HCG shot on day 15 - blood check day 21, low progesterone?

[thegeeter]

Hi - first forum, so bear with me if I posted in the wrong area! I have been TTC #2 for the past 7 mo now, I had my first child naturally and I have PCOS.
We both checked out "fine" except I have PCOS and do not know when I ovulate (the OPK's do not work for me, they kept telling me day 17 / 18 and an u/s showed that I had ovulated earlier than day 17 / 18).

This month was my first time using clomid (50mg day 5-9). I went in on day 13 and the 3 follicles were not ready. Day 15 - 2 were ready and 1 was not viable. I had the HCG novarel shot on Friday - BD'd on Friday, Sat., and Sun., (noticed EWCM on Monday AM but it was gone by Monday afternoon).

Day 21 I went to get my labs and they called back (today, day 22) and told me that my progesterone was low (5.4) and I most likely did not ovulate. However, I could have been a late ovulator, they are not sure. Anyone have any insight? Did I not ovulate at all with this shot? Is there even a chance I could be pregnant this cycle? Are those blood labs accurate? Thanks so much -

[Elaine Brown, MD]

Hi!
While your progesterone is not optimal, I usually consider any level above 2 to be evidence of ovulation.  I don't suppose they did an ultrasound to confirm ovulation--sometimes this can be done on day 20 or so to look for the corpus luteum cyst that should form after ovulation.

In most cycles resulting in pregnancy, the progesterone level is higher, so I suspect that you didn't get lucky this time around, but I have been wrong more times than I like to admit!  I usually advise waiting until the period is missed before checking a pregnancy test.  Since you are taking Clomid on days 5-9, your period should begin on day 30.  IF is does (or even better if you are pregnant) it is good evidence that you ovulated.
You may wish to ask your RE what he/she thinks about luteal phase insufficiency.

Good luck!
Dr B

[thegeeter]

Thanks for your response. I will ask my Dr. about the luteal phase insufficiency. The Dr. would like to move my dosage up to 100mg, would you advise this? They did not do a post ovulation ultrasound, just utilized the blood work from day 21 (which I suspect was at max 5 days post ovulation).

What are some treatment options with luteal phase insufficiency?
Thanks again,