The way around this is to comment "Adequate luteal
function" for day 21 progesterone of > 30 nmol/L and
"Sub-optimal luteal function" for levels 20 - 29
nmol/L and "Inadequate luteal function for levels < 20
nmol/L. The inference from the latter is, that
ovulation may occur but subsequent luteal function may
not be sufficient to induce endometrial decidual
changes to support a fertilised ovum.
regards.
--- Brian Senior <[log in to unmask]> wrote: > I
recently had a convoluted dicussion with a
> consultant gynaecologist about
> the interpretation of progesterone results.
>
> The problem arose because of the comment on our
> reports which reads
> "Progesterone results between 30 and 80nmol/l on day
> 21 of a 28 day cycly
> are consistent with ovulation". The question arose
> "What does a
> progesterone result of 20nmol/l mean?".
>
> Clearly, any result of 20nmol/l in a patient
> overwhelmingly suggests
> luteinisation rather than other rare causes
> (Granulomas etc). Also
> luteinisation is predominantly associated with
> ovulation; a quick Medline
> search indicates that luteinisation without
> ovulation occurs in no more
> than 10% of cycles and that where this happens the
> same patient is likely
> to ovulate in the next cycle.
>
> Thus, a result of 20nmol/l is also "consistent with
> ovulation" and in terms
> of probability is best taken to indicate ovulation
> rather than anything
> else. So what is the lowest progesterone
> concentration for which a report
> could indicate that the probability of ovulation
> outweighs the probability
> of non-ovulation?
>
> The problem with our current comment is that while
> it is true, the inverse
> of the comment is not. This is leading some
> clinicians to draw the wrong
> conclusions (the gynaecologist says it is his GP
> colleagues who are
> confused!). How do others get round this problem?
>
>
> Brian Senior
> Department of Clinical Chemistry,
> Royal Bolton Hospital,
> BOLTON, Greater Manchester.
=====
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
Whiston Hospital
Prescot
Merseyside L35 5DR
UK
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