Pregnancy, Low Progesterone Level and Prometrium
Question
Dear Experts,
I am teaching NFP to a woman who was exhibiting short luteal phases in cycles, and her physician prescribed prometrium. Now she is pregnant, and her progesterone level at 6 weeks is just around 12. Her physician has put her back on the prometrium. Is this cause for concern?
Concerned NFP teacher
Answer
Last Updated: June 17, 2013
A progesterone level of 12 at about 6 weeks pregnant is indeed on the low side. Most Obstetricians do not have access to a protocol for supplementation of Progesterone in pregnancy for high risk women. There have been a number of recent published studies documenting that progesterone supplementation for high risk women does result in a lower incidence of preterm delivery. As a result of this data, some obstetricians are beginning to supplement with standard progesterone suppositories. They do not have a protocol to direct their treatment, so the supplementation is a “one-size-fits-all” approach.
Dr Thomas Hilgers (who has a fertility practice in Omaha Nebraska) has done much research in this area. He has developed a protocol for supplementation and monitoring of progesterone in pregnancy. According to his protocol, it would be recommended that you be supplemented with Progesterone injections of 200 mg (available from some compounding pharmacies in the 100mg/1cc concentration) intra-muscularly on a twice weekly basis. Your progesterone levels would then be checked every two weeks, and the doseage adjusted according to Dr Hilgers’ protocol.
If you elected to pursue this route, you would likely need to find a physician in your area who is familiar with Dr Hilgers’ protocol and could direct treatment, working with your obstetrician (if he or she were agreeable). You can contact Dr Hilgers’ Fertility Institute by looking up the Pope Paul VI institute on the internet (web site address available from the California Association of Natural Family Planning). You would then be able to obtain a list of physicians trained to use the Progestrone Support Protocol.
Dr. John Gisla
Dr Thomas Hilgers (who has a fertility practice in Omaha Nebraska) has done much research in this area. He has developed a protocol for supplementation and monitoring of progesterone in pregnancy. According to his protocol, it would be recommended that you be supplemented with Progesterone injections of 200 mg (available from some compounding pharmacies in the 100mg/1cc concentration) intra-muscularly on a twice weekly basis. Your progesterone levels would then be checked every two weeks, and the doseage adjusted according to Dr Hilgers’ protocol.
If you elected to pursue this route, you would likely need to find a physician in your area who is familiar with Dr Hilgers’ protocol and could direct treatment, working with your obstetrician (if he or she were agreeable). You can contact Dr Hilgers’ Fertility Institute by looking up the Pope Paul VI institute on the internet (web site address available from the California Association of Natural Family Planning). You would then be able to obtain a list of physicians trained to use the Progestrone Support Protocol.
Dr. John Gisla
Answered By:
John Gisla, MD
Dr. John Gisla, Board Certified by the American Academy of Family Physicians, pracitces in the Sacramento Region.
