Progesterone Assay

What sample is needed to estimate progesterone?

1. This is done on the patient’s serum.
2. Always note the sex of the patient.
3. In the female, note the day of the last menstrual cycle.
4. The serum is stable for 7 days at 4 °C.
5. Can store serum for 3 months at -20 °C.

What precautions are necessary for Progesterone assay?

1. Avoid hemolysed samples that will affect the result.
2. Take the history of the recent use of radioisotopes because that will affect the result.
3. Estrogen and progesterone therapy will interfere with the result.

What are the indications for Progesterone assay?

1. This test is part of the infertility study.
   1. Confirm ovulation.
   2. To evaluate the corpus luteum function.
2. To assess the high risk for early spontaneous abortion.

How will you define progesterone

1. Progesterone is a sex hormone like estrogen.
2. It helps to regulate the accessory organs during the menstrual cycle.
3. Progesterone is an important hormone for preparing the uterus for the reception of the blastocyst and maintaining the pregnancy.

How will you discuss the pathophysiology of Progesterone?

1. Progesterone is a female sex hormone needed to prepare the uterus for pregnancy.
2. progesterone is C_²¹  steroids.
3. The initiation and control of luteal secretion of progesterone are regulated by LH and FSH.
4. Progesterone has no specific binding plasma protein. This is bound like cortisol to cortisol binding globulin.
5. Free progesterone is 2% to 10% of the total.
6. This is like estrogen as a sex hormone.
7. It helps to regulate the accessory organs during the menstrual cycle.
8. Progesterone acts primarily on the endometrium.
9. It starts the secretory phase of the endometrium in preparation for the implantation of a fertilized ovum.
10. This is important for the implantation of the blastula that is produced by the cleavage of the fertilized ovum.
11. In nonpregnant females, it is produced by the corpus luteum.
12. Progesterone maintains the pregnancy.

What is the structure of the progesterone?

1. Progesterone is a C21 compound.
2. Like corticosteroids and testosterone, it contains a keto group at C3 and a double bond between C4 and C5.

What are the sources of progesterone production?

1. Progesterone is produced by the ovary’s Corpus luteum (granulosa cells) in the first week of pregnancy.

2. In non-pregnant women, progesterone is secreted mainly by the corpus luteum.
3. During pregnancy, the placenta is the primary source of progesterone production.
   2. The placenta produces progesterone by 12 weeks of gestation.
   3. The Placenta follows this during pregnancy, which starts producing progesterone.
4. The adrenal cortex and testes are minor sources of male progesterone production.
   1. The adrenal cortex is also a minor source of progesterone in the female.
5. Progesterone is metabolized into metabolites conjugated with glucuronic acid and excreted as water-soluble glucuronides.

What are the ways of transporting progesterone?

1. Progesterone has no specific plasma-binding proteins.
2. Progesterone is bound to corticosteroid-binding globulin.
3. Plasma-free progesterone varies from 2% to 10% of the total concentration. This unbound progesterone remains constant throughout the normal menstrual cycle.

What are the phases of progesterone levels in the body?

1. The progesterone peak level is a mid-luteal phase of menstruation.
   1. In non-pregnant women, progesterone is produced by the corpus luteum.
   2. Progesterone levels in nonpregnant women are elevated during the luteal phase, reaching a maximal level 5 to 10 days after the LH peak at mid-cycle.

What is the single best test to evaluate ovulation?

1. A series of tests gives the day of ovulation when there is a peak progesterone level.
2. Plasma progesterone levels start to rise with ovulation, along with the LH hormone, in approximately 6 to 9 days.
3. The level falls, and menses occur.
4. After ovulation, there is a rise of 4 to 5 days, then it falls.
5. Supplementary progesterone can be given to maintain early pregnancy in case of inadequate luteal phase progesterone production.
6. There is a gradual increase in pregnancy from 9 weeks to 32 weeks of gestation.
7. Its level is higher in the twin pregnancy.

What are the Progesterone metabolites?

1. Progesterone is converted into Pregnanediol, conjugated with glucuronic acid produced by the liver, and then excreted by the kidneys.
   1. Progesterone 2% to 10% free and rest is bound to corticosteroid-binding globulin (CBG).
2. Pregnanediol is most easily measured as a metabolite of progesterone in the urine and plasma.
   1. Pregnanediol level in the urine is unchanged even in fetal distress or even the death of the fetus.

3. Progesterone and Estradiol, their role in the secretion/inhibition of FSH and LH.