Normal HCG but falling progesterone

[Jen78]

This is my first pregnancy post m/c and I have had my HCG and Progesterone levels tested 4 times since 11dpo.  My numbers were on 11dpo: HCG  39 and 20 progesterone.  On 13dpo: HCG 143 progesterone 25.   On 15dpo:  HCG 343 progesterone 20.  On 18dpo  HCG 1182 Progesterone 16.    I am concerned that my progesterone was falling and my doc put me on prometrium (oral tablets taken vaginally) 2x per day "just in case".  1.5 days after I started taking it my HCG was 4772 and progesterone was 31.  Can it rise that much in 1.5 days from the prometrium alone?  I was told that its normal for progesterone to fluctuate like that and that its likely my prognesterone may have risen back up on its own? Is that true? I can't find information on that anywhere else.   I was also told I may not even need progesterone supplements but I should continue to take it until 12 weeks so my levels aren't fluctuating so much betweeen now and then.  

I am currently 6w5days pregnant and I had an ultrasound at 5w5days where we saw a yolk sac, fetal pole and HB of 90 which I was told was good for how early it was.  I am very concerned that there is a reason my progesterone was falling and that I am just proglonging an inevitable miscarriage.

[gorilla-keeper]

Here's a quote from Dr.Mark Perloe, medical director of Georgia Reproductive Specialists in Atlanta and director of reproductive endocrinology/infertility at Atlanta Medical Center:

"Progesterone levels can vary from laboratory to laboratory. The level can also vary from morning to afternoon and even drop 50 percent after a meal. Unfortunately, most physicians are not aware of this fact and do not advise their patients to check levels early in the morning and while fasting.  There is no specific value necessary to "maintain" a pregnancy. In fact, I have had patients with enzyme defects who had levels of 2ng/ml who have carried without a problem."

Therefore, I wouldn't worry if I was you-- your levels still look good!!
good luck,
cherie

[Jen78]

Thank you so much for that info that is so reassuring!  I m/c in April at 8 weeks, and after seeing a heartbeat, and I can't find comfort in this pregnancy. Since I am on progesterone, I can't believe that I am going to end up with a healthy baby.  

I had not found anything else on progesterone levels fluctuating EXCEPT for my doctor!  She said that what happened to my levels is exactly why they should not test progesterone every time because it scares people like that and since mine started high there is likely nothing to be concerned about.   But in researching it on the net, I found nothing that says progeterone can fluctuate and that it would be normal for it do so; only that it should steadily rise.   And then to be put on progesterone only made me worry more.  I am a nervous wreck!  I have another ultrasound Thursday and I am preparing myself for the worst but hoping for the best.  

Thanks everyone for your comments!

[cutiemama]

I have never had my progesterone levels checked with either of my 2 PGs. What is the significance as I have read so much about progesterone on this forum? Is this a standard test like hcg levels or is it something that is done more when a woman has had trouble ttc? I am having some difficulties with this PG and am wondering if I should be having my progesterone checked as well?

[pmom]

my progesterone levels was checked with this npregnancy due to 2 prev. miscarriages. progesterone is vital in helping to sustain a pregnancy. people are usually put on it only till yhe placenta takes over the production of progesterone....usually around 12 to 14 weeks. i, as well as many women on here, believe that being put on progesterone supplements help them carry to term. women with repeat miscarriages and trouble concieving normally are the ones who get their levels checked. i hope i helped. also note that progesterone suppl. don't always prevent a miscarriage. good luck to you.
tiffany

[gorilla-keeper]

Dareko,
See my earlier post, and my doctor said that progesterone levels are a HIGHLY debated and controversial issue.  He said that many women are supplimenting when they really don't need to be, and that it is NATURAL to have variances in the levels.  When I miscarried at 6 weeks, I was only at 2.5-- but he said that this was a sign of a failing pregnancy, and not a pregnancy failing from low progesterone.  Obviously, IF your doctor recommends using it, I would do so; but if your doctor hasn't mentioned it as a concern, I wouldn't worry about it.  The latest research has shown that too much progesterone CAN cause problems-- it can desensitize the body to it, and cause estrogen levels to rise.  As long as your hcg levels continue to rise and your ultrasounds/heart beat is normal, your chances of another mc are extreemely low, according to my doctor.
More from Dr.Mark Perloe:

"Rarely is progesterone supplementation of any value. A low progesterone level seen during pregnancy is a sign of a failing pregnancy, not its cause. Progesterone replacement for "luteal phase defect" does not correct the problems with the developing follicle. Ovulation treatment is necessary to fix this problem. There are NO studies that show that adding more progesterone can save a pregnancy. This is a myth that has been foisted on many women by well-meaning physicians who are not aware of the latest research in this area.

Progesterone treatment should be reserved for women who have undergone ovulation treatment with injectable medications, those who underwent IVF or egg donation, or those who are suspected of having an immune basis for recurrent pregnancy loss. For these cases, several forms of supplementation are available. Progesterone creams can vary in strength and absorption from brand to brand. The use of progesterone troches or suppositories is a very cost-effective alternative to injections or Crinone vaginal cream (which is very expensive). "

By NO means am I an expert, and I have heard from many friends of mine who sware by using progesterone creams/suppositories, but I would consult your doctor about your case first!
cherie

[Liza55]

Once again reading posts helps show the huge differences in practice among all these OB's. I m/c in July @ 8 weeks,never heard a heartbeat. Noone mentioned my previous blood work as reflecting an abnormal anything! I'm about 5 weeks pregnant again now and the first few appt. are w/nurses (not my MD). I'll definitely ask them about the progesterone levels and demand they include a level in the initial blood work. I'm nervous that I should maybe be on progesterone?!

[first time mommy]

Wow, I've been looking for an answer to dropping progesterone for weeks! I went from 26-24-19-19 and then insisted on supplements. I'm 7.5 weeks. I though forsure that I was going to m/c and vould not find anything on the web about these fluctuations. My MD with reluctant but gave them to me. I wanted to know what book you are quoting from? If I was able to read this forum prior to freaking out about my levels, I wouldn't have insisted on Prometrium. I hope I'm not doing any harm now.

[gorilla-keeper]

I actually got it off of the web, although Dr.Perloe has a book out called "Miracle Babies and Other Happy Endings for Couples with Fertility Problems".  However, you can go to this website:
http://health.ivillage.com/author/bio/0,,6rtb,00.html
and scroll down the page and you will find over 30 pages of questions/answers of pregnant women with problems that he has responded to.
Here's 2 of his that relate to progesterone levels:
http://www.howtomakeafamily.com/experts/perloe/mpqa11.htm
http://health.ivillage.com/infertility/0,,67k3,00.html
and here's one that talks about why progesterone suppliments are not helpful:
http://health.ivillage.com/infertility/infertmedical/0,,tc,00.html

Personally, I'm on the fence about the whole suppliments deal... I don't have experience or knowledge enough to make a judgement.  This last link above has made me question buying the cream myself though.  It will give me peace of mind though, if we get pregnant again and have fluctuating progesterone levels-- and I will ask my doctor about fasting before a test and scheduling it early in the morning (in the past I was tested after eating and at different times of the day... always wondered why they had that little box on my form saying "fasted or not?"!!)
cherie

[IWantToBeAMom]

Everything sounds really good to me.  Your progesterone fluctuated but now it's back up again, that's good.

I think you're going to be fine.  Your numbers and u/s show everything is going perfectly.  Enjoy being pg and congratulations!

[pmom]

I agree with the prevoius post.....just enjoy. All sounds great. I would stay on the progesterone though, it can't hurt you. I was on it when i was 6 weeks along and i am now 21 weeks along. Good luck to you and keep us posted on your story.
Tiffany

[cutiemama]

Thanks for the insight. My first PG was totally normal with no problems conceiving so i guess that's why it's never come up. I just wanted to understand the role progesterone plays in pregnancy and why there are so many women who are taking some type of supplement. You ladies answered my question, so thanks.

[Jen78]

Basically, progesterone is the glue that holds your pregnacy/baby together. There are certain ranges the number should be in and it should steadily rise throughout your pregnancy.   If it drops too low, it could be indicative that the pregnancy is failing and that a miscarriage is impending.  There is great debate out there whether or not supplementing progesterone will help keep the pregnancy alive so it can be carried to term or whether or not it just delays an inevitable miscarriage.

[first time mommy]

Thanks for the info. I can't believe I never stubbled upon that after weeks of research. It's just so hard to relax in the first trimester. Everywhere you read someone had a m/c at 7+ weeks which is so sad. It almost seems like m/c is more common then the statistics. Thanks again.