21 day progesterone test question - help!

Can someone please help?

I have been taking clomid since March with no luck, I get my progesterone level checked on day 21 of my cycle each month to see if I ovulated. The past 2 months it has been a level of 45, however this month is 85! It's the highest it's ever been.

Is this a good result? Could it possibly be a sign of pregnancy? Any information would help please!!

Thanks

All of the different fertility doctors that I have been too, all agree that 7 days post ovulation (dpo) is the ideal day to get tested for your progesterone levels, if you know when you are ovulating. However 6, 7, 8 and 9 dpo are all considered ok for the test too, in the doctors opinion. The difficulty is in knowing when (if) you have ovulated, without scans to confirm it.

OPK's and charting have limited use in some women, but are a starting point for some. I find OPK's useless, but charting works for me, and allows me to go for blood testing at the right time following ovulation. However charting can be confusing for women who are annovulatory (like attila).

With such irratic cycles, it will be difficult to pinpoint when to test, to know for certain that you will get an accurate result. You can try opk's and charting but don't rely on them necessarily to be accurate, but if you are ovulating regularly they might just help.

oh, okay, responding to a very old query.... watercolor - i think you should chart your temperature fro a couple of months to see if you are ovulating (fertilityfriend.com is one site which you can use to do this, there may be others) since your cycle sounds like it's too erratic to tell when to do day 21 bloods just from cycle length. good luck.

mumofone - i have an eleven day luteal phase, as i recall i did a day 21 test on day 18 of a (normally) 26 day cycle. even if your cycle is a bit variable, if you know your lp you can work out when to do the test from when you ovulate. my progesterone levels were fine, they just fall faster than other people's, obviously. an eleven day lp is okay, it's only when it's below ten that it's considered defective (though most gps do swear that all women throughout history have 14 day lps....)

Just starting out here so apologies in advance for not having gotten my head around the abbreviations and for jumping onto this post. I've been reading all the advice given to women with irregular cycles who are TTC with great interest. We have been trying for a while, but I see now that there is a lot of information out here that I wasn't aware of (so thank all you mumsnetters for that!).

My GP advised a series of tests, including FSH/LH, Oestrogen and 21 Day Progesterone, a couple of months ago - but because of the irregularity (longest cycle 46 days, shortest 30 days, all totally erratic) I have been totally confused and still haven't gone. One rule seems to be that I get my period when I least expect it (this month it was exactly on the same day as last month, which has never happened before and was obviously weeks before I thought it was coming). Don't know if it's relevant but they don't last very long either, around day 2 I'm almost done.I picked up an OPK, but have since learned (on mumsnet) that these are pretty much useless for irregular cycles :(

Is there any law of averages sort of calculation for when I should just get these tests done? I'm keen to get this process started as I'm approaching my mid-30s and it's making me a wee bit nervous. Please advise.

Hello All,

I have been reading your questions and comments and I thought you all sounded very knowledgeable. I was wondering if you could give me any advice.

My situation - I have a 21 month old. Since having her my cycles have ranged from 22 to 29 days. Before having her they were every 27 days like clockwork. We managed to get pregnant on the first month of trying last time.

I 'sort of' got pregnant in January this year. Had faint +ve's for a week and then a heavy bleed. We've been trying ever since and no luck.

I have been charting my BBT and I do see a spike each month - so I think I am ovulating. I am a sonographer so I have been doing a bit of research myself and I am definitely producing a dominant follicle that ruptures. My ovaries do not look polycystic (although I haven't had any bloods done to look at this).

My luteal phase is showing as 11 days (according to Fertility Friend) and I am concerned that it is too short.

I have spoken to my GP and he has referred me for a day 21 progesterone test and prolactin. I understand that this whole 'day 21' thing is very confusing. I have no idea from one month to the next how long my cycle is going to be. It was 23 days last month, 28 the month before and 24 the month before that. Am I right in saying that the test is supposed to be 7 days before my period?

I'd greatly appreciate any thought that you might have...

Quite unbelievable some of the advice we are given Spirita by our GPs - no wonder yours showed no ovulation on day 21 if you only just ovulated! I ended up going at 7dpo...against my GP's directions as she told me to go at 3dpo...although i told her that.
My levels at 7dpo were 30. So ovulated but have been told they should be above 40. gOOD Luck.

My GP and acupuncturist both said 7dpo is what is really meant by "Day 21" so if you know when you ovulate, that is when you should go. This has been confirmed by my own research around the interwebby. If you don't know when you ovulate but have regular periods of whatever length, 7 days before your period would be the best guess (as if you have the supposed "average" 14 day luteal phase, this would be the same as 7dpo. If you don't have a cycle at all or a very iregular one, I think they just use Day 21 as a starting point and go from there.

The aim of the test is to catch your progesterone peak and it usually peaks around 7dpo.

Sorry to drag this thread up again. i've asked this on a separate thread but I'm now getting really confused as KnackeredCow's GP husband says progesterone test should be done 7 days before next period but then it says ideally 7 days after ovulation. I ovulated yesterday. I know that from today my period will come in the next 10/11 days without fail (obviously not textbook 14 day LP). So should I get tested in 7 days (7DPO)....or 3 days (7 days before next AF?)?

Hi,

PCOS is a very individualistic disorder and affects each woman with it very differently so what may be a problem for one does not affect another. BTW when I was diagnosed with PCOS it was done on the basis of my irregular periods and bloodwork showing a consistent LH/FSH imbalance.

Painful periods are not normally associated with PCOS. That problem usually has other causes.

The commonality is the cystic follicles on the ovaries.

Who needs a degree in medical science when we have MN?

I hope that you dont have PCOS either, but even if you do it is possible to have it "mildly" (and if your periods are fairly regular you would more than likely fall in that camp) Also many many women with PCOS have trouble free pregnancies, so its not all gloom and doom.

Good luck with your scan and further blood tests. xxx

Chocolatemolehill,

Day 5 for LH/FSH is right on the cusp; it should really be done a bit earlier. Day 2 is the standard for that one.

LH and FSH are two very important hormones as they kickstart the ovulation process. They can look okay if only looked at separately; it is only when they are compared that imbalances can be seen.

LH and FSH should ideally be about the same. As MummyAbroad has already suggested I would have this rechecked on or around day 2 and if a similar result arises I would be looking to have an internal ultrasound scan done to see whether the ovaries are polycystic. The cystic follicles however, associated with PCOS are very small and it can take a skilled sonographer to spot them. A clue as well re PCOS is that a polycystic ovary can be larger than normal size. A normal sized ovary is about the size of a walnut. Some GPs do not know that much about this type of problem at all so GP should be looking at referral now.

Would be wary of using the OPKs as these can give false readings if PCOS is there. Multiple false positive results are commonplace if PCOS is indeed present.

Hi chocolatemolehill I think day 5 is OK, as long as you are pre ovulatory and not therfore picking up the LH surge, you are in the right part of the cycle.

Your LH is high (suggesting PCOS) it says here

"LH/FSH ratio. This ratio is normally about 1:1 in premenopausal women, but with PCOS a ratio of greater than 2:1 or 3:1 may be considered diagnostic"

I believe all doctors use different criteria, but mostly they will be looking for correlating bits of evidence, e.g. high LH, plus cysts seen on ovaries on a scan, plus irregular periods etc. before they will give a definite diagnosis. They may also want to see if this high LH occurs again or is a one off, so they might ask you to repeat the test.

I'm sure KnackeredCow and Atilla will be able to add a lot more info for you soon.

Atilla Yes, you're right. I do agree that OPKs and temping are likely to be a complete waste of time (and money) in your situation.

I do agree that some women who usually ovulate miss the odd month.

I agree that some women with PCOS can and do ovulate. Although, I would not be surprised if it was found that when they finally ovulate, their period follows 12 - 16 days later as bleeding is usually triggered by the fall in progesterone levels. However, I don't think it's worth us arguing over it. As you said this forum is here for support.

I still disagree with some of your other assertions based on my reading and personal background (I did some final year modules in Endocrinology at University), but I think it's best we agree to disagree.

Sites like this are good for exchange of information and support, definitely. The world of subfertility can be an extremely lonely and frustrating one to inhabit....

Hi KC

I would agree that if a woman has consistently regular cycles she is more likely to be ovulating regularly than otherwise. Even so some normally fertile women have the occasional anovulatory cycle so the "ovulation 12-16 days before period" assertion does not stack up. It does not also follow that women with irregular cycles ovulate later and women certainly can have more than one LH surge every month (that is also why there are problems with OPKs as well in terms of multiple positive results).

Some women with PCOS do ovulate occasionally but many women with such problems do not (I have PCOS and never ovulated, well not without assistance anyway. Still don't now!.

I guess you would agree that in my case using OPKs or temp charting (and I did consider it prior to embarking on the subfertility rollercoaster) would have been a waste of time.

Prof Winston wrote a book several years ago called "Infertility" and the quote is from that publication.

More importantly however, I do hope that they can find a way forward with regards to your fertility problems. All this was hard going on occasion and such sites like this one were not available to me at the time, at least they are now for which I am glad.

Good luck to you.

A

I find the best way to tell when ovulation occurs is temping using a basal body temp thermometer. I had (before pregnancy, god only know what my cycle will be like now, or when I will get AF back!) a 28 day cycle, but a short luteal phase so I would typically ovulate on day 19/20. If you aren't temping already, I'd highly reconmend it!!

Attila Precisely. You were anovulatory.

Page 26 of the actual NICE guidelines linked in my post above (look at the page number in the actual document), not page 26 of the pdf file that would display if you put 26 into Adobe's "go to page" facility.

Section 3.1 Paragraph 2 full guidelines gives information on ovulation.

In my previous post I said: "I do not say that the majority of women have a 28 day cycle." I haven't actually contradicted you.

I have maintained that most ovulatory women ovulate 12 - 16 days before menstruation. I have not said that all women, or even most, ovulate 14 days before their period. I have also not said that every woman who has periods is ovulatory.

In fact NICE states on page 42 that "Regular menstrual cycles in the range 26 to 36 days are usually indicative of ovulation". If you turn this on its head it would suggest that irregular cycles are indicative of irregular or lack of ovulation.

To do the progesterone test, however, a doctor has to start somewhere and therefore the test is based on averages.

As far as I am aware there is usually only one LH surge every month. OPKs can fail in women who have polycystic ovaries because in these ladies, who may be anovulatory, there is a consistently high level of LH.

I have the utmost respect for Robert Winston, and in fact I chose the NHS Fertility Consultant that I am under for the exact reason that he trained under Professor Winston.

I am currently reading Robert Winston's "A Child Against All Odds"(Paperback version published 2007)

If it interests you, this is what Professor Winston says in the book mentioned above:

"I am very dubious about the snazzily packaged home testing kits that ostensibly predict a rise of luteinizing hormone (LH) in the urine, indicating that 'ovulation is taking place normally'. The manufacturers claim to help women time intercourse to give the best possible chance of conceiving. In fact, timing intercourse is generally a bad idea, adding stress to an already difficult situation. Frequent, unhurried is far more likley to help and far more likely to sustain relationships that may be under strain. Moreover, a rise in LH does not show if there are problems with the rest of the cycle. Women with PCO, for example, tend to have high levels of LH all the time." P. 55

His arguments against them are because they can impact negatively on a couple's relationship and mask undiagnosed problems.

He does not say that they do not work in women with a regular, ovulatory cycle in which other potential problems with the cycle have been excluded.

I choose to use them because the control over my cycle provides me with some comfort. I started to use them after 1 year of regular SWI had proven fruitless. I have a regular cycle and all my blood tests were normal. The FC suspects tubal infertility in my case and was happy for me to continue to use them.

I can't comment on the sentence you quoted without knowing where it was from. I would argue that it doesn't contradict NICE's assertion because theirs is based on ovulatory women in which there is a regular cycle. Again, there will always be exceptions to what is usual.

What I would say to the OP is that as she has a regular cycle, so it is highly probably that she regularly ovulates in the majority of her cycles.

I have very irregular cycles and I can say that I never ovulated at all throughout that time despite having periods around every 6 weeks (blood tests done throughout showed no ovulation and a consistent LH/FSH imbalance).

Professor Winston came out with that sentence I quoted re ovulation and he of all people should know what he is talking about!.
I sincerely wish that women did ovulate about 14 days before the start of the next period but the fact is they do not and ovulation does not work like that. The 28 day cycle is very much a poor guide for many women.

I am probably not looking at the right page but I could see nothing about ovulation in the NICE guidelines.

There is also more than one LH surge every month - that's why these OPKs can fall down so badly.

Cycles that are consistently over 35 days in length are more likely than not to be anovulatory.

My pleasure

Wow, I have just learned loads, thanks knackeredcow

Attila I do actually disagree with you on that one.

I pulled that statement "Ovulation usually takes place 12?16 days before the start of the next period." from NICE guidelines See page 26 based on a review of clinical evidence. You'll also note that I say most not all, and I do not say that the majority of women have a 28 day cycle.

And

"Regular menstrual cycles in the range 26 to 36 days are usually indicative of ovulation.... Ovulation involves leutinisation of the mature follicle and release of the oocyte. Both are triggered by the LH surge. In practice, testing for release of the oocyte by observing follicle rupture is impractical so ovulation detection is based on the detection of circulating progesterone produced following leutinisation of the follicle. Urinary LH kits used by couples can suggest when ovulation is imminent. Ovulation can be confirmed retrospectively by measurement of serum progesterone in midluteal phase, approximately on day 21 of a 28-day cycle. For women with irregular cycles, this test may need to be performed later in the cycle (e.g. day 28 of a 35-day cycle) and repeated weekly until the next menstrual cycle starts, unless the bleeds are so infrequent that ovulation induction therapy will be needed in any case. Values range from 16 to 28 nmol/l as the lowest limit indicative of ovulation [Evidence level 2b]" NICE page 42

What I am saying is that if you ovulate 12 - 16 days before your period, then somebody with an irregular cycle ovulates a lot later. A woman who has a 42 day cycle, will on average ovulate on day 28 and therefore the test would need to be carried out on day 35.

If you read my post I do not suggest that chocolate is tested on day 21. All doctors refer to the progesterone test as the "day 21 test" but you'll see that I make it quite clear that it should be done 7 days after ovulation (as mummyabroad states) if ovulation date is known OR 7 days before *chocolate's period. I suggest that she is tested on day 24, as do you.

The accuracy of the timing of the "day 21" test is not known until a woman's period actually starts when the doctor can assess whether the test was performed at the right time or not.