Can somebody explain the day 21 test and progesterone to me desperate

[lostittoday]

Hi
I have recently had a day 21 test done and my doctor told me my progesterone was very low I think she said it was 0.7.

Does this suggest I didn,t ovulate.
I have been experiencing irregular periods all the time I have been ttc with cycles ranging from 23 up to 62 days.
I did ask my doctor what it could mean but she said I need my other blood hormone tests doing first, fsh, Lh, etc before we can get the full picture.
I have been told that this other test needs to be done on day 3 however I am now on cd 32 with no af as yet, so I don,t know when I can expect my period and therefore don,t know when I will be having this other test.
Now I am not that knowledgable on all of this but from looking it up on the internet progesterone is the hormone that shows if you ovulated or not, and if you have ovulated it will be raised.
Does this mean I didn,t ovulate then with it being so low.
Is it possible that I could have ovulated very early on in my cycle and for my progesterone level to have reverted back to normal by the time this test was done.
Can the fact that my cycles are irregular affect the result.
Please help I am going out of my head.
I am under the care of a fertility clinic but I am not due back until the 27th of June where this can be explained to me properly.
I am really worried I have been quite tearful at times fearing that I am doomed to not have any more children.

Anybody please

I was told you need a prog level of 30 to ovulate. After I came off the depo I had a couple of tests of around 25 and I wasn't ovulating. 0.7 sounds incredibly low. If it really was that then you wont have ovulated. Do you have any other signs of ovulation - pain, change in cervical mucus etc?

I'm really sorry, I know how hard it is having all these tests.

The fact that your cycles are irregular will definitely have affected the results. Have you used ovulation sticks?

If you are that irregular it probably means that you hadn't ovulated by day 21 - however, that doesn't mean you don't ovulate as you tend to ovulate 14 days (ish) before period so if you have a 62 day cycle you would have ovulated around day 48.

There are drugs which can make you ovulate, or ovulate more regularly. I think often if you don't ovulate until later than the norm the eggs aren't as good so the drugs make you have a more normal cycle.

The other blood tests are to check your quality/quantity of your eggs - they would give a doctor more of an idea of why your cycle is irregular.

Have you been offered an ultrasound ? This can detect polycistic ovaries which is often a cause of irregular, long cycle I believe.

Yes I have had a ultrasound , no sign of polycistic ovaries.
I am so worried and sad about it all.
I really don,t feel I can wait until the 27th of june.
I want to speak to them now about it.
I am 37 years of age and I am worried about early menopause.
My mom and sisters went through it about my age.
I am worried about diminshed ovarian reserve that sort of thing.

Hello, I am NOT a Dr but have been through similar blood tests so know a little about the hormone results. If your progesterone level is low on day 21 (and I think the lowest it should be on day 21 or thereabouts is 30) then it does mean that your body didn't ovulate properly. Progesterone is produced by the empty sac left by the ovulated ovum so it wasn't released properly. 0.7 is very low so it would seem you didn't ovulate at all as opposed to you ovulated early. The other test done on day 3 will measure your FSH and oestrogen levels just to check that a) you are producing eggs and b) you are producing enough oestrogen to make them grow to the correct size to force ovulation. The LH test will be done when your eggs are the correct size to be ovulated (between 18 and 25mm)- LH makes the body ovulate so normally should be tested om about day 13 to 15 of a regular 28 day cycle.

Please do not worry about these tests, easy to say I know, but if you have hormonal imbalances then these can sometimes be sorted out by taking supplementary hormone tablets or injections so its not the end of the world.

I'm not a Doctor so I could be totally wrong because all cases are individual - I am just talking from my personal experience.

Good Luck !!!

pootlesmum thank you.
I dread hearing the words sorry but its unlikely you will be having any more children.
I think I am in for a rough time of it.

The test day is really important. Progesterone peaks 7 days after ov, then your levels decline, so doing it on the wrong day does make a difference. It's called 21 day bloods as it assumes you will ov on day 14, but of course many people don't.

I tried to speak to the nurse who took my bloods about this, because they were taken very soon after I ovulated but she dismissed me and did them anyway. My results were too low to indicate ovulation - actually, I was pregnant.

Do you temp or use OPKs - I would try to arrange the blood test for 7 days after you next ov (even if you have to lie to them about what cycle day it is).

Also - what was the measurement used on your reading? Was it nmol/L?

They say it should be around 30 nmol/L to indicate ov, I'm wondering if your 0.7 was actually 7 nmol/L.

saymyname

I have not tried the temping or OPKs.
I didn,t want to make it too stressful.
However I don,t think I can be any more stressed than what I am now.
I do have a stash of tests which I never used, so I may start giving them a whirl.

Do you think its possible that I could ovulate around day 8 for instance and for my progesterone level to have not shown this on the day 21 test.
Sorry dumb question I know, this ttc lark is really sending me loopy.
You know I am even toying with the idea of doing a pregnancy test as well I am on cd 32 with no period.
However with my track record of irregular cycles I think its unlikely that I am pregnant.

Oh god I don,t know.
I really need to see them at the fertility clinic.
Even though my doctor had the result, I had gone to see her about something else btw,
its the fertility clinic that I am supposed to see about it.
My doctor is not much use in this field.
I really cannot bear waiting until the 27th of June.

Lostittoday,
It might be a good idea to document everything that happens in your next cycle and bring it to the clinic with you.

Day 1 - You start bleeding (make a note of how much blood, anything else discharged such as clots, and how long you bleed for)

Day 3 - Have the Follicle Stimulating Hormone Test (FSH) and Oestrogen Test done to check that you do have eggs and you do produce the hormone to grow them properly.

The idea of using OPKs is excellent, you can buy them cheaply from the internet and test your urine every day until you get a surge which means that your body has produced the Lutenising Hormone (LH) needed for ovulation. If your cycle is 63 days long then you will have to buy a lot of them. (You don't normally have to start testing until about day 9 of a regular 28 day cycle but if I were you I would just test every day so at least you won't have the worry of 'did I miss it out?'.

When you get the surge, even if its very, very faint (again make a note of how dark the surge line is compared to the control line - very faint means low LH, very dark is good), then you should have your progesterone re-tested 7 days later. Hopefully it will be above 30 which normally indicates that you have successfully ovulated.

If you start bleeding again before your appt make a note of how long your cycle was.

If you have all this info with you at the clinic it will be a good thing.

I wish you the best of luck, I know its horrible having to wait.

Yes, do what pootlesmum suggests.

There is a seller on ebay called babymad that does really cheap OPK sticks, I can recommend those.

I'm not sure about oving on day 8 - I wouldn't rule it out. Has the cycle you were tested on come to an end yet? What length was it? if it was a 62 day cycle you may well not yet have ovulated when they performed the test, which could be why it was so low. Timing is everything so OPKs should help with accuracy of test dates.

Good luck, and try not to worry.

Thank you I will do that.
Do you know anything about what Oestrogen levels should be.
My doctor has already run lots of hormone tests ie fsh, lh, the works and told me every time they were okay without actually going through what my levels were.

At the time though I didn,t realise that these tests should be done on day 21 or day 3.
My doctor never told me this either so they were probably done on the wrong days.
The fertility clinic did have the results of a oestrogen test I had done and it was 200.
I asked if that is okay, she said it was a little low but it depends on whereabouts it was done in my cycle.
Have you any idea on what oestrogen levels should be.

No I am still on that cycle.
Currently on cd 32 with no period yet.
Its frustrating as I am waiting to have the day 3 test.

If you have another long cycle then it's entirely possible the test wouldn't show ovulation as you were yet to ovulate.

I've not had oestrogen tests, so don't know about them. I know we're not supposed to link to other forums (please forgive my MNHQ, it's for a good cause) but there are a lot of very knowledgeable people here It might be worth doing a search on "oestrogen levels" or just posting.

As I say, my Dr's were crap, wouldn't listen to me about the test day for day 21 bloods and got a poor result because it was done on the wrong day. I would expect your fertility clinic to be far better informed though.

I suppose I just have to leave it in their hands.
Roll on the 27th of June.
What should I do if I don,t get my period this time, do I just have to wait for the next cycle and then have the day 3 test done.
I really feel as though this is delaying everything.

www.fertilityplus.org/faq/hormonelevels.html#female

I'm rubbish with computers so don't know how to post links but if you retype the above there is a lot of good info on what hormone levels should be.

I hope it works. If not, type www.fertilityplus.org and then search for it.

Hi Lostittoday

A level of 0.7 for progesterone would indicate that ovulation did not happen in that particular month.

Have you been properly evaluated for thyroid imbalance?. Such things can also cause ovulation to go awry (polycystic ovaries is another common cause of such problems).

In your particular circumstances I would not advise the use of OPK's at all as they will not be helpful. They are pointless to use with irregular periods anyway. You could likely get multiple positive results. The problem with OPK's is twofold - firstly such kits assume that there is only one LH surge each month and that such a surge is automatically followed by ovulation. Both of these are simply not true.

It is also not correct to assume that ovulation takes place around two weeks before the start of the next period. Ovulation is not an exact science and it can occur earlier, later or not at all in any given cycle.

Would also try and get your GP to refer you to a gynae or endocrinologist as they can look at thyroid problems more carefully. If it is a thyroid imbalance that is at the heart of such problems then it can be treated. It is certainly not an absolute barrier to conception.

If your cycles are irregular the blood test can be done according to calendar days i.e the 3rd (to test and compare the level of LH against that of FSH) and 21st of the month.

The fertility plus org site also I think has details of thyroid hormone levels.

my doctor is doing another thyroid check.
My tsh was 19 on my last check so it will be interesting to see what it is now.

Thanks for the suggested websites I will take a look at them

Your TSH level was 19!!. That's way over what it should be.

Have you been properly evaluated to see if hypothyroidism is present?. You should be seeing a specialist asap, do not let your GP continue to mess about.

Lostittoday I'm sorry you are having such a stressful time of it.

I've never had hormone tests (yet) but the day 21 test is designed to be in the middle of your luteal phase, ie the 2 wks or so between ovulation and AF. The luteal phase is virtually always between 9-16 days. If you have erratic or long cycles, it will be the phase before ovulation that changes, not the luteal phase.

So if you have a progesterone test done before you ovulate (which it sounds like you did), it will certainly be low. THat doesn't mean you won't go on to ovulate.

Temping is a good way of showing that you have ovulated, because the release of progesterone makes your temperature rise. If you could get the test done at short notice, you could maybe monitor your temps and go in after you have seen a rise for a few days.

BTW the book 'Taking Charge of Your Fertility' by Toni Welscher (sp?) is really, really helpful in explaining all this, much better than me!

Good luck