period can range from 2.3 to 40 ng/mL.3 Such fluctuations raise questions about the reliability of a single progesterone determination for the differential diagnosis of LPD. The pulsatile secretion of progesterone argues for either assaying multiple specimens separately or pooling multiple specimens for processing in a single assay."
From: Progesterone: Physiology and Clinical Utility (PDF)

With a pooled progesterone test you should do it fasting, on any three days during your mid-luteal phase -- 5-9 dpo.

I've also read that luteal phase dysfunction is best tested in tandem with an endometrial biopsy and basal charting.