Serum progesterone in nonpregnant women

Minimum values for midluteal plasma progesterone and estradiol concentrations in patients who achieved pregnancy with timed intercourse or intrauterine insemination without a human menopausal gonadotropin

Objective

The aim of the study was to assess the lower limits of midluteal plasma progesterone and estradiol concentrations in patients who achieved pregnancy with timed intercourse or intrauterine insemination without a human menopausal gonadotropin stimulation.

Results

We included 297 pregnant cycles of 297 women and assessed midluteal plasma progesterone and estradiol concentrations and pregnancy outcomes, retrospectively. These cycles were compared with the non-pregnant cycles (406 cycles) of the same women who became pregnant. Mean midluteal plasma P4 and E2 concentrations were significantly (P < 0.01) higher in pregnant cycles (14.5 and 188.5 pg/mL) than in non-pregnant cycles (10.7 and 162.6 pg/mL). The 5 percentiles of progesterone and estradiol in pregnant cycles were 5.6 and 70.2 pg/mL, respectively. The lowest progesterone and estradiol levels in pregnant cycles were 2.3 and 23.4 pg/mL, respectively. In non-pregnant cycles, many women had low P4 levels that were less than 5.6 ng/mL. Subgroup analyses showed slight differences among the four groups, which may have been due to the ovarian function of each group. Miscarriage was not related to progesterone and estradiol concentrations. These values may be useful for the evaluation of necessary values for pregnancy with timed intercourse or intrauterine insemination.

Accuracy of calendar-based methods for assigning menstrual cycle phase in women

Background:

Sex steroid hormone fluctuations during the menstrual cycle are considered a risk factor for noncontact anterior cruciate ligament injuries.

Objective:

To determine whether self-reported menstrual history data can be used to accurately categorize menstrual cycle events using calendar-based counting methods.

Study Design:

Descriptive laboratory study.

Methods:

Seventy-three women completed a menstrual history questionnaire and submitted to blood sampling for the first 6 days of menses and 8 to 10 days after a positive ovulation test over 2 consecutive months. Frequency counts determined whether appropriate criterion hormone (progesterone) levels were achieved at predefined calendar days.

Results:

For the criterion of progesterone >2 ng/mL, 18% and 59% of women attained it when counting forward 10 to 14 days after the onset of menses and counting back 12 to 14 days from the end of the cycle, respectively. Most women (76%) attained the criterion for ovulation 1 to 3 days after a positive urinary ovulation test. Regardless of the counting method employed, the criterion of progesterone >4.5 ng/mL for identifying midluteal phase was attained in 67% of cases. Serial blood sampling for 3 to 5 days after the positive urinary ovulation test captured 68% to 81% of the hormone values indicative of ovulation and 58% to 75% indicative of the luteal phase.

Conclusion:

These data suggest that self-reported menstrual history and calendar-based counting methods should not be used alone if accurate identification of ovulation is essential. A urinary ovulation test and serial blood samples for verification of progesterone postovulation enhance the proper identification of menstrual cycle events.

Clinical Relevance:

Given the cost of serial blood sampling on numerous days, the use of urinary ovulation kits and strategically selected serial blood sampling could significantly reduce participant burden and provide cost-effective measures for clinical studies related to anterior cruciate ligament injury epidemiology.

Reference values for the midluteal plasma progesterone concentration: evidence from human menopausal gonadotropin-stimulated pregnancy cycles

OBJECTIVE

To determine reference values for the midluteal plasma progesterone concentration.

DESIGN

Retrospective analysis.

SETTING

Infertility clinic at an academic medical center.

PATIENT(S)

One hundred ninety-two infertile women who became pregnant after induction of ovulation with hMG.

INTERVENTION(S)

The plasma progesterone level was measured during the midluteal phase of the hMG treatment cycle.

MAIN OUTCOME MEASURE(S)

The midluteal plasma progesterone concentration was correlated with the outcome of the pregnancy.

RESULT(S)

In this cohort of 192 women in whom ovulation was induced with hMG and 5,000 IU of hCG, the mean midluteal plasma progesterone concentrations were 29.07 ng/mL, 25.85 ng/mL, 31.49 ng/mL, 41.39 ng/mL, and 28.64 ng/mL in all cycles that resulted in pregnancy, cycles that resulted in full-term singleton pregnancy, cycles that resulted in full-term multiple pregnancy, cycles that resulted in preterm pregnancy, and cycles that ended in miscarriage, respectively. There was no statistically significant difference in the progesterone concentration 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 and those that resulted in multiple pregnancy. The minimum value that was compatible with a full-term pregnancy in this cohort of women was 10.83 ng/mL.

CONCLUSION(S)

In a cohort of 192 women, the minimum plasma progesterone concentration on day 7 in women who attained a full-term pregnancy after induction of ovulation with 5,000 IU of hCG was 10.83 ng/mL.

Plasma progesterone levels as an index of ovulation

Plasma progesterone levels were measured in three groups of untreated women. (1) Nine women with follicle rupture, proved by laparotomy or laparoscopy, had values of greater than or equal to 40 nmol/l on days 18-24 (days-10- -5 from the next period); thus a value of less than 40 nmol/l should not be taken as evidence of ovulation. (2) Nineteen healthy women with normal menstrual histories had hormone assays on alternate days during one cycle. In five of them all values were less than 38 nmol/l. (3) Forty women had a single progesterone assay on days 20-29 of a conceptual cycle. Eight of them had a level less than 40 nmol/l. Ovulation had certainly occurred in all of them, but it is difficult to assess whether the sample timing was optimal since there was no following menstrual period. Progesterone levels in drug-induced conceptual cycles were in general higher than those in spontaneous pregnancy cycles. Women with luteinization of the unruptured follicle frequently had values of greater than 40 nmol/l. Conversely, a secretory endometrium was not uncommon in cycles with values of less than 38 nmol/l.

Time-course relationships between serum LH, serum progesterone and urinary preganediol concentrations in normal women

A specific and sensitive gas chromatographic method was used to investigate the concentration of pregnanediol glucuronide in urine in relation to the time of ovulation. Serum LH and progesterone concentrations in the same subjects were used as evidence for the occurrence of ovulation. The urinary concentration of pregnanediol glucuronide in 24-hour collections and in overnight specimens increased 2-fold or more from the day of the midcycle LH peak to the time of predicted ovulation (24-48 hour after the LH peak) in parallel with the rise in serum progesterone concentration.

Plasma progesterone in women with a history of recurrent early abortions

Basal body temperature, vaginal hormonocytology, and plasma progesterone concentrations were studied serially in consecutive menstrual cycles of 8 normal subjects and of 10 patients with a history of recurrent early abortions. The menstrual patterns and characteristics of basal body temperature of the patients did not differ significantly from those of control subjects. The mean plasma progesterone concentrations at the midluteal phase of the study cycles of three patients were below those of the lower limit of the control group (4 ng/ml). The results of this study support the conviction that an inadequate luteal phase is more likely to occur in women with a history of recurrent early abortions.