Common misconceptions about Progesterone after Ovulation
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.
Medically reviewed by: Dr. Gary Levy, a Board-Certified Reproductive Endocrinologist and OBGYN. Dr. Levy has been the IVF director of a busy, academic, fertility practice. He specializes in complex endocrine and reproductive cases. He is a prolific researcher and author publishing dozens of articles in many prestigious peer-reviewed journals. He also serves as Chief Medical Officer at Fertility Cloud, a comprehensive virtual fertility care platform that helps couples with fertility testing and treatment, all from the comfort of their own homes.
Written on 4/4/20
Updated on 5/3/21
Keep reading to learn more about common misconceptions about progesterone after ovulation.
When our founder, Amy started to suspect that she had a problem with ovulation — specifically, adequate progesterone production after ovulation — she brought this concern to her physician and asked for progesterone supplementation.
Despite the doctor’s reluctance, he prescribed progesterone and a couple cycles later Amy was pregnant. She gave birth to her beautiful daughter who is now 6!
After Amy’s experience, she discovered there was a significant lack of knowledge in women’s health surrounding the importance of adequate progesterone production when trying to conceive. Many women and their doctors did not understand or believe in the benefits of progesterone.
Read on to understand more about progesterone, why it’s important, and common misconceptions that could be preventing women from uncovering what could be an easy fix.
Why is progesterone important?
Progesterone is the hormone produced by the empty follicle (corpus luteum) after ovulation occurs. It is required to make the uterus “sticky” enough to allow an embryo to implant, should conception occur. Progesterone also creates a healthy uterine environment in which an embryo can thrive. Without enough progesterone, it is more difficult to successfully conceive.Unfortunately, knowledge surrounding ovulatory dysfunction is incomplete. Despite ovulation, ovulatory dysfunction may manifest as an inadequate quantity of secreted progesterone resulting in luteal phase deficiency, or progesterone deficiency. Many doctors question if this is a real diagnosis and if adding progesterone supplements is beneficial.
Misconception #1: Studies show progesterone supplements don't help fix problems with ovulation.
When Amy asked her doctor for a progesterone supplement, he gave it to her — not because he thought it would work, but because taking the supplement wouldn’t harm her. This lack of faith in the effectiveness of progesterone supplements stems from a study conducted in 2015.
This study followed 836 women. When a woman got a positive pregnancy test, half were given vaginal progesterone and the other half were given nothing. Live birth rates were only 2% higher in the progesterone supplement group. So, the study concluded that progesterone supplementation didn’t really help.
But this experiment was flawed. Basic biology tells us that progesterone is required to prepare the uterine lining for implantation, which is why it is released by the empty follicle right after ovulation. So, by the time a woman got a positive pregnancy test, the embryo had likely already implanted.
Correcting progesterone deficiency after confirmed pregnancy is almost “too late” since progesterone is critically needed to prepare the uterus for conception. This study was highly publicized when it was published, so the information spread widely to medical professionals and women seeking care.
In 2017, another study was published. In this experiment, women were given progesterone at the start of their luteal phase (3 days after ovulation) and were able to have adequate levels before getting pregnant. The results of this study showed a 17% increase in live birth rates in women with a history of pregnancy loss.
Misconception #2: A blood test is the best and only way to confirm ovulation.
If you suspect you have lack of ovulation or suboptimal ovulation (meaning not enough progesterone is produced after ovulation), your doctor may order a cycle day 21 progesterone blood test. A day 21 blood test aims to measure progesterone at the point in your cycle when it should be reaching an optimal level, about 7 days after ovulation occurs. However, there are a few reasons a blood test can fall short.
First, a serum progesterone test done on cycle day 21 assumes you ovulated on day 14 of your cycle. However, every cycle is different in length, so one woman may ovulate before or after day 14. In fact, a woman’s cycle length can vary from 21-35 days! If you ovulate before or after cycle day 14, a cycle day 21 blood draw may not be exactly 7 days after ovulation and could give you false assumptions about your levels.
Additionally, a single serum progesterone measurement doesn’t always show the full picture. In Amy’s case, her progesterone levels would rise, and prematurely drop. She would get a positive mid-luteal serum level indicating ovulation, however the progesterone would prematurely drop resulting in an inadequate luteal phase.
Second, progesterone is secreted into the blood in pulses. Studies have shown that serum progesterone levels can fluctuate eight times over a single day. So, progesterone can range from 3-30 ng/ml, depending on what time of day you draw blood.This makes it extremely difficult for doctors to know if the amount of serum progesterone at that point in time is enough to support successful conception. At 8 am, your progesterone levels could look great, but by 4 pm they could be low. Depending on if you get the blood draw done at 8 or 4, the information provided could be giving an inaccurate picture of what is actually going on over time. The only definitive answer a progesterone level can provide, is whether or not ovulation has occurred.
Proov PdG tests are the first and only FDA cleared PdG tests to confirm successful ovulation at home.
So, what does this all mean for me?
The most important thing for you to do is stay educated and ask your doctor the right questions. The good news is that now there is a great way to confirm successful ovulation at home so that you can understand this important piece of the fertility puzzle!
After progesterone circulates through the blood, it is then passed into the liver where it is metabolized and secreted into urine as PdG (Pregnanediol Glucuronide). Studies have shown that PdG levels in first morning urine show an average of the serum progesterone levels from the day before. Because PdG shows an average, this makes it a better way to measure the overall progesterone production after ovulation.
Proov PdG tests are the first and only FDA cleared PdG tests to confirm successful ovulation at home. Since Proov PdG tests measure levels in urine, they are non-invasive, making it easy to measure your levels over critical days during the luteal phase to confirm successful ovulation. Successful ovulation occurs when PdG levels rise and remain adequately elevated for long enough to allow for the best possible chance at conception.
We like to see 3-4 positive Proov PdG tests on days 7-10 past peak fertility (i.e. a positive LH test), with a positive on day 10 past peak fertility to confirm successful ovulation. Anything less than this or that lacks a positive result on day 10 could be a sign of “weak” ovulation which could make it more difficult to conceive.
The more you know about your progesterone levels and ovulation quality, the sooner you can get pregnant!
More questions? Reach out to us at firstname.lastname@example.org!