Q: My wife was given injection HCG, Susten 200 mg BD in her first and second pregnancy empirically. What tests are needed to confirm whether she really needs progesterone & HCG? My wife conceived 1 & a half years after marriage. Doctors suspect a luteal phase defect & started with these medicines. What further investigations are required and at what day of the period should it be done?

A:To confirm luteal phase defect you should have the serum progesterone level estimated on day 21 of a 28 day cycle, or after 7 days after ovulation has been documented by ultrasound (in those not having regular 28 day cycle). Also, it should be done at least in 3 consecutive cycles to be sure. In older times, an endometrial biopsy was done premenstrually to check whether or not the endometrium was out of phase. As it is an invasive test and is not done these days.