Conflicting Advice on Progesterone and Infertility

Question

I am 27 years old and my husband and I have been trying for our first child for five months. I have been charting since we got married almost two years ago, really for my form of birth control but then turned into charting to get pregnant. I am consistently inconsistent meaning I range from a 28 day cycle to a 42 day cycle, seeming to always have about a 14-16 day luteal phase. My temps go up and down not having a very clear peak day. My cervical fluid goes from the creamy consistency to wet and egg whitish to sticky then my cycle.
Four months ago I went to a hormone specialist and found that on day 21 I showed a 0.5 for my progesterone and a 158 for estrogen as well as a 25 for testosterone. I was put on a 2% cream to use on days 12-28 and then I tested again that month on day 21 and had changed 1.7 prog. /148 est. then I went up to a 4% cream starting on day eight of my next cycle I did an ovulation kit that month finding out I ovulated on around day 21. But still working that info didn’t get pregnant.

My OBGYN says “get off of the progesterone! Hormones are not FDA approved that they even have nothing to do with pregnancy and that I had to try for a year and or have had three miscarriages to talk abut how to get pregnant with her. Also that using the cream can cause me to not ovulate.” My Dr. says we have to get my levels balanced….

I am confused. I understand through my research that my levels should be balanced to get pregnant and or to keep the baby when I DO get pregnant…? I started yoga and relaxing more but at the end of the day using the cream has made me feel like I can get through my days easier without such a fight. I am a better boss and service provider when I can take the day on with joy rather than a poker face. I also dropped two lbs doing what I always do (eating healthy and workout 4x a week)

Thank you sooooo much in advance for clearing up some things for me being that I am very confused.

Alicia

Answer

Dear Alicia,

I am sorry that you are meeting such difficulties but it is wonderful that you are charting because this gives a physician excellent information to target testing and interpret results. Charting also helps a couple participate in rather than be incidental to their fertility investigation. Additionally, the goal is to find the reason for the difficulty and restore health. Because of these things, a charting couple is usually considered infertile or sub fertile after six months of fertility-focused intercourse.

The testing of your hormones is a good start; however, it is better to draw the blood in relation to the peak day (the last day of any peak type mucus) and not necessarily on Day 21. Physiologic markers such as cervical mucus are accurate markers of biologic function and blood tests and ultrasounds etc help to fine tune that information especially when coordinated with the chart.

Peak type mucus is a result of increasing estrogen levels from the egg follicle on the cervical crypts. Estrogen causes the mucus to be elastic (stretchy), slippery (lubricative), and /or clear and it has been shown that most ovulation occurs on peak day. Right after ovulation, the remaining follicle produces progesterone which is needed for endometrial development and sustaining a pregnancy. If the progesterone amounts are too low, not sustained, or drop off too early, cycles are irregular and miscarriages are more likely. Other hormones factor into healthy cycles such as thyroid, testosterone, DHEA, etc.

You describe symptoms of low progesterone levels, irregular ovulation, and anovulatory cycles (no ovulation). It is quite possible that you have follicular cysts that are prolonging your cycle and delaying ovulation. Additionally, the follicle that develops may not be sufficient in producing enough progesterone in the normal rise and fall pattern of the luteal phase. Also it is possible that though the follicle enlarges, the egg never ruptures out so you have the appearance of fairly regular cycles but without actual ovulation.

If this is the case as it is for many women with irregular cycles, progesterone is used with excellent results. Creams, vaginal suppositories, injections, and oral routes are used during post peak only, following ovulation, from the third day after your peak through the 12th day after your peak. This helps to normalize the cycle. The use of bio-identical progesterone (exactly what your body makes) is typically used by myself and colleagues and has been found to be safe in all three trimesters of pregnancy as well. A study is soon to be published that reviews the data regarding the use of bio-identical progesterone over forty years via the Pope Paul VI Institute. The data shows that bio-identical progesterone can be used safely in all three trimesters of pregnancy.

Additionally, 17- hydroxyprogesterone caproate has been used since the 1950’s as Delalutin to help reduce miscarriage. It was taken off the market and then returned to market after a NIH study showed its effectiveness and safety. It was remarketed in 2011 as Makena and the cost was artificially elevated. After a firestorm of criticism, the company reduced the price. What your Ob/Gyn may have been commenting on was that Delatutin/Makena have not been studied in all three trimesters. IM Progesterone just had a labeling change for use in the first trimester whereas the creams and oral preparations never had a first trimester warning. This all may contribute to the varying conclusions that physicians have regarding progesterone.

Nutrition is always important for fertility and general health. Physicians are becoming more knowledgeable about this area and how it impacts fertility. There is a good basic book called “Fertility, Cycles, & Nutrition” by Marilynn Shannon which you may find helpful. Additionally adequate restorative sleep, sensible exercise, and maintaining a healthy weight are vital.

I hope that this information helps you.

Gretchen V. Marsh, D.O.

Answered By:

Gretchen Marsh, D.O.
Dr. Marsh graduated from Western University of Health Sciences in 1987 in Pomona, CA and is board certified in Family Medicine by the American Osteopathic Board of Family Physicians. She has been certified as a NaProTechnology® Medical Consultant (NaPro) and Creighton model Fertility Care System (CrMS) teacher since 2001. She and her husband, Jon, have 5 sons and live in the Reno region, where she sees patients in person, in addition to her telehealth services offered via MyCatholicDoctor.com

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