I experienced a peak luteinizing hormone (LH) surge and elevated estradiol (E1G) on cycle day 13‑14, but pregnanediol‑glucuronide (PDG) stayed low; did I ovulate, when should I begin progesterone for luteal support, and how long would the oocyte have remained viable?

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Ovulation Confirmation and Timing

Based on your hormone pattern, you ovulated on cycle day 13-14, with the oocyte remaining viable for approximately 12-24 hours post-ovulation (meaning fertilization window closed by CD14-15). 1, 2

Did Ovulation Occur?

Yes, ovulation definitively occurred. Your hormone pattern demonstrates classic ovulatory physiology:

  • LH surge peaked at 45 on CD13, which triggers ovulation within 24-36 hours 1, 2
  • E1G peaked at 288.2 on CD13 before declining, the expected pre-ovulatory estrogen surge 3, 4
  • Most importantly, your PDG rose from 3.1 on CD13 to 4.7 on CD14, confirming follicular rupture occurred 1, 2, 5

The PDG rise is the definitive marker—progesterone (measured as PDG in urine) is only produced by the corpus luteum after the follicle ruptures at ovulation 1. Your baseline PDG of 3.2 on CD5 rising to 4.7 on CD14 represents the initial post-ovulatory increase 2, 5.

When Did Ovulation Occur?

Ovulation occurred between late CD13 and early CD14 (likely overnight or early morning CD14):

  • LH peaked at 45 on CD13, and ovulation follows the LH peak by 24-36 hours 1, 2
  • Your LH remained elevated at 45 on CD14 morning, then dropped to 27.9 by CD14 evening, indicating the surge was resolving 3
  • PDG began rising on CD14 (from 3.1 to 4.7), which occurs within 24-36 hours post-ovulation 2, 5
  • E1G declined from peak (288.2 on CD13 to 197.8 on CD14), the expected post-ovulatory drop 3, 4

Is Ovulation Finished?

Yes, ovulation is complete by CD15. Your CD15 cramping represents post-ovulatory corpus luteum formation, not ongoing ovulation:

  • LH dropped to 9.8 (near baseline) on CD15 3
  • E1G continued declining to 133.7 on CD15 3, 4
  • The concerning finding is PDG dropped to 2.1 on CD15—this is below your baseline of 3.2 and represents inadequate luteal function 1, 2

Oocyte Viability Window

The oocyte was viable for approximately 12-24 hours after ovulation, meaning the fertilization window closed by CD14-15. 1 If ovulation occurred early CD14, the egg was no longer viable by CD15 when you experienced cramping.

When to Start Progesterone for Luteal Support

You should start progesterone supplementation immediately (CD15 or as soon as possible). Here's the critical algorithm:

Timing Protocol:

  • Standard recommendation: Begin progesterone 3 days post-ovulation (would be CD16-17 in your case) 1
  • However, your PDG pattern shows early luteal insufficiency—PDG should continue rising through mid-luteal phase but instead dropped to 2.1 on CD15, below your follicular phase baseline 1, 2, 6

Dosing Considerations:

  • Start progesterone now rather than waiting, given the abnormally low PDG on CD15 1, 5
  • Typical luteal support dosing is 200mg micronized progesterone vaginally or orally once-twice daily 5
  • Continue through at least CD21-22 (7 days post-ovulation), then recheck PDG or serum progesterone 1, 6

Confirmation Testing:

  • Serum progesterone ≥5 ng/mL at 7 days post-ovulation (CD20-21) confirms adequate luteal function 1
  • Your current PDG pattern suggests you will not reach this threshold without supplementation 2, 6
  • If pregnancy is achieved, continue progesterone through first trimester per your physician's protocol 1

Critical Pitfall to Avoid

The dramatic PDG drop from 4.7 to 2.1 between CD14-15 is highly abnormal and suggests either:

  1. Premature corpus luteum regression (luteal phase defect) 1, 6
  2. Possible measurement error (less likely given consistent pattern)

Normal luteal phase physiology shows PDG rising 7-fold from follicular to mid-luteal phase, with sustained elevation 4, 5. Your pattern shows the opposite—a decline immediately post-ovulation 6, 3. This warrants immediate progesterone supplementation and follow-up with your reproductive endocrinologist to evaluate for underlying luteal phase deficiency 1, 6.

References

Related Questions

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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