A 29-year-old woman with primary infertility for 2 years has regular 28-day cycles and a normal pelvic ultrasound. Her day 21 serum progesterone is 4 ng/mL. What is the most appropriate interpretation?

• A Confirms ovulation; proceed to tubal assessment
• B Suggests anovulation; start clomiphene citrate
• C Suggests luteinized unruptured follicle syndrome; perform diagnostic laparoscopy
• D Indicates luteal phase deficiency; measure mid-luteal progesterone again next cycle ✓

Explanation

A mid-luteal progesterone above 3 ng/mL (or 10 nmol/L) confirms ovulation, but values between 3 and 10 ng/mL may indicate a deficient luteal phase. A single borderline value should be repeated in the next cycle before diagnosing luteal phase defect. Anovulation is ruled out by a value above 3 ng/mL. Clomiphene is not indicated when ovulation is occurring.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.