QuestionThank you so much for your help and guidance. I will ask for the progesterone. However, It seems the use of progesterone is controversial. Here is what I came across many times and upon discussing this with my midwife decided not to supplement. I am afraid of prolonging a pregancey that is not viable or is problematic. What is your opinion of this?
Here's comment by Mark Perloe, MD (he is the medical director of Georgia Reproductive Specialists in Atlanta and director of reproductive endocrinology/infertility at Atlanta Medical Centeron) on answering a question about having low progesterone and wanting to know what to do about it:
"Unfortunately, many women are led down this wrong path, receive the wrong treatment and ultimately suffer another miscarriage. Their physicians incorrectly decide that low progesterone -- the "pregnancy hormone" of which you speak -- was the culprit and promise that things will go better the next time if only you take enough progesterone. Research shows us that falling or low progesterone levels are a sign of a bad pregnancy and NOT the cause of pregnancy failure.
So first, you did not miscarry because the progesterone level was low. Let's blow this myth away and try to figure out why you have miscarried."
According to the some research, using progesterone supplimentation will only prolong a doomed pregnancy... What is your opinion of this?
Thanks so much for your help!
Erika
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Followup To
Question -
About a month ago I started what I thought was my first period since being pregnant with my 10 month old. I am still breastfeeding. It was longer than my usual period of 3-4 days lasting 7 days and heavy at times. Two weeks later I ended up bleeding again with cramps. Later that evening I was bleeding heavily and having several large clots. After talking to my midwife I went to the ER where they determined through ultrasound and bloodwork that I was 5w3d pregnant. They did not see a fetal pole but did see a gestational sac and possibley a yolk sac. They said the pregancy was still in the uterus and sent me home diagnosed with a threatend miscarriage. Two days later my midwife sent me to have and HcG and progesterone test. 48 hours later I had another HcG test. My progesterone was very low (3 something) and my HcG was 34,000. 48 hours later my HcG was ~56,000. She told me with progesterone that low and my HcG not doubling she felt certain I would miscarry. With everything in mind I decided not to take progesterone supplements as not to prolong the enevitable. It has been a week and while I have had some light spotting and cramping off and on nothing to make me think I have miscarried. I am in limbo not knowing whether I will have a baby or not. From my own research it seems that 48 may not have been a long enough doubling time for HcG levels as high as mine. Also, if I am still nursing would that not increase my prolactin level and in turn decrease my progesterone level? If I am set to miscarry how long should I expect the process to take and when should I return to my midwife if it does not happen? Any help or guidance would be greatly appreciated.
Answer -
It appears that your HCG values are, indeed, increasing, even though they are not doubling every 48 hours. Although we usually see a doubling of the HCG values every 48 hours, it is not written in stone. Your HCG value rose from 34000 to 56000, which still is good. At 5-6 weeks gestation, we only see an empty gestational sac on sonogram. After 6 weeks gestation, we usually can see a fetus and a fetal heartbeat. I would suggest that you get another sonogram. If you see a fetus and a fetal heartbeat, it is a good sign. Unfortunately, your progesterone level appears to be low. You should have started the progesterone supplementation, which usually helps prevent miscarriage. It is certainly not inevitable that you will miscarry, so I do not know why you did not start the progesterone. Progesterone is not effected by prolactin level. If you are nursing, your prolactin level is elevated, but this has no effect on progesterone level. Repeat the sonogram. If there still is no fetus seen after 7 weeks gestational age (two weeks after the first sonogram) then it is a non viable pregnancy and you should have a D&C. If, on the other hand, they do see a fetus and a fetal heartbeat, all is well.
AnswerProgesterone supplementation by itself may or may not prevent a miscarriage. I do agree with Dr. Perloe that falling progesterone levels are a sign of a bad pregnancy and not a cause of this failing pregnancy. However, time and time again, we have helped prevent a bad pregnancy by supplementing low progesterone levels. First of all, progesterone supplementation can correct a luteal phase defects and can also give you enough progesterone until the placenta is developed (at around 12 weeks). We have seen that progesterone use can, indeed, prevent a miscarriage if the cause is low progesterone. Since there really is no "down side" to taking the progesterone, it can't hurt. It will not prolong the pregnancy if it is doomed to miscarry.
