In ART proactive initiation of stimulation
is not commenced till serum progesterone is below < 0.9 ng /ml. If stimulation
s started then there will be improper growth
of follicle.. The rate fall of P from cycle day 1 to day 5 has been worked
out: The reason as to why P value was
high in absence of demonstrated CL Cyst in some cases is as
viewed in basal scan is possibly due to
the fact that good no of Luteal cells of last cycle is still physiologically
& endocrinologically active and is secreting progesterone(improper or tardy
luteolysis). . .This may be a reflection
/ sequence of continued LH hyperactivity .In fact there is a separate chapter on “Progesterone
during COH in the book titled” Ovarian stimulation” Ed by Mohamed
Aboulghar & Botros Rizk –Cambridge
University Press “ Chapter no 8. One may read if time permits.
When to initiate Stimulation if
P value on day 3 is high? I fully agree
with Dr. Palak Sir, though many of us will be hesitant to initiate Ovulation
induction when P vale on day 2/3 exceeds> 0.9 ng. /ml (so called cut off
value).because there will be reduced rate of Foll development. The rate of fall
of P level has been aptly described in the book titled “Manual of IUI &
OI”-Ed Richard P Dicey- published by Cambridge University Press from 4843/24, 2nd
floor, Ansari Rd, Daryaganj, and New -in Delhi-1100 002. In pp.73 (Chapter 7).
How long one should defer initiation of
Stimulation if P value is above the arbitrary level of 0.9 on day 3? What harm
may ensue if we make delay intuition of stimulation??The fall in normal cycles,
PCOS women & and in women who exhibit persistent of CL have also been
mentioned there. Normally what happens is that e2 LEVEL DOUBLES EVERY 2 DAYS
BUT P VALUE DECREASES BY 50% PER DAY DURING EARLY Foll phase of the cycles.
Many recommend delaying the initiation of stimulation for couple of days till P
value comes to reasonably low level. (Say around 0.9 ng in absence of Ov cyst
< 10mm as was in this case.
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