Progesterone For Pregnancy

 

Often we meet women who have been misprescribed progesterone by doctors who aren’t as familiar with the nuances of fertility medicine and the physiology of ovulation.  If used incorrectly, prescribed progesterone can act as a birth control, rather than support fertility. Unfortunately, this is a common occurrence as there are so many misunderstandings around ovulations and progesterone. This is a huge key to fertility. At Famlee, our mission is to help bring clarity to women’s health and fertility—and that includes the ever-misunderstood ovulation hormone: progesterone. Let’s get started with the last part of our four-part series…

When should I use progesterone?

Progesterone supplementation is beneficial when:

1. You are pregnant… and the initial pregnancy labs tell us the embryo is growing in a healthy way but the ovary is not able to increase its progesterone production in response. So, if we see the beta HCG rising well in early pregnancy but don’t see the natural progesterone levels rising with it, then it makes sense to start taking progesterone suppositories twice per day until the placenta takes over at week 10-12 of pregnancy—especially if there is a heartbeat seen at 7 weeks.

Before taking progesterone, please talk to your provider. Progesterone can increase nausea, fatigue, constipation, headaches and bloating in the first trimester. Once you are on progesterone in pregnancy, you have to be very careful to take it twice per day to keep the progesterone levels stable. Skipping days could unintentionally trigger a miscarriage. It is important to have good support to help you manage your progesterone supplementation during the 1st trimester and guide you on coming off it around week 10-12 of pregnancy.

 

1. You have a specific medical situation or procedure, such as with IVF (in-vitro fertilization). With assisted reproductive technologies (ART), it is very common to use progesterone starting around the time of an embryo transfer until the end of the first trimester. It is also common to be given progesterone by a perinatologist for those who have suffered from premature delivery. Progesterone, in this instance, helps to keep the cervix more tightly closed with hopes of preventing early delivery in late second or early third trimester.
2. You are under the care of a trained providers’ advice. For example, it can be very helpful to use progesterone in cases of recurrent pregnancy loss. In this case, the miscarriages have often happened after a heartbeat is seen at 7 weeks or after the initial beta HCG labs look very healthy. It does not typically apply to chemical miscarriages (remember, for that we focus on improving your natural ovulation).
   
   In some instances of recurrent miscarriage, there is a specific uterine enzyme that can be degrading the embryo while it is trying to grow. In this very unique situation, progesterone can be used for an entirely different role than we have previously discussed. In this case, it deactivates that harmful uterine enzyme.  There is a very specific fertility protocol to use if this is suspected.

Will taking progesterone help me ovulate better?

No. Remember, the time when the egg is grown is in the follicular phase or the first two weeks of the cycle. If we want to make a bigger egg, which is considered more compatible with pregnancy, then we need to provide support in the follicular phase. It is taken from cycle Day 3-7 to encourage the growth of larger follicle(s)/egg(s). By the time we get to the luteal phase, giving progesterone is like adding a band-aid on the problem rather than truly getting to the root of the dysfunction. We know how to help you create a larger follicle/egg, which is more compatible with pregnancy. When you do that, you will make more of your own progesterone.

Should I take progesterone all month long?

NO, absolutely not. When you are trying for pregnancy, you shouldn’t take progesterone all month long. In this case, more is definitely not better! It will give the body the message that it has already ovulated, so it won’t grow or release an egg. In this way, it will act as a birth control, which is NOT what we want. This fundamental lack of understanding in the fertility space is a common injustice to women and couples trying to conceive. 

What does your natural progesterone do when you are pregnant?

Once an embryo implants in the uterus it starts releasing a hormone called beta-HCG. This tells the ovary that there is a pregnancy, and causes the ovary to increase the amount of progesterone it releases to keep the body from bleeding. The ovary is then responsible for producing progesterone to hold on to the pregnancy until a placenta is created, which happens around week 10-12 of pregnancy.  

 

Will taking progesterone prevent a miscarriage?

Hands down, this is the hardest question. If the ovulation is small, as shown by a low progesterone, you are at higher risk of miscarriage. This is not because of progesterone deficiency or “luteal phase defect” as it used to be called. This is from the egg being too small to be compatible with a viable pregnancy. Often this results in no pregnancy, but sometimes a chemical pregnancy happens in this situation. This is a fertilization of the egg that stops growing relatively quickly after implantation.

 

At Famlee, we are committed to trying to help women avoid miscarriages—but, in this case, we hate to say that progesterone will not help. In fact, it will only prolong the trauma by keeping you from knowing that you have an unhealthy pregnancy. This can be a result of taking enough progesterone to keep you from bleeding—indicating a likely miscarriage—until you don’t see a heartbeat on ultrasound. Some pregnancies can look healthy in their initial growth but are genetically not able to activate a beating heart. Blocking your body from showing you as early as possible if an embryo has stopped growing only makes an already difficult situation harder. (Please note, this is different from RECURRENT miscarriages that we discussed in #3 of the first question!)

 

We hope this information has been empowering and helpful for your fertility journey.  There are so many important aspects of ovulation and progesterone to understand.  At Famlee, we want to empower you to truly understand each aspect, so you can make sure you are getting the best fertility support possible.  Remember, we’re here for you every step of the way!

 

This concludes Part 4 of our Four Part Progesterone Q+A Series. Click here for more information on the Famlee Fertility Kit.