Progesteron Levels

I Have PCOS and finished my second cycle of Clomid on September 7th 2009...I went in for a CD21 Progesterone test and last month it was 26.48 and this month it was 14...The ME said that I did not ovulate with that level and that I had to have my period and then go on October 12th for a U/S to see if there was even a folicle and if not then up my dose from 50MG to 100MG and check every month till I get a folicle...I am a little confused because I have read many things saying that unmedicated your level should be anywhere above 10 and medicated they like to see at 15 or above but it doesn't mean you didn't ovualte...Can you help me maybe sort this out...I am a little confused....

[Elaine Brown, MD]

Hi!
A level of 14 seems pretty good to me!  I have seen women with levels of 1.2 etc.  It may be that because of your PCOS you are not producing one dominant follicle that is large enough to rupture, but rather lots and lots of small immature follicles that are big enough to produce progesterone but not big enough to be released and fertilized.  
I do think that it is worth your while to do some mid cycle ultrasounds to check to see what is going on--you should have one or two dominant follicles maturing around cycle day 11 or 12 if you are going to ovulate and conceive on cycle day 14.
It may be that you need to go to IVF if you are not responding well to oral medications.
Women with PCOS often produce lots and lots of tiny immature follicles in response to the medications rather than one or two "good" ones.  Another possibility is a GnRH pump, but try the clomid first (or ask about Femara--the data is pretty good).
Good luck!
Dr B