Ovulation but Low Progesterone?

[QS88]

Hi, please does anyone have any knowledge / experience to help with my query?

I'm 29 and have been ttc for 2 years. I have regular 25 day cycles, no history of sti of pid or anything, 2 scans show womb and lining are normal, ovaries normal, nothing obviosly wrong with tubes (as much as they can see with a scan which I understand finds any issues about a third of the time, although have upcoming dye test). Other half has had his semen analysis twice, which is fine.

The only test that has come back off is progesterone - I have been tested twice, and both times the progesterone has been "lowish" - about 17. The specialist has told me to disregard this, as all progesterone shows them is that you MIGHT not be ovulating, but we know I am. But I thought that progesterone also aided implantation? I have read conflicting things. Could this be the reason for my infertility? I am terrified of having "unexplained infertility", as everything else seems normal, except my tubes haven't been tested yet. Has anyone had a tube blockage with no risk factors or symptoms?

Any advice would be gratefully received.

Just out of interest, how do you know you are ovulating?

I was going to ask the same question.

What cycle day was your progesterone level tested?

Any test done over six months ago should be discounted, you need up to date blood test results?. Have any day 2 tests been done?

Do not ever accept the “diagnosis” of unexplained, it’s no diagnosis at all and is sometimes told to couples when they as the couple have not been adequately investigated.

Agree a million% with Attila. What cd was the test on?

Having progesterone in your system is very suggestive of having ovulated at some point in that cycle. There isn't really any other source for it.

The question then becomes is progesterone low because you aren't pregnant, or aren't you pregnant because progesterone low? A chicken and egg scenario, if you will. Science has not really answered that question. There hasn't been evidence that adding progesterone helps to support miscarriage except in the case of assisted conception like ivf.

Some recurrent miscarriage clinics will prescribe it as a Hail Mary if nothing else has been found as an issue... but some of this stuff is definitely a mystery.

I struggled with secondary infertility for years. I had low progesterone and really long cycles. I tried Clomid but nothing happened. I did have one pregnancy that ended in mc at 9 weeks. Then I had a cycle of Menopur (but I could be totally wrong about that name, it was a long time ago) the doctor gave me an injection once a month and then I had to inject myself too. First cycle was unsuccessful and then I took a break as I was going away. I got pregnant that month (he is now 10 years old ) but throughout this time I was using ovulation sticks and the month I actually got pregnant was the first strong positive I got for ovulation. I was a bit cynical about them so I used to take them daily to a piece of paper to get an overview. There was such a marked contrast between that and previous "positives". (so i got the positive, called dh home from work before I left for the airport - went away without him - and that did it). I suppose my experience meant that i was not ovulating as i should have been on previous cycles.

Hello OP, I had two progesterone tests, came back as 10 and 14. They said I might not be ovulating but I got pregnant the month I had the 14 value. I was a bit worried my ovulation wasnt happening or it wasn't 'strong enough' after the first test so I started taking vitex from my period to ovulation. It might be a coincidence but I got pregnant the first month I took it. I suspect the progesterone tests were a timing issue and I had been ovulating earlier than I thought. Fingers crossed for you.

Thank you all for your replies. I have always had LH surges at the "right" time, with cm, but more than that my last scan by chance fell mid-cycle, the day I got a positive LH, and there was a clear follicle about to rupture. The nurse doing the scan said she estimated that it would rupture in about 12 hours. So am I safe in thinking I do?

Progesterone test was done 7 days before period - so day 18 of 25 day cycle.

Out of curiosity, was that 8 days after the scan/ positive opk?

Has there ever been day 2 tests done to compare your LH level against that of FSH?. If not, I would be asking them why that is.

It is certainly possible to get more than one LH surge throughout the month. If you are assuming ovulation solely based on LH surges at the "right" time then chances are you could be wrong about that happening.

@QS88 I don't have an answer but wanted to say I'm in the same boat and will be asking my consultant what to do in a couple of weeks.
I've had 2 very low progesterone tests (7.9 and 10). I'm certain I tested the right day. Also had a scan showing a follicle ready to rupture just before ovulation, I've seen temperature rises whilst temping and positive LH Clearblue ovulation tests. So everything points to ovulation happening, but progesterone is low.

Progesterone comes from the corpus luteum which is created when the egg breaks down... So maybe we're not ovulating after all? Maybe it's not coming out of the follicle?

Do you know how long your luteal phase is? Mine is very short which is also a progesterone issue. Please do let me know if you get any answers and I'll update you once I've seen my consultant.
I've also tried Agnus Castus / Vitex and it definitely helped but 2 years TTC and still no joy. Confusing!

You can get a rise in temperature in the second half of the cycle when an egg has not been shed so charting in itself is not infallible.

Hope your next appointment with the consultant gives you some more answers. I would also want to know what your current day 2 LH and FSH levels are like because these two hormones kickstart the whole ovulation process. If these are out of sync then ovulation will be affected.

@attilathemeerkat ahhh, I didn't realise you could still get a temp spike even without ovulating. Thank you. It looks like the only true way of establishing ovulation is the progesterone test then?
I know my day 2 levels were fine, it's only been the progesterone so far. Not sure about the OP.

Thanks @Beth821, it is reassuring to know it can happen, even with low progesterone.

@Sylva123 Thank-you, I would be really interested in what they say. Similarly I will update with anything I am told which I think is helpful. In the meantime, there are two things I am thinking - I have read on the Ava website that even if the follicle doesn't rupture, so long as there is a follicle present, it still forms a corpus lumen (sp?) and produces progestetone. As such, no rupturing in itself shouldn't result in low progesterone. From what I have read, this non rupturing is most common when someone takes a lot of anti-inflammation medication, so you could look into this if you are.

Seccong thing - it is widely accepted that physical or mental stress reduces your progesterone. This is because the stress hormone cortisol and progesterone are chemically quite similar, so if chronically stressed, the body metabolises peogesterone to make cortisol (I have checked quite a few scientific journal articles which all say the same). As such, I have a theory (frustratingly I can't find anything which says either way) that perhaps the corpus lumen is acting "normally", however the progesterone it produces gets eaten up by the body. This would explain why anecdotally some women find they are pregnant when they have a break from trying / go on holiday etc.

There seems to be not very much research on this topic / we are told that only acute stress can affect fertility (as it stops a woman from ovulating), but if it lowers progesterone, could it affect fertility as it prevents implantation? Again, as far as i can find, there isn't any clarity on whether progesterone is needed for implantation. Certainly something I am thinking about though, I have recently changed my role at work to something less stressful, and plan to go part time to see if it helps. It will be expensive to do, but I figure less so than fertility treatment 😕

@physicskate I got my LH surge / saw the follicle on the scan on day 12 of 25 day cycle, so should be a long enough luteal phase.

Looks like it might have been more like a 12ish day luteal phase (instead of 'standard' 14), in which case you might have just missed peak ovulation by testing 7 days before af (as there wouldn't have been enough time after ov for it to peak?). This is all just conjecture!!!

And I agree that a 12 day lutel phase IS long enough, but just might be tricky for progesterone blood testing, ifyswim.

@QS88 it's interesting that your cycles are 25 days. Mine are too, sometimes shorter, but I tend to ovulate later, around day 15 according to the Clearblue tests. So your luteal phase looks longer, which is a good thing. My consultant told me to do the progesterone test 7 days after ovulation, rather than 7 days before the period, so I don't know if that would change things?

Thank you so much for sharing what you'd read about the follicle. That makes a lot of sense and it's so good to get any info on this. I agree that there's very little research. From what I've read, it's almost better to not be ovulating because there's a clear solution to that. The jury is out on whether things like progesterone cream actually work, according to Google.
The stress thing is hard - I don't feel stressed, I do yoga and reflexology, take lots of time out to relax. I hope cutting your hours does help. It's got to be worth a try.

Last time I spoke to my consultant they said they'll try me on clomid anyway - I'll let you know what happens. Good luck! Let's hope we get somewhere soon. X

Yes, in a messed up way I would have been happy with no ovulation, as like you say there is a way forward. This is the article I was talking about www.avawomen.com/avaworld/lh-surge-pregnancy/
Good luck to you too X

My story is so so similar. I’m 28 (nearly 29) and just starting this journey too. My progesterone levels have also showed as being low and I feel like my luteal phase is very short e.g. ovulation was about 8 days ago and I already know my period is coming because of discomfort down below. My doctor thinks I’m ovulating because my cycle is usually 25 days and she thinks I’ll probably come back as having ‘unexplained infertility’ which is just a kick in the face. I’ve got an HSG appt letter coming in the next few weeks apparently but I think I might just pay to have it done privately. I’ve been taking vitex fruit and actually bought some clomid in Spain at a pharmacy. Just feel totally frustrated.

@ttcscot I hope the HSG goes well. I don't know if it is useful but I've used Forth Life to do some extra progesterone tests whilst I wait for my next NHS ones. You do them at home and send them off and they cost about £30. They were useful to me because there are such long gaps between each of my consultant appointments.
Did you try the clomid? What happened?
Last year I went crazy on the B vitamins because it's meant to lengthen the luteal phase. Either that or the vitex helped a little bit but I still didn't get pregnant so stopped taking them.
I saw a nutritionist last week and she has recommended I eat foods that reduce oestrogen dominance.
Good luck! It is so frustrating. Let's hope we get somewhere with it.
@QS88 how are you getting on? X

Hi @Sylva123 I also used the Forth Life service to confirm the low progesterone result I got from the GP. Useful idea, although didn't bleed enough using the pricker the send - almost sliced my finger off to get the sample .

AF is due today, one it comes I can book my HSG and will post an update incase it is helpful to anyone.

@TTCScot that's horrible that your GP said that when you haven't even had the first lot of tests done - infertility is only unexplained in a small number of cases (I think about 10%). Although I worry about this diagnosus too, I try to keep the facts in mind. You shouldn't have medical professionals jumping to the worst case. By the way , you're only supposed to have HSG after period ends and before ovulation, so might the reason for the letter taking a few weeks? Just a thought.

@Sylva123 Can I ask what diet/foods were recommended?

@unknownscot yes of course. She told me to eat cruciferous veg (or the Brassica family of veg) as apparently it blocks oestrogen. Also red grapes and pomegranate. She said to cut the sugar down (I'd been eating way too many Percy Pigs) and to up the fibre. Hang on I'll find the article she sent me and I'll copy and paste it...

Here it is:

^Below are some foods that decrease oestrogen levels by increasing or improving elimination. These should be consumed regularly and especially in the luteal phase (the phase just after ovulation).
• The Brassica family of vegetables: broccoli, cauliflower, brussel sprouts, cabbage, and kale
• Dark leafy greens: dandelion greens, collard greens, mustard greens
• Liver-supportive foods: onions, garlic, ginger, turmeric, basil, cumin, fennel, dill, black pepper, horseradish, rosemary, beets, strawberries, peaches, cherries, turnip
• Lemon juice
• Certain red wines (not white) that are high in resveratrol like Merlot, Pinot Noir, especially from Sardinia and Sicily.
Below are some foods that increase oestrogen levels are usually foods with high Glycaemic indices. These should be avoided - especially in the luteal phase:
• Milk
• Refined sugar
• Processed foods
• Caffeine > 100mgs daily (coffee, tea, chocolate)
• Excess Alcohol and drugs
• Non-organic animal products^

I'm also just starting "seed cycling" - I'm not confident it'll do much tbh but anything that increases the amount of seeds I eat can't be a bad thing. So that might be worth a google too. I know my diet was wrong because I was so tired so am hoping to have more energy at least.

This isn't from a nutritionalist, but I read that soy also promotes oestrogen dominance as it has phyto (plant) oestrogens in.