Conception

Progesterone intake in case of PCOS: answers the expert

Good morning doctor, I am writing to have some clarifications regarding the intake of progesterone before ovulation . In July of this year I was diagnosed with pcos only with ultrasound control, as I am trying to get pregnant I was prescribed inofert.

In September, as agreed, I return to the gynecologist who, however, has moved and entrusts me to a colleague who agrees with the diagnosis but only prescribes hormonal checks on the 3rd day of the cycle. All results normal (she didn’t prescribe me estrogen) except ANDROSTENEDIONE 18.8 nmol / L (int. 1-11.5) which confirms the PCos diagnosis. During the last visit at 17pm he sees a dominant follicle of 14mm and tells me that in about 4 days I will ovulate.
He prescribes progesterone ovules from 14 to 24 days to start immediately despite not having checked progesterone on 21 days because he says I certainly won’t have good values. The point is this (excuse the length): I’ve read progesterone blocks ovulation, so why did you prescribe it to me earlier? At 17 pm she sees that I haven’t ovulated but she still tells me to take it and she knows that I have a cycle that varies from 32 to 40 days and I never ovulate before 17 pm (I’ve been taking TB for 6 months), wouldn’t I risk blocking it? Excuse me but I already know that for us who suffer from pcos it is difficult to get pregnant, I don’t want to complicate things further!
Thank you for your patience and I hope to have an answer soon
Kind regards

Dear Mrs,

you can calmly follow the instructions given to you by your gynecologist as they are correct.
The gynecologist does not have the dosage of your progesterone available on the 21st day of the cycle, however he knows that your cycles can last up to 40 days. From this and from the fact that he has PCOS he can infer that progesterone levels in the second half of the cycle are low.
For this reason he prescribed natural progesterone which is given precisely in women who are trying to get pregnant because it does not hinder ovulation. In fact, in the physiological cycle, progesterone begins to increase already during ovulation, reaching maximum levels about 8 days later. 
Its role is to prepare the lining of the uterus for implantation.
If progesterone was started too late it would not have time to perform its function and pregnancy could not take place.
Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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