Progesterone Level Following Tubal Reversal
I am 38-years-old and I have been trying to conceive for one year after undergoing a tubal reversal. Recently my doctor measured my progesterone level in the luteal phase after a 50 mg. dose of clomid. It was 10 ng/ml. My dose of clomid was then increased to 100 mg. and my most recent luteal phase progesterone was 27 ng/ml. My doctors told me not to get excited because this means nothing as far as pregnancy is concerned. Why do they keep basing my clomid and treatment (profasi shots) on what last months progesterone levels are if they don't mean anything?Question:
Multiple techniques are available for the monitoring of clomiphene therapy. Basal body temperature charting, ultrasound monitoring of follicular development, LH kit testing and progesterone levels are used to document development of an adequate follicular cyst and ovulation. Progesterone levels over 3 ng/ml in the luteal phase document ovulation. Progesterone levels are typically greater than 10ng/ml on day 21 of an "ideal" 28 day cycle. Human chorionic gonadotropin is occasionally utilized in clomiphene induced cycles in order to "set" the time of ovulation for insemination or intercourse.
The evaluation of progesterone in clomiphene induced cycles, with ovulation triggered by hCG, or which occurred spontaneously (no hCG, but detected by LH kit testing), revealed no difference in luteal phase progesterone levels after adjusting for patient age. Furthermore, the pregnancy rates did not differ between the hCG and spontaneous LH kit groups, even after adjusting for patient age and number of motile spermatozoa inseminated. Mid-luteal progesterone levels ranged from 20 to 32 ng/ml with an average of approximately 25 ng/ml.
In a study of mid-luteal progesterone levels in human menopausal gonadotropin stimulated cycles given 5000 IU of hCG to trigger ovulation, the average progesterone levels were approximately 20 to 40 ng/ml. There were no statistically significant differences in the progesterone concentrations between the cycles that resulted in full-term pregnancy and those that ended in miscarriage, but there was a statistically significant difference between the cycles that resulted in singleton pregnancy (average 25.9 ng/ml) and those that resulted in multiple pregnancy (average 31.4 ng/ml). The minimum value that was compatible with a full-term pregnancy in this cohort of women was 10.8 ng/ml.
The progesterone level desired in any stimulated cycle appears to be somewhere between 10 and 40 ng/ml. Higher progesterone levels often correlate with the ovulation of more than one mature follicle.
Reversal (tubal reanastomosis) in selected patients can be expected to result in "open" tubes in greater than 85 percent. While there is a risk of ectopic pregnancy (tubal pregnancy) in 2 to 15 percent, approximately 70 percent of couples are expected to achieve an intrauterine pregnancy within one year if the woman is ovulatory and there are no significant sperm defects. A hysterosalpingogram is usually performed within one year of the procedure if pregnancy does not occur.
Patients who have not achieved a pregnancy within one year after tubal reanastomosis should have a hysterosalpingogram. Progesterone levels may be helpful to insure that an adequate ovulation or ovulations have occurred. Dosage adjustments of clomiphene may occur in order to achieve progesterone levels which are within a range known to result in successful pregnancies.Answer: