Progesterone Testing when Trying to Conceive

Recently, we talked to Dr. Karen D. Poehailos, MD, CFCMC, who is a board certified family physician in Charlottesville, VA and serves as the Regional Medical Director for ThriVe Central VA Women’s Healthcare and as a family physician at WellFamily Medicine. We covered all things progesterone with Dr. Poehailos and we learned so much that we couldn’t wait to share with all of you!

Proov Team: Remind us, why is progesterone so important?

Dr. Poehailos: Progesterone is the hormone produced in the luteal phase by the corpus luteum (formed from the empty follicle) after ovulation has occurred. It is responsible for preparing the uterine lining to receive an embryo - it creates a healthy environment in which the embryo can implant and develop.

Proov Team: So, what are some common misconceptions about testing progesterone?

Dr. Poehailos: There are many misconceptions surrounding progesterone testing and why it’s so important! Many doctors do not test for progesterone until after a woman has had a positive pregnancy test or one or more pregnancy losses. I do the opposite: I believe in testing progesterone before a woman even gets a positive pregnancy test.

Proov Team: Why?

Dr. Poehailos: Because progesterone helps the body prepare before pregnancy by ensuring the lining is ready for implantation and that the mother’s immune system doesn’t recognize the baby as something foreign and attack it. If progesterone levels are inadequate, these preparatory steps won’t occur as well, which can make conception more difficult.

Proov Team: How do you test progesterone before pregnancy?

Dr. Poehailos: The current standard of care is to test progesterone levels through a cycle day-21 blood test, which would be seven days after suspected ovulation, when progesterone should be on the rise. However, a day-21 blood test is only effective if a woman ovulates exactly on day 14, which isn’t realistic as every woman’s cycle is unique. If a woman ovulates earlier or later than day 14, the blood test could give an inaccurate assumption about progesterone levels.

Proov Team: Okay, so let’s say a woman ovulates on day 16. How do you still make sure you’re testing her progesterone levels accurately?

Dr. Poehailos: Great question! I like to test progesterone multiple times during the luteal phase. I encourage my patients to chart their cycles so their peak fertility day (or day of suspected ovulation) is accurate for their specific cycle. I then do blood work on days 3, 5, 7, 9, and 11 after suspected ovulation. I don’t test every day because it is often inconvenient for the patient and expensive if her insurance doesn’t cover it. This testing gives a more complete progesterone picture, especially since I often see adequate levels on day 7 and then a drop on 9 and 11. From there, we work together to form a treatment plan.

Proov Team: Your testing technique sounds so familiar! Testing PdG - the urine metabolite of progesterone - with Proov is very similar. Proov testing protocol recommends testing daily on days 7, 8, 9, and 10 after suspected ovulation to confirm that healthy ovulation has occurred. We recommend testing through day 10 post ovulation for the same reason you test progesterone through day 11 - PdG levels often drop after day 7. Since Proov is non-invasive, you can test PdG from the comfort of your own home, without blood draws! Dr. Poehailos, do you think Proov could help your patients?

Dr. Poehailos: Yes! In fact, Proov has already helped one of my patients, D (changed for privacy). D actually went to the Proov team when none of her doctors would listen to her concerns about ovulatory issues. She tested with Proov and found that her PdG levels were low during the testing window, indicating suboptimal ovulation. You connected D to me and I then was able to do follow up progesterone blood tests and help D get pregnant. I am happy to share that D is now about halfway through her pregnancy and having a boy!

D’s Ultrasound!

Proov Team: That is so amazing! So, if a woman tests with Proov or through a blood test and finds her levels aren’t optimal, what do you suggest she does to help increase those levels?

Dr. Poehailos: I have a few recommendations:

Progesterone supplements: Bio-identical progesterone is widely available and is one of my go-tos. You will need a prescription from your doctor. For low levels in pregnancy, I typically recommend intramuscular supplements, as these are most effective at raising progesterone levels in the uterine lining and blood. Vaginal and oral supplements don’t treat progesterone levels in both the uterine lining and blood as effectively. If for whatever reason you choose not to go with an intramuscular supplement, I suggest taking both vaginal and oral supplements together, to ensure adequate levels in all parts of the body. For a luteal phase defect during cycles, I usually use vaginal and/or oral as my first choice instead of intramuscular.
Diet: There are some foods which promote progesterone production, including beans, broccoli, brussel sprouts, kale, nuts, and pumpkin, among others. You should also try to eat foods which contain vitamin B6 and zinc.
Herbals: Some herbals promote progesterone production including red raspberry leaf, chasteberry (or vitex), and maca.
Reduce stress: Stress triggers cortisol, the stress hormone. Increased stress causes the adrenal glands to produce more cortisol over other hormones, such as progesterone.
Maintain a healthy weight: Maintaining a healthy weight goes both ways - being underweight causes the body to make hormones needed for survival (which are not reproductive hormones), while being overweight causes a higher production of estrogen from fat cells. Too much estrogen can lead to an imbalance between estrogen and progesterone.