Very low day 21 progesterone levels. Could it be that I just ovulated late?

[GiraffeAHolic]

I'm on my first Clomid cycle (took 50mg days 2-6)

I had my day 21 (but was actually day 22) blood test on Monday and just got the results.

My progesterone level was 1.8 :(

I know that's really, really low but is it possible that I'm not out this month but that I simply didn't ovulate at the average time?

Surely a day 21 test relies on you ovulating around day 14?

I've been doing OPKs and never got a positive but I got two days of almost positives - the darkest I've ever had - last Friday and Saturday, so cd19/20.

I had no EWCM then that I noticed (although seem to have loads today - sorry TMI) but if by some fluke I did ovulate then, surely that wouldn't have shown up on the test. Would it?

Can someone tell me if this is right or did anyone have a day 21 test that showed a low level and still go on to conceive?

I'm driving myself crazy here and I can't see my dr until 5/10 and the dr I spoke to today really didn't seem to know what she was talking about

Perhaps you didn't ovulate on CD19 /20? perhaps your cycle was just "ramping up"... if you are getting lots of EWCM today then maybe you are going to ov. soon.

Are you still doing the OPKs or did you stop after you got the near positive?

Sorry to hear you are getting so wound up, it is very confusing. Have to admit, I know next to nothing about Clomid so don't know how that may have affected things

Giraffe

A progesterone level of 1.8 to me indicates also that your LH and FSH levels are awry and I cannot see that level rising much if at all for the rest of the cycle. LH and FSH are important as these kickstart the ovulation process; if these two hormone levels are awry then ovulation will be affected. Did you ever have your LH and FSH levels compared via a day 2 test?. If not this should have been done before now.

Please do not use OPKs when using clomid; the kit will read the increased LH the clomid is producing (hence the multiple positive results). Clomid's primary function is to make the ovaries work harder.

If the doc that you refer to is the GP then this person should refer you to a gynae at a subfertility unit. Clomid is quite powerful stuff and this problem is actually outside the GPs remit. You would be better off under the care of a gynae in any event.

BTW do you have a diagnosis?. If not, it was poor practice to give you clomid without a diangosis beforehand?. Not everyone who presents with ovulation problems (this is often why clomid is prescribed) can be given clomid.

You will need to be persistant in order to get answers. In your case I would insist on a referral to a specialist and do not take no for an answer.

I think it's definitely possible.

I also took Clomid this month but didn't use OPKs or have blood tests and I found I didn't get any of my usual signs of OV but I have a feeling that mine also happened around day 18/19.

Girfaffe were you being monitored at all by ultrasound? That should tell you whether you were likely to ov around CD 14 or not as you are right, if you didn't ov until later, the CD21 test would be off.

I am on my second round of clomid and was told last month that I wasn't going to ov as there were no signs of a decent follicle at CD14 but then I did go on to ov at CD21 - which obviously wouldn't have been picked up if I'd had bloods taken then.

I agree with Attila that OPKs aren't helpful if you're on clomid as all hormones skyrocket; and other indications (like EWCM) can also be off because of that. That's why it's really important that you are monitored properly by other means.

I also echo her recommendations that you push to see a specialist who should be a bit more clued up about it all.

Good luck with it all!

Attila - question or two for you - you said "A progesterone level of 1.8 to me indicates also that your LH and FSH levels are awry and I cannot see that level rising much if at all for the rest of the cycle.", can you tell me how the progesterone result directly indicates that the LH and FSH levels are "awry", and secondly why is it not equally possible that delayed ovulation could have occurred and that it would not be possible for the progesterone levels to rise at a later stage? I am baffled by your statement.

To add to the mix of questions for Attila :) - - My LH and FSH readings at Day 2 were normal. They took LH and Estriodol readings on Day 12 (when I had a follicle that wasn't growing as fast as they expected) and those were normal too -- and yet I don't ovulate as per day 18 / day 22 progeterone tests of 0.4...

My doc / consultant hasn't been able to clarify what the case is - as in why I am not ovulating.

hi and thanks for all your replies.

to answer some questions:

Yes I have a diagnosis of PCOS, proved by internal scan.

I normally have cycles ranging up to 180 days so I have no benchmark for normal cycles.

My GP hasn't referred me on my request, I was previously under the hospital and had my tests there but had a bad time and cannot cope with the stress of going back there.

I didn't have day 2 bloods as I took Norethiserone to starts a cycle and started the Clomid on day 2 so presumably the results wouldn't have been accurate anyway.

Hi Giraffe,

Unfortunately I was not surprised to read you have PCOS. It is a very common and individualistic disorder; it affects each women with it very differently. The commonality though is the cystic follicles on the ovaries.

I am very sorry to read of your previous experience. Would you ever consider being referred to another hospital?. It is certainly fair to say that some NHS units are far better than others. I write that as well as PCOS is not a condition that should be messed around with by GPs as they simply do not have enough knowledge.

PCOS will muck up cycles something chronic (I have PCOS myself) and normally in such cases there is an excess of LH compared to FSH. It will have a knock on effect on the levels of progesterone; my levels were not much higher than 1.8 even later in the cycle.

LH and FSH should be the same or about the same on Day 2. If LH and FSH levels are not compared against each other the test is meaningless as they should be compared; it is only then that an abnormality is seen.

Follicles need to grow to around 20mm; if they are smaller than this then ovulation is again affected.

As mentioned before LH and FSH are two hormones that kickstart the whole ovulation process. If these hormone levels are awry for whatever reason (and usually with PCO there is an excess of LH to that of FSH) then ovulation will be affected. Progesterone is therefore only part of the story here. Ovulation is not only about progesterone.

I would ask you womanlytales whether you have had internal ultrasound scans to see if there are signs of polycystic ovaries.

Yes Attila, I have had a scan to confirm that one of my ovaries was polycystic and the other had a follicle in it so they cdn't tell -- though the cons said mostly it is a case of both being polycystic - this was before the ovarian drilling.
Post the drilling I am not sure..my most recent scan on day 2 said my left ovary was normal and my right had a follicle / cyst it it.