Day 21 Progesterone level (PCOS)

[Elakiya]

Hi,

I’ve been trying to conceive for a while now. I suffer from PCOS. I have regular 29 day cycle (it was previously 38 but I was put on metformin and that has massively reduced my cycle length. I’ve also managed to lose quite a bit of weight 10kg.

I’ve been seeing a private gynaecologist. He did day 2 bloods and day 21 bloods. My day 2 bloods came back normal and my day 21 came back as 22.2. I was told that it indicates I have not ovulated as it’s under 30. I’m getting mixed signs from reading around as it says I have ovulated just that it could be under 5 days since I ovulated or that my endometrial layer is not thick enough to receive a fertilised egg (something to that extent lol).

I do use OPK’s I had a strong peak from CD16-CD18. Basically no idea whether I am within the under 5 days category.

My gynae told me that I can go about this naturally as he thinks a bit more weight loss should do the trick (nightmare during the pandemic with gyms closed but maybe I should stop making excuses for myself). He also gave me the option to take clomid and gave me a prescription for it.

I’ve decided to go down the weight loss route however I am curious to know what other people’s progesterone levels were. Sorry for the long post, I like to give background lol 😂

Bump 😞

Day 21 progesterone tests should be done 7 days after ovulation - which may or may not be on day 21.

OPKs don't guarantee ovulation, but I would have expected your day 21 test to be done on CD24-26. So I reckon you are in the

@Curiosity101 Thanks. I am hoping you’re right and I did ovulate. Although it’s been over 6 months since my cycles were this regular and still not even a faint line on pg tests.

Ah well. I shall keep going on my weight loss journey and see if I can eventually get there

Hi!

I have been getting progesterone tests done. One came back at 20 and they said this was equivocal (they’re unsure if I ovulated) then I re-did it the next month and their cane back as 31, so I probably did. I also am losing weight. Tough journey!!

From my understanding p should be done 7 days before AF/CD1. This can be tricky if you are irregular but if you always have a cycle of 29 days, you should get a retest on CD22. Could you ask for this, might put your mind at rest?

@Izzie321 It's a common misconception that the 21-day progesterone should be done 7 days before AF (it is written down incorrectly on several websites). This is due to the example of the 'perfect' 28-day cycle. On the perfect 28 day cycle, it's assumed ovulation is on CD14.

The 21-day progesterone test is meant to be done 7 days after ovulation, which in the 'perfect' cycle is also 7 days before AF hence the misconception. To confirm ovulation it should always be done 7 days after ovulation, not 7 days before AF/CD1 as in those cases progesterone may not have risen enough to give the correct answer.

Sorry, just to add. The other reason 7 days before your period is quoted is that most people don't know when they ovulate. So for the average person, 7 days before their expected period is as good a bet as any. But it doesn't account for those with shorter luteal phases (12 days or less).

Okay, great! I thought it was a common misconception that it was 7 days after ovulation 🤣🤣

It's a weird one. I guess technically by definition the vast majority of people going for a 21-day progesterone test definitely don't know if they're ovulating or not (hence the test). So the doctors have to pick a date for most people, and 7 days before the expected period is the best guess they can go with. It does rely on a 14-day luteal phase to be accurate though. And a 14-day luteal phase doesn't seem to be the case for most people based on what I've seen on these boards.

They are technically trying to measure the progesterone level 7 days after ovulation though. So if you are doing OPKs and/or BBT and can pinpoint an ovulation date then really the 21-day test should be 7 days after that date.

@Curiosity101 do you know how much progesterone roughly increases by per day? As my LP could potentially be very short, if we go by the last peak on the OPK’s does that suggest my progesterone never hits the 30 mark and that’s why it’s short?

@Izzie321 I wish they’d checked more days like say 21 and 25 or something like that. But then I read somewhere that your progesterone has to drop so you can get your period? or something like that so maybe day 25 would then be too late to test.

@Elakiya I'm not sure I'm afraid 😔

My guess based on what you've said is that you are ovulating but have a short luteal phase (which may or may not be an issue for your fertility).

I have/had a short luteal phase until I was diagnosed with Hashimotos and started Levothyroxine. Last cycle my luteal phase changed from 11 days to 13/14. This is the main reason I mentioned that your 21 day test might have been mis timed. If you have a short luteal phase then you can be incorrectly identified as not ovulating where in reality it's a short luteal phase that's causing an issue. Also if you did have an underlying thyroid condition then it can often be mistaken for PCOS depending on how PCOS was diagnosed. Was it confirmed via ultrasound?

Has your GP suggested retesting next cycle? If I were you I'd probably have a chat with them and request a retest, but ask if they'd be willing to book it 7 days after a positive OPK. Hopefully that'll give you a more accurate answer about ovulation and if you are ovulating then you can start looking into other avenues.

Good luck!