# Low 21 day progesterone levels



## sunshine daisy

This is my third infertility treatment.  We have them for male factor and both times they were unsuccessful in good part because I completely over-reacted to the injections and we had to stop the meds a week before egg collection.

This week I had a 21 day progesterone test and my GP has come back saying it is 26 which is very borderline.  I'm not sure what this means.  Does it mean borderline for whether IVF/ICSI is feasible?  Does it mean I'm not ovulating or am getting menopausal?

I know I might be worrying unduly as I have a fairly irregular period and it is normally at least 32 days so we might have just tested too early (I'm testing again tomorrow) but now I'm worrying that I might have left it all too late.

When I had my first ICSi 5 years ago the clinic said I'd had the response of a 19 year old rather than the 34 year old I was.  After the second the consultant said I had an excellent ovarian response.  However afterwards I got pregnant naturally but our daughter was stillborn and it has taken me this long to recover and feel well enough to try again.  Now I'm panicking that I've left it too late.  I know fertility declines reasonably sharply in your late 30s but I wasn't expecting it to fall off a cliff.

Any ideas?


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## alison1971

Hello Sunshine,

I too am 39 and wondering that I left it too late! (of course I did, but life, bereavement and depression (DP) got in the way in our 30's)...

I am also curious about the progesterone.. I dont have an answer for you, only that I had a test done a little early, on Day 19 and mine was 22.5 so less than yours. My GP told me that "something had clearly happened and I flung off an egg" as he put it! But yes, it sounded a little too low from what I have read. I asked him and he said no, it was fine. I have read conflicting numbers, some places say over 30 to show ovulation, but others say anything over 15. If anyone else has a clue, please post and let us know!

You are doing all you can, getting help so console yourslef with that.

I also have started taking Wheatgrass.. have you heard of that? Its expensive but me and DP have both noticed that we have more energy and more interested in babymaking since taking it! So it must be doing some good. Its meant to be good for your cycles/hormones and is known as a "uterine tonic".

Good luck xx


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## ☼♥ Minxy ♥☼ ©

Hi ladies

*Sunshine*...so sorry to read about your daughter   I can't even begin to imagine how you deal with such devastating news 

*Alison*...how long have you been ttc ? Are you about to start IVF treatment ?

Whenever you're comparing any hormone levels you need to consider the unit measurement used as otherwise can take out of context.

Most clinics will look for a progesterone level of 30 nmol/l or over at 7dpo (dpo - days past ovulation). Having tested on cd(cycle day) 21 assumes you ovulated on cd14. Progesterone peaks at 7dpo so this is ideally when it should be tested so if you do ovulate earlier or later than cd14 then try to get progesterone tested accordingly.

30 nmol/l is approx 10 ng/ml which is why you may read sometimes that a level over 10/15 means ovulation...this is because they're using a different unit measurement. Many US websites use the ng/ml unit measurement when referring to progesterone.

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

With progesterone levels in the mid-high 20's (nmol/l) then this is classed as "borderline" ovulation which could mean you were tested on the wrong day (so not 7dpo) or possibly that the egg that was released was a little immature so the level of progesterone wasn't as good.

With regards to progesterone levels and response to IVF, it doesn't really matter so much because with IVF you're not ovulating naturally, you're having your whole cycle controlled by the drugs....so your response and how many follicles develop and subsequently how many eggs are collected is more based on your FSH (and possibly AMH) levels. Your FSH (and AMH) is tested at the beginning of your cycle and gives an idea of your ovarian reserve and how you'll respond to the stimulating drugs.

If you've not had FSH, LH, E2 (oestradiol/oestrogen), prolactin and thyroid tested already then I'd definitely request these be done. These tests need to be done between cd1 and cd6...best time would be cd2/3.

Hope that answers some of your questions.

Good luck to you both
Natasha

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## alison1971

THankyou so much Natasha for your kind and detailed answer.

Ok, well my progesterone was 22.5 nmol, so as I suspected, either a little early on an incomplete ovulation. I do normally ovulate around day 13/14 so this was about 5dpo as far as I could tell. 

I've not yet been referred for IVF but the GP said he would refer us to the NHS clinic in a month or two, depending on the results of DP SA which he is having on 15th Feb.

My FSH was 10.2 and LH 9.8 on day 2. I started acupuncture today and am taking Wheatgrass. I've also been referred to an endocrinologist because my Prolactin is 1335. I am seeing him Friday, I put up a separate post asking anyone for suggestions of what questions to ask.


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## Hope2005

HI! 

Regarding progesterone levels- I spoke to the pharmacist today because I am taking anti depressants (to cope with this issue) and she is saying that my medication (sertraline) can cause prolactic levels to go out which in effect can affect progesterone levels. Anyway, I am not sure my score yet for the progesterone, I am having it done next week. Can medication affect FSH levels? 

Thats all

Thanks 

Hope


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## ☼♥ Minxy ♥☼ ©

Hi Hope

No medication should not effect your FSH levels unless you're taking fertility drugs.  FSH levels relate to your ovarian reserve ie how many eggs.

The drugs shouldn't directly effect your progesterone levels but if they effect prolactin then high prolactin levels can intefere with ovulation......and subsequently if you don't ovulate properly ie immature egg released, irregular/sporadic ovulation, late/early ovulation then your progesterone levels will be effected.  Progesterone is released from the corpus luteum which is the area of the follicle where the egg ruptures during ovulation.

Hope that helps
Good luck
Natasha


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## Hope2005

Hi there

well, Iam getting more answers here than my own Dr. They are all useless (sorry if I am honest and open). 

My own Dr question me about what tests to do to see why my FSH are high. I dont think that sounds right. 

You are right, hopefully the progesterone levels will give more answers.

Take care , hugs Hope xx


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## alison1971

Hey Hope.. if you feel your GP is not clued up/helpful then switch doctors ASAP. We are free to register with any GP in the locale, if they are taking new patients. Ring around and ask questions, are they up to speed on fertility issues? You can take charge of your own health and not leave it in a doctors hands, they are not gods right !! Good luck.


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## ☼♥ Minxy ♥☼ ©

I completely agree with Alison re changing GPs.  If you are not entirely happy with your GP then change practices.  

I used to have an absolutely awful GP years ago but didn't have any choice as the GP surgery I wanted to go to wasn't taking anymore on their books....but I just kept checking back with them and eventually was able to change.  

So pleased about this as the previous GP just couldn't understand why I was so concerned about ttc....but I was 34 at the time of starting out and had already had severe endo diagnosed for 15 years at the time (plus a septate uterus)......he (and his wife who was the other GP there) were so rude and just kept telling me not to worry, why was I concerned and even when I asked about what supplements/vitamins to take (as took a lot of herbal remedies) I was told once "well you're not pregnant are you so why worry about what you should and shouldn't be taking" and another time "your blood tests shows you're not ovulating but we won't do anything about it yet" (when actually, when I got my results and took them to fertility consultant I was told my progesterone level was really high so showed I had no problems ovulating at all !!)....totally useless.

I would definitely do as Alison suggests and try and change....... 

The only thing I would add is that GPs are just that..."general practitioners" so they often aren't completely clued up when it comes to more specialist areas such as fertility.....quite often I've had to tell the GP what blood tests I need, why and on what days !!

Good luck
Natasha


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## bron11

You all appear to have good fantastic answers to your questions.  I was also told that my Day 21 test was 13.3 so put me back on Clomid to try again.  Test may not have been done on right day given needs to be taken 7 days after ov but given tests weren't really showing this not much help.  FSH over 15 not view as good for treatment but AMH preferred to give indication of egg reserve and how someone will respond to treatment.

bron


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## ☼♥ Minxy ♥☼ ©

bron11 said:


> You all appear to have good fantastic answers to your questions. I was also told that my Day 21 test was 13.3 so put me back on Clomid to try again. Test may not have been done on right day given needs to be taken 7 days after ov but given tests weren't really showing this not much help. FSH over 15 not view as good for treatment but AMH preferred to give indication of egg reserve and how someone will respond to treatment.
> 
> bron


Hi Bron

Was your progesterone level 13.3 ng/ml or 13.3 nmol/l ? 10 ng/ml is approx 30 nmol/l....so if it was 13.3 nmol/l then that would indicate that "something" happened but either you were tested too early (as ideally needs to be 7dpo as you mentioned) or the egg was just too immature (or too old/too mature) to be able to produce a good level of progesterone (if it was 13.3 ng/ml then this would indicate ovulation).

Are you still on clomid ?

As for getting an idea of what a womans ovarian reserve is like and how she may respond to stimming drugs during IVF, having FSH, E2 (oestradiol/oestrogen) and AMH tested at beginning of cycle can give a clearer pitcure. It's always a good idea to try and get E2 tested alongside FSH as a high E2 level can suppress FSH and make the FSH appear lower than it actually is.

Also, when comparing any hormone levels, need to consider the unit measurement used and the "normal range" as different clinics and labs use varying measurements and range...if compare same hormone but different measurements then takes out of context.

Here's some more info...

(follicular stage) LH - range 1.9 - 12.5 iu/L
(follicular stage) FSH - range 2.5 - 10.2 iu/L

FSH levels to indicate ovarian reserve (all in iu/L):
under 6 = Excellent 
6 - 9 = good 
9 - 10 = fair
10 - 13 = diminished
13+ = hard to stimulate

LH should be similar level (or slightly lower) to FSH, if it's higher than FSH then may be indication of PCOS.

Oestradiol (Oestrogen - E2)

1 pg/ml = 3.67 pmol/l

100 pg/ml = 367 pmol/l (pg/ml to pmol/l = 3.67)
100 pmol/l = 27 pg/ml (pmol/l to pg/ml = 0.272)

different labs do use varying ranges...as can be seen here....

different clinics ranges for FOLLICULAR PHASE - oestradiol (E2)
37-539 pmol/l
40-606 pmol/l
75-250 pmol/l

You can find some more info on this website...this is US website so the unit measurements vary...

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

...and some info on AMH

AMH 1 ng/ml is approx 7.14 pmol/l (eg my AMH level of 16.3 pmol/l is approx 2.28 ng/ml)

http://www.sharedjourney.com/test/amh.html

http://www.tdlpathology.com/index.php?option=com_content&task=view&id=201&Itemid=73

http://www.advancedfertility.com/amh-fertility-test.htm

Hope that helps 

Good luck and take care
Natasha

[red]This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites[/red]


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