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From: JOHN SETH <[log in to unmask]>
To: Brian Senior <[log in to unmask]>
Subject: Re: Reference Range for Progesterone
Date sent: Mon, 17 Jul 2000 15:02:43 +0000
Hi Brian
We take a fairly simple-minded, but I believe practice- orientated
approach to this problem. Essentially the question is whether the
infertile patient with cycles is likely to require ovulation induction
therapy to achieve pregnancy, or whether no, or other interventions
are needed.
Our approach is based on the data from Hull et al, Fertil. Steril.
37:355, 1982. Their conclusions were:
1. The lowest single mid-luteal serum prog level in at least 1 of 2
cycles in which pregnancy was achieved without treatment was 28
nmol/L.
2. In clomiphene or gonadotrophin-treated cycles, a higher level of
progesterone was needed to achieve pregnancy.
So our practice is to indicate (where appropriate) on our reports
that a level of 30 nmol/L (approximated from 28) or higher in one or
more cycles is predictive of preganacy without the need for
ovulation induction. It follows that levels less than this are predictive
of a lower probability of pregnancy without ovulation induction.
You may say that we are ducking the issue as to whether a level of
20 is indicative of ovulation or not, but I don't believe there any data
to support firm statements on this. Thus there may be luteinisation
without ovulation (unruptured follicle) or ovulation with imperfect
luteinisation.
There are data in the literature attempting to define the lower limit
of progesterone in normal cycles, (Wathan et al, 1984, Ginsburg
1992) and the figures range from 8 to 45 nmol/L. I think their basis
is very shaky. I think it much more useful to interpret the
progesterone level in terms of the probability of need for ovulation
induction, rather than trying to answer the more academic point of
ovulation or not.
I'd be interested in your comments, and of others that you might
receive
Best wishes
------- End of forwarded message -------
John Seth, PhD.
Clinical Scientist
Dept of Clinical Biochemistry
Lothian University Hospitals NHS| Trust
The Royal Infirmary of Edinburgh
Lauriston Place
Edinburgh
EH3 9YW
Scotland, UK
Tel +44 (0)131 536 2706
FAX +44 (0)131 536 2765
Mobile 041 103 1811
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