Chapter 19: Targeted Hormone Assessment of the Menstrual Cycle

Hilgers TW

Reproductive Endocrinology · Ovarian Hormones

Chapter 19: Targeted Hormone Assessment of the Menstrual Cycle

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 251-258, 2004

RRM Academy Synopsis

Peak Day timing gives a truer hormone profile, a chapter argues

A textbook chapter argues that hormone blood tests give a truer picture when timed to a woman's Peak Day than to a set day. The chapter describes the Creighton Model FertilityCare System (CrMS) method. It reports two case series, of 193 and 620 cycles.

Key Findings

A day-21 or day-22 progesterone test presumes a 28-day cycle. The chapter cites a textbook figure that cycles last 28 days in only 5 to 10 percent of cases.
Ovulation occurs on Peak +/-2 days in 95.4% of cycles, according to the study the chapter cites. The chapter uses the Peak Day to split the cycle into before and after ovulation.
In one charted example of six cycles, the Peak Day ranged from day 14 to day 20. The chapter says a routine day-22 draw would have given inaccurate information about luteal function.
Estradiol timing was studied in 193 cycles and progesterone with estradiol in 620 cycles. In these two series, the chapter reports that timing captured the profile in the large majority of cycles.
Progesterone after the Peak Day was significantly lower in women with infertility from all causes (n=114) and infertility related to endometriosis (n=79) than in women of normal fertility (n=23).

RRM Context

Restorative reproductive medicine reads hormones against cycle charting. NaProTECHNOLOGY, formalized by Dr. Thomas W. Hilgers, builds its hormone evaluation on the charted Peak Day. A single hormone level drawn without a chart leaves the clinician flying blind about where in the cycle it fell.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter describes how charting with the CREIGHTON MODEL FertilityCare System (CrMS) is used to time blood sampling for estradiol and progesterone, with the Peak Day dividing the cycle into pre-ovulatory and post-ovulatory phases. Hilgers argues that a progesterone level drawn on day 21 or day 22 presumes a 28-day cycle and, because of the natural irregularity of the menstrual cycle, is for the most part worthless. The chapter sets out a targeted periovulatory estradiol profile and a targeted post-ovulatory progesterone and estradiol profile, and reports series of cycles in which most profiles were accurately targeted, while noting that targeting is not very helpful in very long and irregular cycles. Comparisons in the chapter show targeted post-Peak progesterone levels significantly lower in women with infertility, including infertility related to endometriosis, than in women of normal fertility.

Topics

Reproductive Endocrinology › Ovarian Hormones › Progesterone · Diagnostics › Hormone Testing › Timing of Testing · Menstrual Cycle › Cycle Biomarkers › Hormonal Markers

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 19: Targeted Hormone Assessment of the Menstrual Cycle

Peak Day timing gives a truer hormone profile, a chapter argues

Key Findings

RRM Context

Abstract

Topics

By this author

Related research