21 day progesterone test question - help!

[Chocolatemolehill]

Hi ladies,

I was referred today for a few blood tests, including the one for progesteron. The GP told me to get it done on the CD 21. But I'm wondering whether this is right... Doesn't the day depend on the cycle length? (Mine is 31days, not 28). Shouldn't the date of the test be counted backwards, from the day my period is due? I read somewhere that it needs to be 7 days before the period is due... Is this right? Any ideas?

Ideally it should be 7 days after you ovulate. That would be day 21 if you are "textbook" and ovulate on day 14.

If your cycle is a bit longer than the textbook 28 days, chances are you ovulate later too, so you could go in a few days later. If you do know exactly when you ovulate, then go in 7 days after that.

Hope that helps

My doctor said she'd try it on day 21 this month but if there wasn't a result then we'd try a bit later next month. We did look at my cycle lengths though and worked it out.

Hi
I've had this done in November and as my cycle is incredibly long (51 days at last count!) my doctor said to test at my '21st day' which worked out at day 44! As she said that obviation should be 7 days before af was due. As she's been my dr since birth and knows I'm not the most patient patient(!) so i would push to be referred asap when I knew her limits

Just keep on at your doctor and double check if your not sure.

Hth x

I think you are right - I seem to remember that my gp recommended I aim for 23rd day due to my cycle length (got BFP the same month, so fingers crossed for you :))

hi, i've had mine done on day 23 and my cycle averages to be 31 days.

hi, i've had mine done on day 23 and my cycle averages to be 31 days.

Chocolate Yep you are right. The test should be carried out 7 days before your period is due. Have just checked with DH - he's a GP.

MummyAbroad is correct that in a perfect scenario the test is most accurate 7 days after you ovulate, but as she says not everybody knows when this is.

Most women ov 12 - 16 days before their period, with 14 days being average. Therefore, 7 days before your period should be 7 days after you ovulate or thereabout.

As you have a 31 day cycle, book in for day 24, or as close as you can get.

I had a 28 day cycle on the month I was tested so I booked in for day 21, however I know that I actually ovulated on day 16 (I get Mittelschmerz and this was also the day after I got an LH surge on an OPK). I was tested on day 21, which was actually only 5 dpo. My result was fine at 39.1. It may have been higher if I'd been tested on day 23, but it didn't actually matter that I was technically 2 days out.

HTH.

Thank you all ladies - it's really helpful and I really appreciate you taking time to reply!!

So, as I'm using OPKs - should I then have the test done 8 days after I get a positive result, assuming I'd ovulate the day after? Or should I just go for CD24?

What cycle day do you normally peak on, assuming your cycle is usually regular?

"Most women ov 12 - 16 days before their period, with 14 days being average"

Unfortunately the above assertion made is not correct. Ovulation is not an exact science and women can ovulate earlier, later or not at all in any given cycle.

Only around 12% of all women have a 28 day cycle; the "normal" range for cycles is between 21 and 35 days or with less than 4 days of variation from month to month.

As I had no real cycle to speak of I had my day 2 and day 21 tests done according to calendar days. The day 21 is a standard test done, if it is done a couple of days "later" than day 21 it should not make any overall difference to the final result (they like to see a value of 30 or above re this test). I would aim to have this test choc done around day 23/24 (particularly if the day 21 falls over a weekend).

Do not just rely on the day 21. You should have day 2 tests to check and compare both your LH and FSH levels as well. If your progesterone is out of sync then chances are the LH and FSH are out of sync too.

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.

Wow, I have just learned loads, thanks knackeredcow

My pleasure

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.

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).

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 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!!

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

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....

Thanks so much to all of you (Knackered and Attilla - you are brilliant and so helpful) - I've learned a lot! Sorry for a late reply but I didn't get a chance to come here over the last two days.

My 22 CD falls on Friday and 25 CD on Monday so I'll probably book the 22nd but may delay if the OPKs show late ovulation - what do you think?

II looked again at my notes on my cycles and realised that they are less regular that I thought. There were three of 30-32 days, followed by 28 and 37 day cycles. I ovulated on cd19, CD16 and CD25 (judging by OPKs) so a bit all over the place really...

Another test issue (I really hope you haven't had enough of me yet!) - I just had my FSH/LH test done and am also wondering whether it was performed on the right day... You talk here about day 2 (and I read somewhere else that it is day 3) but I actually had it done day 5 (my GP told me day 3-8). Do you think it's ok?

Both FSH and LH were ok but LH was higher than FSH (11.6 and 6.4 respectively) whereas I read they should be approximately similar. Do you know how it works? Should I be worried here or does it look ok?

Thanks so much again for all your info and help!

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.

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.

I really hope that it's not PCOS! (but, as you both suggested Attilla and Mummy, the results are pointing that way...) My periods are not super regular but not too bad either: not counting the last one which was v long (37 days) they are usually 28-32 days.
And I don't have any other symptoms - weight problems, excessive hair growth, painful periods etc.
Luckily I already have a referral for a scan.
Doing another teston day 2 is probably a good idea though...

Making babies it's a lot of hassle and sometimes it seems like we need a degree in nedical science, don't you think? :)

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

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.