QuestionDear Dr. Ramirez,
I had clomid and HCG trigger after ultrasound showed a 22mm follicle. Got my progesterone lvel checked today and it was only 2.33ng/mL as opposed to 2.5 and above. I'm really concerned that I did not ovulate even after the rigger since you mentioned before that it is very rare to not do so after a trigger. What could be wrong with me and what should I do?
Thanks a lot!
TY
AnswerHello,
Clomid can cause a luteal phase defect, which is inadequate progesterone production after ovulation. Usually if you ovulate, the ovulatory follicle turns into a corpus luteum cyst and this cyst produces progesterone. That is why the level elevates and the reason for the temperature elevate in a temperature chart. If the CL does not form or work correctly, then the progesterone will not elevate. This can be caused from a lack of ovulation, which can occur in a Clomid cycle despite the HCG trigger, or due to suppression from the Clomid. For this reason, I ALWAYS supplement a Clomid cycle with progesterone.
If in fact you did not ovulate, then you will not have a menses. If you have a menses, then maybe there was something wrong with the progesterone test or you have a luteal phase defect. If the latter, then you should supplement with progesterone (Crinone 8%, Prochieve 8%, Prometrium 100mg or Endometrin 100mg) in the next cycle.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
check out my blog at http://womenshealthandfertility.blogspot.com
