Maternal & Child Community
Progesterone Levels in Early Pregnancy
About This Community:

This patient support community is for discussions relating to breast feeding, childhood disease, colic, child discipline, immunization, lactation, newborn care, post partum depression, Sudden Infant Death Syndrome (SIDS), and special needs children.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

Progesterone Levels in Early Pregnancy

I am 6w4d pregnant with my 5th pregnancy.  My last pregnancy ended in a miscarriage a year ago at around 12 weeks.  My progesterone levels are not high so I am on progesterone suppositories 2 times daily (100MG) and a progesterone shot wvery other day.  My first progesterone reading was 15 that I am told is in the normal range but low.  After 2 days on suppositories my level rose to 24.  On the day of testing I had not had anything to eat prior to the blood test.  48 hours later my progesterone had dropped to 19 and the Dr. decided to start the progesterone injections.  On  this day I did have breakfast prior to the blood test.  I have read on the internet by various Dr's that fasting before progesterone is the best as eating will affect the results - my fertiltiy clinic says not.  When I inquired if these results were an indication of another miscarriage I received a rather ambiguous answer.  Is it normal or somewhat normal for progesterone to fluctuate and does anyone know if fasting does in fact make a difference.  My HCG level more than doubled in my last 48 hour period and I have also read via internet that the HCG level is a better indicator of pregnancy success than progesterone levels. In my 2nd and third pregnancy I did have some bleeding early in the second trimester which would possibly indicate progesterone fluctuations. Any comments would be appreciated
Related Discussions
6 Comments Post a Comment
Blank
Avatar_n_tn
Progesterone levels can vary HOURLY.  

I did a little search using "Progesterone supplementation and early pregnancy".  Here is one article:

Progesterone for miscarriage

Progesterone doesn't prevent miscarriages. Miscarriages happen for many reasons, but lack of progesterone as a cause for miscarriage is not proven. The low progesterone levels found in pregnancies which go on to become miscarriages is a sign that the pregnancy is already failing.

Many studies have been done to investigate whether giving progesterone can prevent this loss, but the end result has been no difference between women who are given progesterone and those who aren't. The only exception to this may be in the case of ivf pregnancies, which are quite different.

There was a review of evidence and consensus statement from the British Royal College of Obstetricians & Gyneacologists. They looked at all sorts of procedures in Obs/Gyn and graded them as either:


-Effective
-No strong clinical evidence
-Wasteful -procedures which are particularly wasteful of resources and appear to be of little or no benefit.

Progesterone administration in the prevention of recurrent miscarriage fell into the last category.

Another recent document from the RCOG on recurrent miscarriage and its causes & management said the following:

Inadequate secretion of progesterone during the luteal phase of the menstrual cycle and in the early weeks of pregnancy has been presumed to be a causative factor in many cases of recurrent miscarriage.

A review of pregnancy rates following hormonal treatments for luteal phase deficiency concluded that the benefits are uncertain, and a meta-analysis of six trials has reported that exogenous progesterone supplementation after conception does not improve pregnancy outcome. (Grade A recommendation). Low progesterone levels in early pregnancy appear to reflect a pregnancy that has already failed.

A multicentre placebo controlled trial of early pregnancy human chorionic gonadotrophin (hCG) supplementation failed to show any benefit in pregnancy outcome. However, a further small randomised study has suggested that hCG improves pregnancy outcome in a small subgroup (n=23) of recurrent miscarriers with very irregular periods and a history of recurrent miscarriage. This finding has prompted proposals for a further multicentre study of hCG treatment in this particular subgroup of recurrent miscarriers.

Since pregnancies recruited to a study between six and eight weeks of gestation are destined to be successful in 98% of cases, analysis of these data will need careful interpretation. hCG supplementation should only be used in the context of ongoing randomised controlled trials.

Click here for the full document (Copyright RCOG).


Some of the studies which found no effect of progesterone supplementation:

Sherman RP et al. Double-blind study of effect of 17-OH-progesterone on abortion rate. BMJ 1963;2:292-295

Reijnders FJL et al. Endocrine effects of 17 alpha-hydroxyprogesterone caproate during early pregnancy: a double-blind clinical trial. Br J Obstet Gynaecol 1988;95:462-468

Klopper A et al. Hormones in recurrent abortion. J Obstet Gynaecol Br Commonwealth. 1995;72:1022-1028

Clifford K. Rai R. Watson H. Franks S. Regan L. Does suppressing luteinising hormone secretion reduce the miscarriage rate? Results of a randomised controlled trial. BMJ. 1996; 312(7045):1508-11

You won't find many newer studies on this as the issue is pretty resolved as far as evidence-based practice goes - as I mentioned, the RCOG did a full review of the literature on this.

Why give progesterone, then?

So why do some doctors carry on prescribing progesterone, in the face of this lack of evidence? Probably complex reasons but I suspect the following are among them:

-some believe that the studies done to date may not have detected a small benefit, and feel that the risk of progesterone use is low. It is unlikely that natural progesterone supplements will lead to problems for the baby, but there is some evidence that synthetic progestagens are associated with an increased risk of defects of the penis in male babies (hypospadias).

-some don't like to say that they have nothing to offer and feel better if they prescribe something.

-some may not have any idea of evidence-based medicine and just carry on doing what they've always done.

-some may receive financial gain by doing so.

-pressure from patients who will not accept that there is nothing that can be done, naturally feel desperate after previous losses, and really want to believe that something will work.

-some doctors, when faced with two options, both of equal use, will choose the most interventional.

Doctors who prescribe a drug for which there is no evidence of benefit really do have a duty to tell their patients that this is the case. "


Please remember that these are not my words, I did a search and came up with an abundance of articles similar to this one.  You have to do what you and your doctor believe to be the right thing.  Most studies don't show any harm to using progesterone supplementation.
Blank
Avatar_n_tn
I too had low progesterone levels in early pregnancy. at 5 wks my progesterone was 9.5, I started on progesterone shots and it actually dropped to 7.2 and eventually back up to 8.5. I am now 32 weeks pregnant so I was able to hang on to the pregnancy, whether or not due to progesterone shots who knows. I also had some dark brown bleeding at about 6 weeks. Good Luck!! Ginger
Blank
Avatar_n_tn
I had 2 high risk pregnancies and spent most of my time in bed. This time with my 3rd child the doctor gave me progesterone shots from the very begining. I feel that is has avoided me from having alot of the complications I had with the other 2 pregnancies. I also bled when I stopped having the shots. I am not going to take the chance of not taking the progesterone which I am taking now orally. What makes me really angry is that my doctor didnt bother to inform me about the side-effects of progesterone I now see other people are having. The other day I drove to work and I was so dizzy I was trying to go as slow as possible. When I got out of the car I was walking as if I had been spun around a few times with my eyes closed. This is dangerous to not let us know the possible side-effects. I also feel extermely tired almost unable to work. I am taking less progesterone to see if it helps and try to slowly go off the medication. I feel I am a little depressed but only because I feel so miserable. Hopefully it will all pass and in the end isnt it all worth it when we see that little baby. I have to keep that in mind
Blank
Avatar_n_tn
I am 5W3days pregnant 03/01/04, 2 years ago I miscarried with my second child.  Over a five year period have tried everything to conceive except fertility which I used for first child.  After my visit to OB yesterday, my test results are as follows. Tidor was 5000, progesterone 1400, all the office requsted is a follow up visit next Wed for another sonogram. No heartbeat was seen yesterday on sonogram.  I am on glucophage (sp) for PCOS, I stopped it yesterday at my doctors request.  Began progesterone pills today.  Last pregnancy I carried a terminated fetus for 6 weeks due to the progesterone I was taking. My question is, Do you think I should be concerned, Is it possible they are not telling me everything.  I thought they would want to check tidor again to see if it doubles, not redo sonogram.  Is is possible to see heartbeat at 7 weeks on sonogram?
Thanks, ashmea
Blank
Avatar_n_tn
27 Years ago I rec'd progesterone shots weekly for a fragile pregnancy.  I had had three miscariages previously.  I did manage to carry this child.  He was born prematurely and for some birth related injury or jaundice, he has cerebral palsy.

He also has many feminine qualities.  Is it possible that the female hormone that can cause penile deformaties (which he does not have)can reak havoc with the hormones in the male infant being carried in the womb?

Thanks,
Blank
Avatar_n_tn
27 Years ago I rec'd progesterone shots weekly for a fragile pregnancy.  I had had three miscariages previously.  I did manage to carry this child.  He was born prematurely and for some birth related injury or jaundice, he has cerebral palsy.

He also has many feminine qualities.  Is it possible that the female hormone that can cause penile deformaties (which he does not have)can reak havoc with the hormones in the male infant being carried in the womb?

Thanks,
Blank
Post a Comment
To
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
Maternal & Child Community Resources
RSS Expert Activity
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
242532_tn?1269553979
Blank
3 Reasons Why You are Still Binge E...
Jul 14 by Roger Gould, M.D.Blank
Top Children's Health Answerers
13167_tn?1327197724
Blank
RockRose
Austin, TX
134578_tn?1404951303
Blank
AnnieBrooke
OR
4268628_tn?1375044776
Blank
Flickan
Monroe, WA
Avatar_f_tn
Blank
Bsmom09
Avatar_f_tn
Blank
arlandonbloom
CO
Avatar_f_tn
Blank
gyspy09