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Medical Monday - Day 21 Testing Blog Feature
Lisa Rosenthal

By: Lisa Rosenthal on July 29th, 2013

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Medical Monday - Day 21 Testing

Testing | Day 21

Day 21 Testing: Medical Monday Updates

Medical Monday Day 21 TestingInfertility comes in all different shapes, sizes and ways. It has many different faces. Chances are if you are reading this, you think or know that infertility is reflected in your face as well.

We are not infertile. Even if we have trouble conceiving, we are not a disease or a disorder. We are human beings with a medical condition. Infertility as a medical condition has ways that it is more specifically diagnosed. 

We've talked about day 3 on this blog and some of the testing that needs to be done on that day. We've discussed what day 3 is (third day of menstrual flow), and now we're skipping to day 21. Day 21 would be the 21st day, counting first full day of menstrual cycle as day 1. 

Just trying to be very clear here. 

Board certified reproductive endocrinologists from RMACT explain day 21 testing for you below.

~Lisa Rosenthal

Fertility Testing and Day 21

On Day 21 of your cycle, your fertility specialist will want to check the levels of progesterone and estradiol (E2) in your system and the thickness of your endometrium (uterine lining). Day 21 testing checks a woman’s progesterone level to confirm that ovulation has occurred. It is done on the 21st day of the menstrual cycle (Day 1 is the first day of flow, not including any spotting).

A low Day 21 progesterone level suggests the cycle was anovulatory (no egg was produced). If no egg is produced, pregnancy cannot be achieved. The timing of ovulation, and the associated peak in progesterone, is related to the subsequent menstrual period, not the preceding one. In an average cycle of 28 days, the time between ovulation and the next period is about two weeks, so progesterone is measured about seven days before the expected period, or on Day 21.

However, if a woman’s cycle is longer or shorter than 28 days, the testing day will be adjusted accordingly. For example, a woman with a 35-day cycle would be tested for progesterone on Day 28. Serial estradiol (E2) levels are often measured for monitoring superovulation in intrauterine insemination (IUI) and in vitro fertilization (IVF) treatment cycles.

If you are not ovulating, there are steps that can be taken to help release the eggs, including drugs. Your fertility specialist will discuss these options with you. An ultrasound exam is also used to measure your uterine lining to determine if it is thick enough for a fertilized egg to implant. See more by clicking here.

Infertility is a medical condition that can be treated. If you are not menstruating or ovulating regularly, even if you do not want to become pregnant, you should be checked. Our reproductive organs and system should be working properly and if they are not, knowing what is going on is paramount to good health. 


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About Lisa Rosenthal

Lisa has over thirty years of experience in the fertility field. After her personal infertility journey, she felt dissatisfied with the lack of comprehensive services available to support her. She was determined to help others undergoing fertility treatment. Lisa has been with RMACT for eleven years and serves as Patient Advocate and the Strategic Content Lead.

Lisa is the teacher and founder of Fertile Yoga, a program designed to support men and women on their quest for their families through gentle movement and meditation.

Lisa’s true passion is supporting patients getting into treatment, being able to stay in treatment and staying whole and complete throughout the process. Lisa is also a Certified Grief Recovery Specialist, which is helpful in her work with fertility patients.

Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association (now Path2Parenthood), where she was Educational Coordinator, Conference Director and Assistant Executive Director.