Advice on Day 21 Progesterone results

[neomamma]

Hi everyone, I'd really appreciate your advice on results I just got back from my GP.
I had Progesterone blood tests taken on Day 19 and Day 23 (there was a weekend and a local holiday in the middle so it wasn't possible to do the bloods on Day 21).

My results were:
Day 19 - 29 nmol/l
Day 23 - 10.3 nmol/l

My GP assured me that anything above 16 is fine, but I've read a few things online suggesting that 30 is what they look for. I know my Day 19 result of 29 is very close to 30 - do you think it's fair to assume that had they taken bloods on the right day (Day 21) the levels would have been above the 30 threshold?

I'm very dubious about the cut-off of 16 and don't really trust my GP on this. When I had a very early miscarriage 8 months ago and the bHCG levels had increased 9% in 78 hours she was happy with them as they "showed I was pregnant" and I had to point out to her that they should have doubled in 48-72 hours and that maybe the pregnancy wasn't viable.

Should I be happy with the results I got, or push my GP for a repeat test? Or push her to explain her threshold of 16? She's said she won't do any more tests for at least 6 months but I don't want to waste time if these results need to be explored more thoroughly.

Any advice would be really appreciated!

hi neo I would say those results don't show ov as there is sucha drop, but I'm not an expert and it depends on whether it was done at right time. how long are your cycles "day 21" is based on perfect 28 day cycle. you should actually be tested 7 days before AF is due. so for example I have a 34 dayish cycle and 14 day leutal phase (time between ov and AF) so would be tested on day 27 not 21. on day 21 i would only just have ovd so would show low levels.

assuming you are In the UK the score should be 30 min. they should also have tested amh and rubella at same time. amh shows ovarian reserve. they sometimes do a day 3 test for FSH but I didn't do that so can't comment.I 've also heard of LH being tested but again I didn't have it.

your dh/dpshould have been given an sa too. they do 2 sa tests min. my dh did his 1month apart.

hope that helps, feel free to ask more if you need to.

Hi Lildottie thank you so much for replying. I had a rubella test done before TTC and it came back clear. GP won't do any more tests as she said the Day 21 Prog was fine but she had to check the levels in her book right in front of me so I am not in any way confident she knows anything about it.

I usually ovulate on Day 14/15 and have an 11 day luteal phase thanks to acupuncture and chinese herbs (and poss Vit b6 too) which increased it from 9/10ish.

my DH is also going to have a SA shortly. Should i speak to another GP in the same practice and ask for a more thorough explanation of the result? My own GP just gave me overpositive comments like "i'm sure it will happen, everything is looking good".

neomamma

I would be seeing another GP within the practice; a result of 30nmol/l is what they like to see to confirm ovulation.

I would also now look into having a day 2 test done to see what your LH and FSH levels are like in relation to each other.

Semen analysis testing should always be repeated and preferably under the auspices of a subfertility unit rather than a GP. (Both of you should go together to receive those results as well). TBH if they are doing all these tests (and the original GP you saw seemed out of her depth) you would be better off being referred to a specialist at a subfertility unit anyway.

She says she won't refer me until we have been trying for coming up for two years as my result is ok, and that is 11 months off so I think I need to try another GP and push harder. On one hand it does feel like maybe if the test had been done a day earlier (ie 4dpo or 7 days before next period) the result could have been ok but I have no faith in my GP's ability to judge this.

neo based on your cycle details I think you can be happy with 29 to confirm ov. timing is key so its not an exact science. if I were you I'd find out more about whether the 19 drop in 4 days is OK. my gut says not, especially as you've had lp issues. I'd be worried if you did get pg the prog wouldn't be high enough to sustain pg or allow implantation. definitely speak to another go in the practice and if that's no better make a complaint. check out clinic websites in your area. my gp said she would only refer us after 2 years if the tests were all normal (dh has bad sperm so got referred) but clinic says you can be referred after 1 year. its taken 7 months to get all scans etc done and have appts etc.

Thank you so much, both of you, for your replies!

neo how old are you?

and you being fine doesn't rule out referral, bad sa result would qualify you for referral.

the reason i am anxious about it is that i fell pregnant the second cycle we tried, and got a strong positive test but very quickly started spotting and miscarried at 4w+6 so your comment about progesterone levels dropping too fast feels like it could be accurate. do you have any links to anything "official" that mentions this kind of detail? i am really struggling to find anything.

I will be 31 later this month. DH is 36. We thought we were so lucky to conceive so early on but have been trying for best part of a year since and nothing has happened. acupuncture and herbs has given me what feels like a more natural cycle (i would guess it has boosted progesterone levels as before i had almost no breast changes post ov but now i do quite noticeably)

i have been charting since we started TTC and chart and fertile fluid patterns indicate ovulation so i am fairly relaxed about that, it's the ability to sustain implantation i am worried about.

do you temp for whole cycle? look at temps for post ov, do they stay as high as first few days? temp rise is due to prog. prog drops causing temp drop. is also what causes AF.

sorry nothing official as this isn't an issue for me, just what I have learnt from 2years hiding out on mn. I've heard people say b6 isn't enough and you should do b6 and b12. or b complex whatever that means!

come into the ttc 10month + thread on conception. there are lots of lovely ladies there who will probably be as to help you more from their experiences.

have you google leutal phase defect for info rather than low prog. I think that gives better search results from what I have just looked at

Thank you Lil. i temp whole cycle and temps go a bit wobbly from about 9-11dpo and then my period arrives 12dpo. i went to acupuncture 7 months ago after reading a bit on luteal phase defect. the acupuncturist thinks i am probably conceiving but not implanting and the reason it worked the one time when i did get pregnant was because i implanted super early and had a clear bfp at 9dpo but then it didn't stick.

sounds like you know where your issues are, I'd definitely push for referral. but a lot of gps don't believe in/acknowledge lpd unfortunately. let us know how you get on

thank you!!

I am only in my late twenties, my day 21 test was 70 something, I have children from a previous marriage and did fall pregnant twice whilst we've been ttc but mced both times - we have been trying about 14ish months now and my GP had no hesitation in referring us to a fertility clinic. Push, or change GP

Just a quick update, saw my GP today and presented her with data on my cycles and luteal phase etc. Told her i'd read in a number of places that 30 is needed and i'm concerned i dont't maintain my prog levels long enough after ovulation. pushed for her to investigate so she has agreed to refer us once my DH's test result is back as the hospital won't accept a referral without it. so a successful appointment i think! thanks again, all of you, for giving me the shove i needed to challenge what i had been told.