Written by: Dr. Amy Beckley, PhD, Founder and Inventor of the Proov test — the first and only FDA-cleared test to confirm successful ovulation at home.
Written on 1/18/21
What is progesterone and why is it important?
Before we can talk about PdG, we need a quick recap on our friend, progesterone! Progesterone, also called “the pregnancy hormone,” is one of the two main feminine reproductive hormones and it plays a vital role in regulating your cycle.
Progesterone prepares your uterine lining for embryo implantation in case fertilization occurs and helps sustain a healthy pregnancy. Just like estrogen, progesterone helps control your mood and well being, having positive effects on neuroregeneration and repair of brain damage.
At the beginning of your cycle, during the follicular phase, progesterone levels are low. They start rising immediately after ovulation and stay high throughout your luteal phase.
If you conceive: Progesterone remains elevated and plays an important role in pregnancy, keeping your uterine muscles relaxed, stimulating the growth of maternal breast tissue, and helping your body’s immune system to tolerate the baby’s DNA.
If you don't conceive: Progesterone levels will start to drop towards the end of the luteal phase, so that your lining can start shedding and you can get your next period. A healthy luteal phase lasts at least 12 days, allowing the embryo to implant in the event fertilization occurs. If your progesterone levels are low to start with, they may start dropping earlier than 12 days after ovulation. This is known as luteal phase defect, a condition that left untreated may lead to infertility and early miscarriage.
If you don’t conceive, progesterone levels will start to drop towards the end of the luteal phase so that your lining can start shedding and you can get your next period.
What is PdG and why is it important?
PdG (or Pregnanediol Glucuronide) is a urine metabolite of progesterone, long studied by scientists in the last 60 years. Once progesterone circulates through your bloodstream it is metabolized by the kidneys and then secreted into urine as PdG. Studies show that PdG levels in urine correlate with progesterone levels in blood.
While progesterone blood tests can be unreliable due to drastic serum fluctuation, PdG levels don’t fluctuate as much. A PdG measurement from a first morning urine sample will show an average of all levels from the previous day. So, PdG testing is an accurate, non-invasive, and convenient alternative to progesterone testing via blood.
Why is confirming ovulation important?
Ovulation is a very important part of your cycle, where a mature egg is being released from your ovary. Not only is ovulation essential for conception, but it is also an important indicator of your overall health. Every woman, whether trying to conceive or not, should educate herself to understand fertility and ovulation.
Contrary to popular belief, we shouldn’t track our cycles only when we are trying to get pregnant.
Learning about your menstrual cycle and your ovulation patterns may help you track many other health issues.
Lack of ovulation may signal Polycystic Ovarian Syndrome (PCOS), thyroid disorders, or even a tumor of the pituitary gland. Additionally, if you don’t ovulate, your progesterone levels will stay low and won’t be able to balance your estrogen levels, which may lead to estrogen dominance. This can put you at a higher risk for conditions like endometrial and breast cancer, stroke, blood clots, and thyroid dysfunctions.
Learning about your menstrual cycle and ovulation patterns may help you track many other health issues.
How does PdG confirm ovulation?
When testing PdG vs. progesterone we have to keep in mind that we are actually testing urine vs. blood. Therefore the units of measure we use and the level at which ovulation is confirmed are different.
In order to confirm ovulation in blood during the luteal phase, we usually test on the 7th day after ovulation, when progesterone levels should be elevated, and expect to see a level of at least 5 ng/ml. Published studies have shown that this correlates to about 10 ug/ml of PdG in urine.
Most PdG tests are set to turn positive at a threshold of 10 ug/ml, meaning that a single positive PdG test confirms ovulation. However, we mentioned that progesterone (and therefore PdG) needs to remain elevated throughout the luteal phase in order for it to be a “healthy” ovulation. We call this “successful” ovulation.
Successful ovulation refers to an ovulatory event in which an egg is released and PdG levels remain adequately elevated for long enough to allow for the best possible chance at conception. This is why PdG testing is so great: you can easily test multiple days in a row to confirm successful ovulation!
Successful ovulation refers to an ovulatory event in which an egg is released and PdG levels remain adequately elevated for long enough to allow for the best possible chance at conception.
Confirming successful ovulation with Proov
Proov is the first and only FDA cleared PdG test to confirm successful ovulation at home. Testing with Proov on days 7, 8, 9, and 10 after peak fertility confirms that successful ovulation did, in fact, occur. We like to see four positive Proov tests during this window.
If you get anything less than four positive Proov tests, this could be a sign of suboptimal ovulation which could be hurting your chances of getting pregnant. Luckily, PdG levels can be raised via natural remedies or prescription medications from your doctor. If you never get a positive Proov test, this could be a sign of anovulation, in which case we recommend consulting your doctor.
If you want to read and store your tests in a convenient place, you can use the clinically validated Proov app. A recent study showed the Proov app to be accurate at detecting changes in Proov PdG tests and confirming ovulation.
Confirming ovulation gives you critical information about your cycle — whether you’re trying to conceive or not. PdG testing is an accurate and convenient way to confirm successful ovulation.