Brief Answer:
Serum FSH, LH, estradiol and progesterone should be measured

Detailed Answer:
Hello Ma'am

I can certainly understand your concern

I have worked through your attached query in detail

The best predictor of ovulation is estimating the Ovarian reserve.

This is done by measuring the serum FSH and LH on day 3. This is done in addition to the serum estradiol levels on Day 3.

Likewise day 21 progesterone is also an excellent indicator of ovulation.

A low Day 21 progesterone level suggests the cycle was anovulatory (no egg was produced).

Normal progesterone levels at day 21 means:

Good thickness of your endometrium (uterine lining), which means uterus is ready for pregnancy.

Confirm that ovulation has occurred and an egg is successfully produced by ovaries, means no problems in your cycle and you have healthy ovaries.

Normal Progesterone levels after ovulation 7 days post ovulation in average 28 days cycle is > 15 ng/ml, which means progesterone level is adequate enough and the woman is ovulated and fertile, while at Day 3 of the menstrual cycle normally seen < 1.5 ng/ml.

Progesterone levels tend to be < 2 ng/ml prior to ovulation, and > 5 ng/ml after ovulation, which means progesterone value must be at least 5 ng/ml at the middle of luteal stage to be good level for ovulation.

Serum progesterone levels rise with some variance after ovulation, peaking at 15 to 90 ng/ml by 10 to 25 days after ovulation (the LH peak) and gradually reducing over the term of pregnancy.

For most fertility centers, FSH levels over 12 mIU/ml is considered poor.

Interpreting Levels of Follicle Stimulating Hormone

A normal FSH level is usually between 3 mIU/ml - 10 mIU/ml.

Levels of more than 12 mIU/ml are worrisome and suggest impaired ovarian reserve.

Levels of more than 25 confirm ovarian failure and are found in menopausal women.

The FSH level is best interpreted in conjunction with estradiol level.

Estradiol levels above 75 pg/ml on Day 3 may indicate a poor ovarian reserve

In few cases, a high baseline estradiol level(due to poor ovarian reserve) can artificially suppress the FSH level, so that it appears to be normal, thus misleading that the ovarian reserve is normal.

Hence it's a good idea to measure the estradiol level when checking the FSH level on Day 3

If the estradiol level is high, then even if the FSH is normal, one cannot assume that ovarian reserve is normal.A normal FSH and estradiol level probably indicate that you have a good ovarian reserve.

Post your further queries if any

Thank you

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Brief Answer:
Kindly repeat tests again

Detailed Answer:
Hello Ma'am

I can certainly understand your concern.

Regular cycles are still possible even in the absence of ovulation. These are called anovulatory cycles.

Additionally Morbid obesity with BMI in the range of 45 is a strong negative predictor of ovulation and sustainence of pregnancy.

Fertility monitors and Ovulation sticks are not ultimate parameters to identify ovulation. They can have both false positive as well as false negative results.

Ultimate guide to predict and identify ovulation is Day 3 FSH, LH and Estradiol estimation and Day 21 progesterone estimation. Only if these hormonal levels are within normal limits, ovulation occurs and conception is possible. There is no alternative hypothesis to this.

Likewise an ultrasound abdomen is required to assess the health of uterine cavity lining.

All I am trying to say is please get the above tests again at appropriate days of the cycle along with Ultrasound abdomen.

Review with reports to determine further course of action.

Post your further queries if any
Thank you

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