Progesterone and is responsible for approximately 70% of cytochrome P450-mediated progesterone metabolism. Other routes include 6α-, 16α-, and 16β-hydroxylation. However, treatment of women with ketoconazole, a strong CYP3A4 inhibitor, had minimal effects on progesterone levels, producing only a slight and non-significant increase, and this suggests that cytochrome P450 enzymes play only a small role in progesterone metabolism. In women, progesterone levels are relatively low during the preovulatory phase of the menstrual cycle, rise after ovulation, and are elevated during the luteal phase, as shown in diagram below. Progesterone levels tend to be less than 2 ng/mL prior to ovulation, and greater
Fern test When high levels of estrogen are present, just before ovulation, the cervical mucus forms fern-like patterns due to crystallization of sodium chloride on mucus fibers. This pattern is known as arborization or 'ferning'. When progesterone is the dominant hormone, as it would be in the second half of a normal cycle, the fern pattern is no longer discernible, and the pattern is completely absent by the 22nd day of a woman's cycle. The disappearance of the fern pattern after the 22nd day suggests ovulation, and its persistence throughout the menstrual cycle suggests an-ovulation (infertility). Fern test Fern test refers to