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. Dr. Levy is 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 12/8/20
Updated on 6/16/21
What is Progesterone?
Progesterone, also named the “pregnancy hormone” is an essential hormone in the process of reproduction, which also helps regulate your cycle. Right after ovulation, the corpus luteum — formed in the place of the freshly collapsed follicle — starts producing progesterone to prepare your uterine lining for potential implantation in case the released egg gets fertilized.
Progesterone levels during the luteal phase usually peak around 7 days after peak fertility. Since women don’t always ovulate on the 14th day of their cycles, it is essential to have progesterone levels tested 7 days after their unique peak fertility observation instead of on cycle day 21.
Progesterone levels during the luteal phase usually peak around 7 days after peak fertility.
Why is progesterone important?
Sufficient post-ovulation progesterone levels ensure your uterus is “sticky” enough to allow for implantation of the fertilized egg. Without enough progesterone, it can be more difficult for an embryo to implant. If your corpus luteum produces enough progesterone to sustain a healthy luteal phase that lasts at least 11 days, you can say you had a successful ovulation.
This is essential if you are trying to conceive, as implantation of the embryo may occur anywhere between 6 to 12 days post ovulation, with the most common day being days 8-10. A shortened luteal phase where you start spotting around days 8 or 9 after ovulation can mean the embryo doesn’t have enough time to implant, which may lead to failure of implantation, or if implantation does occur, increase risk of early miscarriage.
Implantation may occur anywhere between 6 to 12 days post ovulation, with the most common day being day 9.
What is PdG and why is it important?
Once it has circulated through our blood, progesterone gets metabolized by the kidneys and eventually ends up in your urine under the form of PdG, a progesterone metabolite. PdG levels in urine are elevated when progesterone levels are also elevated. PdG is important because it offers a non-invasive alternative to a progesterone blood test.
What is a PdG test?
A PdG test is a urine-based test strip that measures PdG levels in first morning urine. PdG tests, like Proov, allow for non-invasive PdG tracking.
Proov is the first and only FDA cleared PdG test kit to confirm successful ovulation at home. Successful ovulation refers to an ovulatory event in which an egg was released and post-ovulatory PdG levels remained elevated for long enough to allow for the best possible chance at conception.
Testing with Proov on days 7, 8, 9, and 10 after peak fertility — when PdG levels should be elevated — confirms that successful ovulation did in fact occur. For a successful ovulation we ideally like to see 4 positive Proov tests during this testing window. In some cases, 3 positive Proov tests are sufficient to confirm successful ovulation, if the 1 negative occurs on either day 7, 8 or 9 past positive LH test. Anything less than 3 positive Proov tests - or if Proov doesn’t stay positive on day 10 - could be a sign of suboptimal ovulation, in which case we recommend consulting your doctor.
Proov is the first and only FDA cleared PdG test kit to confirm successful ovulation at home.
PdG tracking offers a more complete ovulation picture
Remember that pesky progesterone blood test we briefly mentioned? Serum progesterone tests can also confirm if ovulation did or did not occur. However, blood tests may not offer the most accurate picture of your ovulation, especially if it is just a single blood sample.
The issue with measuring serum progesterone is that testing cannot determine the “quality” of ovulation as it only show levels at a single point in time, and progesterone is released into blood in pulsations. Studies show progesterone values fluctuate up to eight- fold during a 90-minute period. For example, from 2.3 to 40.1 ng/mL during a 24-hour period.
This means that if you go to a lab to have a blood test at 7 am, you may get a very different progesterone level than if you were to test at 5 pm. Serial serum progesterone levels may provide more information; however, it is impractical for most people to obtain blood draws on multiple days in the same cycle. As a result, using blood progesterone testing only could give you an inaccurate assumption about the quality of your ovulation or the quantity of your progesterone production.
PdG testing, on the other hand, allows and encourages you to start testing your PdG levels daily on days 7-10 after peak fertility to ensure your levels are consistently at an adequate level. It has been also proven that PdG levels in first morning urine are not subject to the fluctuations of the progesterone in blood. By reflecting more of an “average” of what the progesterone serum levels were the previous day, the PdG test offers a fuller picture of your levels over time.
What can I do if my PdG levels are low?
First and foremost, if you observe anything less than four positive Proov tests, we recommend consulting your doctor to find the best treatment plan for you. If you never get a positive Proov test, and if Proov appears the same when comparing the before ovulation baseline to post ovulation testing, we recommend consulting your doctor as this could be a sign of anovulation.
Some natural treatments for low PdG levels include:
- Seed cycling: Supplementing your diet with 4 different types of seeds, in different moments of your cycle: pumpkin, flax, sesame and sunflower
- Herbal supplements: Adding herbals such as vitex, maca, or red raspberry leaf to your regimen can help boost PdG levels. Before adding herbal supplements, we recommend consulting your doctor.
- Diet changes: Some foods have been shown to increase PdG production, such as beans, broccoli, and pumpkin, among others.
If you prefer to go the medical route, we recommend consulting your doctor who may be able to prescribe you progesterone supplements or ovulation inducing medication.
PdG testing gives you a more complete ovulation picture as it allows for non-invasive testing over several days. With Proov, you can confirm successful ovulation and be one step closer to reaching your fertility goals!