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EDITOR-
We have been following the recent 'ABC of subfertility' series with
interest. We are keen to clarify a point raised in the article on
anovulation by Hamilton-Fairley and Taylor(1). The article advised that
progesterone may be measured in the mid-luteal phase of a woman's
menstrual cycle to confirm that ovulation has occurred. NICE fertility
guidelines(2), currently under review, make a similar statement. As
straightforward as this recommendation seems, it is our experience that
many doctors give inaccurate advice to women about when to attend for such
a test. In particular, we find that the misleading term 'day 21
progesterone' is still commonly used.
We asked 34 Specialist Registrars attending a regional obstetrics and
gynaecology training day what instructions they would give to a patient
with an irregular cycle of 30-42 days. 12 trainees (35.3%) answered
correctly.
Firstly, the importance of timing the blood sample correctly should
be explained to the woman. She should be told that the sample of interest
ideally needs to be taken 7 days before her next period. She should be
asked to provide samples that allow for variation in her cycle length, for
example, days 23,26,30,33 and 35. Secondly, she must record the date of
the first day of her subsequent period. The results of mis-timed samples
may then be ignored.
It is unlikely that a woman with a regular cycle is anovulatory(3).
Women with irregular cycles often have polycystic ovaries(4), but the
great majority of these will still ovulate. All too often, mis-timing of
samples from women in this latter group leads to the inappropriate
administration of clomiphene citrate, increased anxiety, and delay in
referral to assisted conception.
We strongly believe that the term 'day 21 progesterone' is now
obsolete, and that persistence in its use is detrimental to the management
of subfertility.
1. Hamilton-Fairley D, Taylor A. Anovulation.BMJ 2003; 327:546-9
2. Fertility: assessment and treatment for people with fertility
problems. NICE guideline, second draft for consultation 2003
3. Malcolm CE, Cumming DC. Does anovulation exist in eumenorrheic
women? Obstet Gynecol 2003;102(2):317-8
4. Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries- a
common finding in normal women. Lancet 1988; 1(8590):870-2
Competing interests:
None declared
Competing interests:
No competing interests
03 December 2003
Emma L Sowerby
Clinical Fellow
John Parsons - Senior Lecturer/Honorary Consultant
Assisted Conception Unit, Kings College Hospital, London SE5 9RS
Timing of progesterone assays to detect ovulation
EDITOR-
We have been following the recent 'ABC of subfertility' series with
interest. We are keen to clarify a point raised in the article on
anovulation by Hamilton-Fairley and Taylor(1). The article advised that
progesterone may be measured in the mid-luteal phase of a woman's
menstrual cycle to confirm that ovulation has occurred. NICE fertility
guidelines(2), currently under review, make a similar statement. As
straightforward as this recommendation seems, it is our experience that
many doctors give inaccurate advice to women about when to attend for such
a test. In particular, we find that the misleading term 'day 21
progesterone' is still commonly used.
We asked 34 Specialist Registrars attending a regional obstetrics and
gynaecology training day what instructions they would give to a patient
with an irregular cycle of 30-42 days. 12 trainees (35.3%) answered
correctly.
Firstly, the importance of timing the blood sample correctly should
be explained to the woman. She should be told that the sample of interest
ideally needs to be taken 7 days before her next period. She should be
asked to provide samples that allow for variation in her cycle length, for
example, days 23,26,30,33 and 35. Secondly, she must record the date of
the first day of her subsequent period. The results of mis-timed samples
may then be ignored.
It is unlikely that a woman with a regular cycle is anovulatory(3).
Women with irregular cycles often have polycystic ovaries(4), but the
great majority of these will still ovulate. All too often, mis-timing of
samples from women in this latter group leads to the inappropriate
administration of clomiphene citrate, increased anxiety, and delay in
referral to assisted conception.
We strongly believe that the term 'day 21 progesterone' is now
obsolete, and that persistence in its use is detrimental to the management
of subfertility.
1. Hamilton-Fairley D, Taylor A. Anovulation.BMJ 2003; 327:546-9
2. Fertility: assessment and treatment for people with fertility
problems. NICE guideline, second draft for consultation 2003
3. Malcolm CE, Cumming DC. Does anovulation exist in eumenorrheic
women? Obstet Gynecol 2003;102(2):317-8
4. Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries- a
common finding in normal women. Lancet 1988; 1(8590):870-2
Competing interests:
None declared
Competing interests: No competing interests