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01 Aug 2007

Progesterone results
Dear Dr. Cassim,

I am very confused and concerned.

I've had my first IUI this cycle, this was the procedure I followed:

Jul 09: CD 1: Mestruation started
Jul 12: CD 4-9: Menopur injections
Jul 18: CD 10: Scan, there was one follicle of 17.5mm and a smaller one
Jul 19: CD 11: Trigger shot at 06h45 (Ovidrel)
Jul 20: CD 12: IUI
Jul 21: CD 13: IUI
Jul 22: CD 14: Started Cyglogest 200mg 1 at night
Jul 30: CD 22: Progesterone test.

My progesterone test results came back today, it is 9.5, the sister said it's rock bottom low, and that it indcates I did'nt ovulate.

How is this possible?
Does the trigger shot not guarantee ovulation?
Would a stronger dose of Menopur and Ovidrel be advised?
Should I not have more than one mature follice for a better chance at succes?
If I am using cyclogest pessaries, should my progesterone results not have been higher?
Could I suffer from LUFS?
My husband sperm count is ver high 171 Million, but only has 8%% morphology, this should be adequate for IUI right?

I appreciate you time and dedication to this site.

Kind regards,

Angel Face
Answer 1,200 views
Expert
Fertility expert
fertility expert

01 Jan 0001

Dear Angel face

I certainly agree that the progesterone levels should be significantly higher than what was recorded. The possibilility of poor absorption from cyclogest should be considered although the dose that was used is significantly lower than what we would usually advice, ie 200mg 3 x a day.
Despite this, the fact that you were expected to ovulate should have resulted in a higher progesterone level and my impression is that the trigger dose was administered far too early. One has to be absolutely certain that what one is measuring on ultra-sound is infact a follicle, not a cyst of some sort (para-tubal or para ovarian cyst).

In addition, the response to Menopur appears to be sub-optimal and one should investigate the dosage used. In general we use a minimum dosage of 150iui in this particular protocol. However, this dose may need to be increased depending on age and baseline hormone assays. The 8% sperm morphology is well within the range for IUI and hence the choice of treatment is correct.
I would strongly recommend that a re-look of the protocol used is in order and perhaps a more stonger stimulation regiment be considered.
In cases of poor progesterone absorption, the use of IMI progesterone should be considered as an alternative, and perhaps in the next cycle be implemented from the beginning.
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