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Have Mild PCOS And Decreased Level Of Progesterone. Suggest The Tests To Be Taken

Posted on Tue, 10 Dec 2013

Question: Hi, Please let me know what parameters to test/ how to do a complete hormonal assessment for a cycle. I have mild PCOS and suspect decreased level of progesterone is coming in the way of getting pregnant.

Answered by Dr. Shehzad Topiwala (8 hours later)

Brief Answer: Clarification Detailed Answer: Before I proceed to answer your question, I need to clarify a couple things: I see your gender listed as male. Shall I assume this is a typographical error? Also, I would like to know if your menstrual cycles are regular or not.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (1 hour later)

Yes, I had chosen to consult an endocrinologist and the question was picked up by OB/GYN...I got that transferred and looks like the "user selected category" and "gender" has been altered in the process by the concerned person. This is unfortunate... Anyways, going forward. Yes , the cycles are mostly regular (28-29) days except one time when mid cycle bleeding had occurred. Initially after the miscarriage, my cycles were irregular for few months. I suspect progesterone deficiency is preventing pregnancy because early HPT testing reveals faint second line, which means fertilization may have occurred, but implantation is not happening maybe. I am not sure which day to test in the cycle and what parameters.

Answered by Dr. Shehzad Topiwala (14 minutes later)

Brief Answer: Progesterone Detailed Answer: Thank you for the clarification. So I see your cycles are regular. In this situation, in order to determine absence of ovulation, I generally obtain a serum progesterone level from day 20-24 of the cycle and presume the cycle is 'oligo-anovulatory '(infrequent to absent ovulation) if the level is lower than 3-4 ng/ml. In general, the following tests are relevant to the correct diagnosis of PCOS: Hemogram Electrolytes Liver function tests Kidney function tests HbA1c Lipid profile TSH Free T4 Prolactin 17 hydroxy progesterone IGF1 Additional testing, if necessary, is at the discretion of the treating physician.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (2 hours later)

Thanks, My day 29 progesterone level was 2.9 ng/ml. Does this suggest anything. I will get the day 20-24 testing done next cycle. In case there is progesterone deficiency, can you please suggest any over the counter progesterone cream/supplement which I can take after ovulation takes place. I had once taken duphaston on ob/gyn's advice but I read a lot of negative things about it on internet, that it is FDA grade C drug etc and not prescribed by doctors abroad. Though I did take it from day 18 onwards it resulted in early cycle.

Answered by Dr. Shehzad Topiwala (2 hours later)

Brief Answer: No over the counter treatment Detailed Answer: Reproductive endocrinology is a complex science. Over the counter products are not an option. It requires considerable finesse and expertise to manage ovulation related matters. Duphaston is a type of progesterone. I would not recommend any treatment modality at the moment. It is not a good idea to try and interpret the day 29 progesterone. The result obtained from the correct way of doing it, is more worthwhile to address.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (9 minutes later)

Thanks, As you had said earlier : "cycle is 'oligo-anovulatory '(infrequent to absent ovulation) if the level is lower than 3-4 ng/ml.", I will go ahead with the testing first. In case it is less that this level at that point(day 20 to 24), please suggest what line of treatment will be best. I would not take the medicine unless prescribed by a doctor in person, but I need to be informed about the best way. Is duphaston good if the ob/gyn prescribes again?.Is there any other medicine/better solution. Please let me know.

Answered by Dr. Shehzad Topiwala (2 hours later)

Brief Answer: Pregnancy Detailed Answer: If the progesterone test suggests lack of ovulation then there is a systematic way to approach the condition. The first is to attempt modest weight loss in those who are either overweight or obese. Then guidelines recommend the use of clomiphene. Some advocate metformin, thiazolidenediones, aromatase inhibitors and finally there are gonadotrophin regimens. These are all fairly complex management programs. An online forum cannot do justice to this highly specialized domain of medicine that evolves into Assisted Reproductive techniques such as in vitro fertilization. I strongly advise you to seek a detailed consultation with an endocrinologist in person as soon as you retrieve the day 21 progesterone

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar