QuestionHello, I'm writing from Nova Scotia, Canada. I am 36 yrs old and had been taking oral contraceptives until April of 2011. I detected my first ovulation after coming off the pill in September 2011, found out I was pregnant 2 weeks later, but miscarried at 5 weeks. I then became pregnant again in December 2011 but miscarried once more at 6 weeks this time. I have had several blood tests done and my husband and I had chromosome testing done as well. All tests came back normal. My concern now is that I think I may be deficient in progesterone for several different reasons and because my bloodwork was done on Day 10 of my cycle I'm thinking the results weren't an accurate picture of my pg level if conception were to occur. My specialist doesn't think there's any need to do more bloodwork but I'm pregnant again (just found out yesterday) and I'm worried I will lose this pregnancy too. Would it be harmful to take progesterone supplements without knowing my levels? Thanks for yor time and help.
AnswerHello Jane from Canada,
Natural progesterones are not harmful to a pregnancy and are used all the time with infertility patients and recurrent miscarriage patients. It is best used as either an injection or vaginal suppository. Vaginally is the easiest form to use. I know that "natural progesterone" is sold in health food stores and the like, but these have not been clinically testing and not proven to be adequate for progesterone supplementation. The vaginal forms that are used by prescription are: Endometrin 100 mg three times per day, Prochieve 8% each morning, Crinone 8% each morning and Prometrium 100 mg three times per day. Oral progesterones are NOT recommended because they do not deliver an adequate dose to the endometrium.
If you are worried about an inadequate progesterone level, then you should start it right away. We DO NOT check progesterone levels to see if they are adequate. That is a total misunderstanding by most doctors. There is no way to test if endometrial progesterone levels are adequate by blood testing. It can only be checked by endometrial biopsy in a non-pregnancy cycle. The progesterone we check on cycle day #21 is to see if ovulation occurred in that cycle.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
