Low progesterone and miscarriage? (DS mentioned)

KittyKatMom

I?ve always had several days of spotting before AF and read in TCOYF that this could be due to low progesterone. When we first began TTC, I was worried that we?d have trouble conceiving because of this, but we were very lucky and conceived DS with no issues. Before I became pregnant with him, I would start spotting around 10dpo and then AF would show up full force around 14dpo. After he was born and AF returned, it seemed like I started spotting a little earlier, around 8dpo, with AF again showing around 14dpo.

 

When we were TTC #2, I talked to my doctor about the spotting and expressed my concerns about low progesterone (I was still BFing DS a few times a day, which I believe can also lower progresterone levels), but she wasn?t concerned about it and said to come back if we didn?t conceive within 3 months (we had already been trying for 3). I ended up conceiving that cycle, and was shocked because I had started spotting earlier than ever at 7dpo and even had two days of AF-like bleeding around 9dpo. But after the BFP, I figured it had just been implantation spotting.

 

Fast-forward a few weeks. I was leaving my confirmation of pregnancy appointment and realized that I had forgotten to ask my OB about testing my progesterone levels just to be safe. I thought about calling back, but figured since we had conceived, that my levels must be okay. After my missed miscarriage was discovered, my doctor ordered bloodwork and I found out that my progesterone was at 8, which is super low. I was 8 weeks along at this point and the baby had stopped growing around 6 weeks.

 

I asked my doctor if this could have been the cause of the miscarriage and she said that the low progesterone was likely a symptom of the miscarriage and not the other way around. In other words, my progesterone was dropping because the pregnancy was not viable. Another doctor I spoke with at my practice agreed with this and said that progesterone is not routinely tested, and that I would have miscarried even earlier if my levels were low to begin with.

 

Still, I can?t help but worry that maybe this all could have been prevented if my levels had been tested early in the pregnancy. I know there?s no point in playing the what-if game now, but do you think I should push to have my levels tested before we TTC again? I feel like my doctor will be resistant, since this isn?t something they normally do, but I can?t risk this happening again if there is something I can do to prevent it. Does anyone have any experience with low progesterone?

 

Sorry this got so long and thanks for any advice you can offer.

twotexans

I've been seeing an RE for the last 6 months and used fertility meds to get my BFP, so my situation is a little different.  For me, I would start spotting about 8dpo and AF would show by 12dpo at the latest-usually closer to 10dpo.  My progesterone levels have been tested every cycle for the last 6 months.  I have mild PCOS and would ovulate late. 

Without medication, my levels would indicated ovulation, but were borderline low.  Add clomid and they were a little better.   Then we added a trigger and they got even better.  As my progesterone increased, my spotting became less and less.  That being said, my progesterone was tested at 7dpo of my BFP cycle and was 15.  It was tested again at 12dpo- the day I got my BFP- and was 9.4.  I started 400mg progesterone supps. at 13dpo.  Now we are going to add in progesterone supps. each cycle, to hopefully up our chances.  Obvisouly lack of progesterone was not the cause of my m/c, but it did give my pregnancy a better chance at success.

I would definitely get them looked at.  Lower levels of progesterone can impair your chances for a BFP.  If my case, the spotting was a correlation to lower progesterone levels.  I know doctors have different views on what is normal in terms of spotting prior to AF.  My OB doesn't think it is a big thing, but my RE says it is abnormal.  Good luck to you.

 

keiral

I'm so sorry for your loss!

I had my MC in September and have since spent more time on the TTCAL board, but was just lurking here and felt compelled to respond to your post. 

I was charting, prior to my previous pregnancy, and noticed that I would spot for a few days prior to AF.  I also noticed that sometimes the spotting would correspond with a temp dip in my luteal phase.  I've read that spotting or temp dips in the luteal phase, or a combination of both can indicate a type of luteal phase defect, mainly low progesterone.  I also expressed this concern to my doctor and she did not seem concerned at all.  I'm not even sure she completely followed what I was talking about.  I think that if you are concerned about this you should definitely ask your doctor  to test your progesterone levels early on in your next pregnancy. 

After my MC I expressed this concern to my doctor once again and she did mention that if I was really concerned about it that they could put me on progesterone in my next pregnancy.  Maybe ask about that option? 

Good luck to you!

attalove

I just wanted to say I'm so sorry for your loss. I know it's so hard not to think of all the what-if's. My brain is still trying to make sense of it too. 

I just had a mc with this, my second, pregnancy, after a successful first pregnancy which gave us our DS. 

Last month at my appt to confirm pregnancy, the u/s only showed an empty gestational sac measuring 5w2d & my dr ordered blood work. While my hcg came back great, my progesterone was at a 9 & my OB wanted it more at a 12. Prometrium was called in & I started it that night. 

A few weeks later, unfortunately, I was diagnosed with a blighted ovum & had a d&c Monday. Upon discharge, my OB was sure to tell us that after waiting one cycle post d&c to TTC again, once I did get a BFP in the future, they would have me come in right away for blood work- mostly for our peace of mind. 

All that to say, that if any point in the future you want your levels checked, I would encourage you to ask for it! Even if it's not your offices' standard procedure, you have the right to ask for & receive what you need from your dr. I don't mean the following to sound harsh, but that's what we pay them for. 

GL to you in the future! My T & P are with you!  

caliblondieus

Progesterone is a challenging discussion in the conception world. If you line up 10 REs, 5 of them won't believe in anything related to progesterone and 5 of them will. They are that split on it because there is still no scientific evidence that this is an issue and that progesterone supplementation is the answer to the problem.

Having said that, you have to get a better understanding as to what role progesterone supplementation can play and what you will need to ask for in the future.

The first line of action is whether you have good levels of progesterone after ovulation or not. During any regular cycle, you can ask for a 21 day progesterone check (so this would be about 7 days after you ovulate if you have an "average" cycle of ovulation on CD14). Sometimes this is where women find a progesterone deficiency. It can also be found (as you sort of discovered) through a short luteal phase (the time between ovulation and your period beginning) and/or low basal body temperature.

Here's where things start getting murky. Some doctors won't prescribe progesterone supplements until after pregnancy is confirmed. But studies have shown that if the supplement is given prior to that, it's more likely to support the pregnancy whereas if it's given at a positive beta test or HPT, if it's already destined for miscarriage, the progesterone supplement isn't going to help.

So getting the supplement and taking it starting one to days after ovulation is ideal. Here's where it gets murky again...dosage amount and method of ingestion. Vaginal suppositories or progesterone shots in oil are best. You can usually only get the shots if you're doing IVF. Vaginal suppositories are prescribed by your RE. Creams that you rub on don't do s*** as it takes too long for the body to absorb and get it to the place it needs to help a pregnancy out.

Dosage wise, common dosage is 100mg per day, twice a day and then an upping of the dosage upon a positive pregnancy test. But some docs only do a slight increase. The max dosage is usually around 600mg per day (3 times a day) once pregnant. Problem is, the body really only needs to absorb about 50mg but when it's inserted vaginally, you don't absorb as much as you put in (gravity and all!)

So now that you know more, maybe you can set a plan for next time. Many docs will just prescribe progesterone not because they think it actually works but because there's no proof that it doesn't, there's no proof it causes long term affects on the fetus, AND they think from a psychological standpoint -- it helps their patient.

Push for what feels right to you and create the plan for next time!

Best of luck,

Krista

KittyKatMom

caliblondieus:

Progesterone is a challenging discussion in the conception world. If you line up 10 REs, 5 of them won't believe in anything related to progesterone and 5 of them will. They are that split on it because there is still no scientific evidence that this is an issue and that progesterone supplementation is the answer to the problem.

Having said that, you have to get a better understanding as to what role progesterone supplementation can play and what you will need to ask for in the future.

The first line of action is whether you have good levels of progesterone after ovulation or not. During any regular cycle, you can ask for a 21 day progesterone check (so this would be about 7 days after you ovulate if you have an "average" cycle of ovulation on CD14). Sometimes this is where women find a progesterone deficiency. It can also be found (as you sort of discovered) through a short luteal phase (the time between ovulation and your period beginning) and/or low basal body temperature.

Here's where things start getting murky. Some doctors won't prescribe progesterone supplements until after pregnancy is confirmed. But studies have shown that if the supplement is given prior to that, it's more likely to support the pregnancy whereas if it's given at a positive beta test or HPT, if it's already destined for miscarriage, the progesterone supplement isn't going to help.

So getting the supplement and taking it starting one to days after ovulation is ideal. Here's where it gets murky again...dosage amount and method of ingestion. Vaginal suppositories or progesterone shots in oil are best. You can usually only get the shots if you're doing IVF. Vaginal suppositories are prescribed by your RE. Creams that you rub on don't do s*** as it takes too long for the body to absorb and get it to the place it needs to help a pregnancy out.

Dosage wise, common dosage is 100mg per day, twice a day and then an upping of the dosage upon a positive pregnancy test. But some docs only do a slight increase. The max dosage is usually around 600mg per day (3 times a day) once pregnant. Problem is, the body really only needs to absorb about 50mg but when it's inserted vaginally, you don't absorb as much as you put in (gravity and all!)

So now that you know more, maybe you can set a plan for next time. Many docs will just prescribe progesterone not because they think it actually works but because there's no proof that it doesn't, there's no proof it causes long term affects on the fetus, AND they think from a psychological standpoint -- it helps their patient.

Push for what feels right to you and create the plan for next time!

Best of luck,

Krista

Wow, thanks for all the info! In terms of the bolded, my temp doesn't usually drop until about 14dpo, when AF arrives. So does that mean my luteal phase is in fact 14 days, even though I have several days of spotting prior? I have always counted the spotting as part of the previous cycle and mark CD1 as the first day of heavy red flow. Also, since I was able to concieve twice, is it safe to assume my progesterone level is adequate?

Albah

caliblondieus:

Progesterone is a challenging discussion in the conception world. If you line up 10 REs, 5 of them won't believe in anything related to progesterone and 5 of them will. They are that split on it because there is still no scientific evidence that this is an issue and that progesterone supplementation is the answer to the problem.

Having said that, you have to get a better understanding as to what role progesterone supplementation can play and what you will need to ask for in the future.

The first line of action is whether you have good levels of progesterone after ovulation or not. During any regular cycle, you can ask for a 21 day progesterone check (so this would be about 7 days after you ovulate if you have an "average" cycle of ovulation on CD14). Sometimes this is where women find a progesterone deficiency. It can also be found (as you sort of discovered) through a short luteal phase (the time between ovulation and your period beginning) and/or low basal body temperature.

Here's where things start getting murky. Some doctors won't prescribe progesterone supplements until after pregnancy is confirmed. But studies have shown that if the supplement is given prior to that, it's more likely to support the pregnancy whereas if it's given at a positive beta test or HPT, if it's already destined for miscarriage, the progesterone supplement isn't going to help.

So getting the supplement and taking it starting one to days after ovulation is ideal. Here's where it gets murky again...dosage amount and method of ingestion. Vaginal suppositories or progesterone shots in oil are best. You can usually only get the shots if you're doing IVF. Vaginal suppositories are prescribed by your RE. Creams that you rub on don't do s*** as it takes too long for the body to absorb and get it to the place it needs to help a pregnancy out.

Dosage wise, common dosage is 100mg per day, twice a day and then an upping of the dosage upon a positive pregnancy test. But some docs only do a slight increase. The max dosage is usually around 600mg per day (3 times a day) once pregnant. Problem is, the body really only needs to absorb about 50mg but when it's inserted vaginally, you don't absorb as much as you put in (gravity and all!)

So now that you know more, maybe you can set a plan for next time. Many docs will just prescribe progesterone not because they think it actually works but because there's no proof that it doesn't, there's no proof it causes long term affects on the fetus, AND they think from a psychological standpoint -- it helps their patient.

Push for what feels right to you and create the plan for next time!

Best of luck,

Krista

 Very good info, didn't know some of this either. I was breastfeeding my toddler twice a day with no postpartum AF yet and got pregnant. I found out after several weeks of irregular bleeding (thinking it was AF) that led me to test. My 1st HCG was 16,000 and 1st ultrasound showed 6 week gestational and yolk sac which was encouraging. But my HCG's thereafter were slowly rising. When I saw my Ob, she discussed the option of giving me progesterone since breastfeeding can be associated with low progesterone levels. But she had a bigger fear of giving it to me, "boosting" the pregnancy only for it to fail later in the course (i.e. 16 weeks). Since my levels were not going up appropriately already, she chose not to go that route. It's such a wishy-washy topic and the best person to speak to is your OB. That's right, different Obs/Re's will have their own opinions but if you trust your doc, then speaking to him/her is your best bet on what to do next time. 

caliblondieus

 Very good info, didn't know some of this either. I was breastfeeding my toddler twice a day with no postpartum AF yet and got pregnant. I found out after several weeks of irregular bleeding (thinking it was AF) that led me to test. My 1st HCG was 16,000 and 1st ultrasound showed 6 week gestational and yolk sac which was encouraging. But my HCG's thereafter were slowly rising. When I saw my Ob, she discussed the option of giving me progesterone since breastfeeding can be associated with low progesterone levels. But she had a bigger fear of giving it to me, "boosting" the pregnancy only for it to fail later in the course (i.e. 16 weeks). Since my levels were not going up appropriately already, she chose not to go that route. It's such a wishy-washy topic and the best person to speak to is your OB. That's right, different Obs/Re's will have their own opinions but if you trust your doc, then speaking to him/her is your best bet on what to do next time. 

I'm curious as to what you think she meant by that? Frankly, it sounds like she's working off the old school theory where they didn't understand that the placenta takes over for progesterone development around week 12 of a pregnancy. So there's not a chance of boosting it and then it failing. The question before that is whether you body can make enough on it's own (because there isn't a placenta to help it along) and if it can't before the plancenta takes over, than you have to supplement yourself. So her statement doesn't ring particularly true to me or you misunderstood her.

Just a thought as you move forward.

caliblondieus

Wow, thanks for all the info! In terms of the bolded, my temp doesn't usually drop until about 14dpo, when AF arrives. So does that mean my luteal phase is in fact 14 days, even though I have several days of spotting prior? I have always counted the spotting as part of the previous cycle and mark CD1 as the first day of heavy red flow. Also, since I was able to concieve twice, is it safe to assume my progesterone level is adequate?

When I say low basal body temp, I'm not necessarily speaking of the drop in temp. For the first 14 days (on average) of your cycle, your temp should be around 97.0 (give or take a few tenths of a degree). Once you ovulate (around CD14 or so) your temp should rise at least 3 tenths of a degree and stay above your coverline. Some women note that they consistently have a low basal temp during this time (more in the 96.0 range) and they don't maintain a higher temp once they've ovulated. This is a sign of low progesterone.

Your luteal phase is from the first day of your ovulation until your period starts. If you have spotting in between that (after ovulation but before your period starts) you could have a hormonal deficiency that you should review with your RE.

The fact that you were able to conceive twice is good but that does not mean your progesterone is adequate. Remember, what we're talking about here is whether you body is producing enough progesterone to assist in implantation (possibly as you've implanted twice) AND is it producing enough to sustain a pregnancy (maybe not since you've lost two pregnancies)?

Are your cycles pretty regular in terms of total length at about 28 days?

Krista

KittyKatMom

caliblondieus:

When I say low basal body temp, I'm not necessarily speaking of the drop in temp. For the first 14 days (on average) of your cycle, your temp should be around 97.0 (give or take a few tenths of a degree). Once you ovulate (around CD14 or so) your temp should rise at least 3 tenths of a degree and stay above your coverline. Some women note that they consistently have a low basal temp during this time (more in the 96.0 range) and they don't maintain a higher temp once they've ovulated. This is a sign of low progesterone.

Your luteal phase is from the first day of your ovulation until your period starts. If you have spotting in between that (after ovulation but before your period starts) you could have a hormonal deficiency that you should review with your RE.

The fact that you were able to conceive twice is good but that does not mean your progesterone is adequate. Remember, what we're talking about here is whether you body is producing enough progesterone to assist in implantation (possibly as you've implanted twice) AND is it producing enough to sustain a pregnancy (maybe not since you've lost two pregnancies)?

Are your cycles pretty regular in terms of total length at about 28 days?

Krista

My cycles tend to be short - around 25 or 26 days. They have always been this way since I started charting in 2008. My temp definitely rises significantly after ovulation. Below is a link to my most recent BFP chart:

My Ovulation Chart

And I've only lost one pregnancy. My first pregnancy resulted in the handsome little man in my siggy. :-)

Albah

caliblondieus:

I'm curious as to what you think she meant by that? Frankly, it sounds like she's working off the old school theory where they didn't understand that the placenta takes over for progesterone development around week 12 of a pregnancy. So there's not a chance of boosting it and then it failing. The question before that is whether you body can make enough on it's own (because there isn't a placenta to help it along) and if it can't before the plancenta takes over, than you have to supplement yourself. So her statement doesn't ring particularly true to me or you misunderstood her.

Just a thought as you move forward.

I think I may have not used the best wording - I shouldn't have said boost the pregnancy and then fail. I think she was trying to come across with the fact that giving progesterone may have helped to move things along in the beginning but if a chromosomal abnormality was the reason why my HCG's were not doubling and baby did not develop (which that's usually the cause), then giving progesterone would not fix the problem. We would run the risk of finding out baby did not develop until a later stage in pregnancy. 

But it's a good point you make and even though I won't be BFing by the time we TTC again, I think I will request a progesterone level just in case.  

caliblondieus

My cycles tend to be short - around 25 or 26 days. They have always been this way since I started charting in 2008. My temp definitely rises significantly after ovulation. Below is a link to my most recent BFP chart:

My Ovulation Chart

And I've only lost one pregnancy. My first pregnancy resulted in the handsome little man in my siggy. :-)

I see just two charts and one looks like your positive pregnancy chart so I'm really only working off your one chart. It looks like you have a short cycle but you're ovulating around CD12 so your luteal phase is around 13 or 14 days which is fine. But you do seem to have a low basal body temp as seen that when you ovulate (on a non pregnancy cycle) your temp rises but barely gets to 98.0. But this isn't sure fire proof that you have a progesterone issue. This is why you would need to get tested at the appropriate time in your cycle and also make sure you get tested next time you're pregnant.

One miscarriage is not all that uncommon so you could just have had bad luck and everything will be fine the next pregnancy. There are many, many women who have had one child, had a miscarriage, then gone on to have their second child. When you have multiple consecutive losses (like me) it's a little less likely it's just bad luck and something more significant.

Best of luck!

Krista