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    An_253631 posted:
    I was placed on birth control pills at 15 due to heavy periods. I am now 25 years old and haven't had a period in several years. I am trying to conceive and after 1 round of chlomid and 2 of femara (and provera each time to start a period) I have been referred to a fwertility clinic due to ovulation problems. On the last round of femara I was given an ultrasound after a positive reading with the ovulayion predictor and the gynecologist saw the eggs getting ready to come out and told me I was responding well. i was given a progesterone test 11 days later and it surprised the doctor that the level was low. I was tested weekly twice more with the same result. Could the first progesterone test (after a positive opk) at 11 days have been too late to test leaving the possibility that I could have ovulated? I have had a complete fertility work up and all tests have come back normal.
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    Susannah D Copland, MD, MS responded:
    An_253631,
    Working through ovulation problems can be very frustrating, however the ability of your gynecologist to see the egg containing follicles approaching ovulation on your ultrasound is promising. After a true positive ovulation predictor indicating the LH surge that kicks off ovulation, you should either have a period or a pregnancy. If the progesterone level was low at 11 days after surge and you had a spontaneous period in the days following the blood test, then you may have ovulated and missed the time of highest progesterone. If your progesterone was low after surge and you did not have a spontaneous period, you likely had a false positive ovulation predictor. Your fertility doctor will likely want to adjust your medications to push harder for ovulation. These medication adjustments may involve increasing the dose of your pills or adding injections. In cases where ovulation predictor tests are not reliable, you may choose to use an injection of hCG to trigger ovulation. The fact that your ultrasound is showing ovarian response is very promising and I hope that you will be ovulating soon.
    All best wishes,
    Susannah Copland


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