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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 yrs experience, awarding winning educator
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I am 42 and hve two children who are 4 and 2. We never

Customer Question

Hi
I am 42 and hve two children who are 4 and 2. We never had any trouble getting pregnant but as I am over 42 I thought I should do a few tests. I got my FSH level taken on day 2 of my cycle and it was 10. I also got my LH tested and it was 8.1. I was wondering if you could tell me how this rates and if you think it would be good enough to allow me to get pregnant. My periods range between 29-31 days. I got my progesterone tested on day 21 last month and it was reading 23. Possibly I tested too early as my cycle that month was 31 days. I am having an AMH level done next week. I would appreciate your opinions on these results. Should I check the progesterone again this month. I am currently in dsy 20
Thanks.
Submitted: 7 months ago.
Category: OB GYN
Expert:  Dr. C. replied 7 months ago.
Hi, It's Dr. C. Board certified Ob-gyne. I can help you today. I'm sorry to hear about the trouble getting pregnant. The most reliable ways to check on "ovarian reserve" are the day 3 FSH and estradiol levels and the AMH level. I wonder if they can run an estradiol level off the blood that was already done on day 2. The difference between day 2 and day 3 isn't huge, but the reference ranges are determined using day 3 values. An FSH level of 10 is just slightly high, we prefer below 9. So what I can say so far is that there is too little information to tell yet whether poor ovarian reserve is the problem or not. An estradiol level from day 3 and the AMH level would be most helpful. The progesterone level looks good and does indicate that you did ovulate the cycle it was drawn. Sometimes it's also helpful to get a day 3 ultrasound to measure ovarian volume and resting antral follicle count. I hope this was helpful so far. Please reply if I can clarify anything or add more details.
Customer: replied 7 months ago.
My doctor thought a level of 23 for progesterone was low. I did it on day 21 but I am a 30-31 cycle.
Should I do it on day 23-24?
She also said the AMH will tell a lot and didn't seem concerned about checking progesterone again or mention estradiol test.
Will the AMH tell us enough?
We have only been trying a month but wanted to get checked out just in case so there maybe no issue.
Expert:  Dr. C. replied 7 months ago.
Here is a link to the guideline for an evidence based (supported by research) way to test for ovarian reserve: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Ovarian-Reserve-Testing Day 3 FSH and estradiol levels plus AMH are the typical tests. The Day 3 ultrasound can add some information. The progesterone level is a looser indicator of ovulation. Your level seems reasonable. But the reference ranges are determined by the lab running the test, so perhaps the lab that ran your test has higher reference ranges. You can tell this by seeing an actual copy of the report. The reference ranges are listed on the report. The AMH level and estradiol level on day 3 would be the minimum that I would order for ovarian reserve testing. I try to follow the guidelines. Anything else I can help with today?
Customer: replied 7 months ago.
If my AMH results are good does that mean my progesterone levels are ok too. My friend had to take progesterone tablets as she was getting pregnant but not holding onto it as her prog was too low and lining was not thick enough.
If AMH shows a good result is that all I need worry about?
Expert:  Dr. C. replied 7 months ago.
Unless there is a history of previous miscarriages, we usually wouldn't supplement with progesterone when there is a spontaneous pregnancy (without fertility help). But if your doctor suggested supplementing with progesterone, it would not be harmful. Many doctors do add progesterone supplementation in older women because of the idea of "luteal phase defect". Research evidence for the existence of luteal phase defect is not strong. But often we take a "better safe than sorry" approach and supplement older women or women undergoing any fertility treatments at all. because it is not harmful and it could possibly be helpful in preventing miscarriage. I hope that's not too confusing of an explanation.
Expert:  Dr. C. replied 7 months ago.
Anything else?
Customer: replied 7 months ago.
So if AMH is good. Should I just leave it at that and just keep trying
Expert:  Dr. C. replied 7 months ago.
Yes, and if not pregnant within 6 months of having sex 2-3 times weekly, full work-up. Anything else?
Expert:  Dr. C. replied 7 months ago.
If no more questions, please leave a rating for my service. I aim for excellent and appreciate your feedback. Thanks and good luck. I hope you find yourself pregnant soon.

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