We agree with John Seth about a pragmatic approach. We discussed with our
obstetricians and gynaecologists whether we should adopt (for our GPs) a
graded approach to the interpretation of "day 21" progesterones as outlined
in the Royal College of Obstetricians and Gynaecologists Guidelines:
The Initial Investigation and Management of the Infertile Couple
<http://www.rcog.org.uk/guidelines/infertile.html>
This suggests that progesterones in the 16-30 nmol/L range should be
repeated and if the same or lower may be an indication for controlled
ovarian stimulation and referral to specialist. (>30 nmol/L is regarded as
proof of adequate ovulation)
They said that the infertile patient required referral at the earliest
opportunity and they preferred us to use the traditional <10 nmol
"progesterone suggests anovulatory cycle", 11-29 "progesterone equivocal for
ovulation" and >30 "progesterone suggests ovulatory cycle."
Perhaps they had seen the NEQAS data?
Graham Ellis
Clinical Biochemistry, St. John's Hospital
Livingston,West Lothian
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