Progesterone Dropping

Dear Joey,

Congratulations on your pregnancy. I would make the following comments regarding your case:

HCG is produced by your child’s placenta. Its job is to stimulate the corpus luteum (the structure which is what’s left after the follicle in your ovary has ruptured and released its egg) to produce progesterone. The progesterone maintains the thick nourishing inner lining of your uterus, which allows your pregnancy to be maintained. HCG is an indirect measure of placental mass (the size of your placenta) in early pregnancy. It tends to peak around ten weeks or so, then the level falls off (this is because it is no longer needed since after the first trimester the placenta produces its own progesterone and does not need the help of your corpus luteum). The fact that your hCG has risen to this level (which is a normal level) at nine weeks of pregnancy is a good sign. We would expect it to start decreasing over the next few weeks.

Progesterone is the essential hormone of pregnancy. It allows the pregnancy to be maintained and continue normally. Measurement of progesterone can be reflective of the health of you pregnancy. A level of 27 to 28 is normal at this stage of pregnancy. In addition, this level can fluctuate to some degree early on. This is not necessarily cause for concern.

I would recommend you consider the following:

There is some good data suggesting that supplementation with progesterone (through injection or vaginal capsul/suppository) prevents pre-term birth in high risk women. A woman can be at “high risk” due to a number of factors including: previous pre-term birth or pregnancy complications, maternal age, high blood pressure, frequent miscarriages, high blood sugar, and many other reasons.

Whether progesterone is useful in the first trimester (first 12 weeks) is not known for certain. It makes sense, though, that there may be pregnancies lost through inadequate progesterone production by the corpus luteum. In fact, many doctors who treat infertility and high risk pregnancies have been recommending progesterone supplementation, or progesterone stimulation with extra hCG (by injection), in the first trimester for many years. This makes sense physiologically.

I think you may be a good candidate for progesterone supplementation. Your age and previous miscarriages (perhaps other factors also?) put you in a high risk category in my mind. In addition, there is virtually no “down side” to progesterone supplementation. It is very safe and well tolerated. There are many ways that doctors supplement with progesterone in pregnancy. Some use vaginal suppositories, others use intramuscular injections. Some give a standard dose and don’t measure progesterone levels, and other adjust the dose depending on the blood level of progesterone.

My practice, and what I’d recommend that you consider, is to supplement using a protocol developed by Dr.Thomas Hilgers. Dr Hilgers has an active OB/Gyn practice in Omaha Nebraska. He has developed a protocol based on his years of experience and research. His protocol calls for supplementation of progesterone by injection, then measurement of the progesterone level every two weeks, with subsequent adjustment of the dose of progesterone based upon the levels observed. When the level is very good, the progesterone dose is lowered, or even discontinued. Dr. Hilgers has trained many physicians to use his progesterone supplementation protocol, as well as other treatments he has developed, to treat common gynecologic and fertility problems. His methods are ordered towards diagnosing the cause of the abnormality, then devising a treatment plan that is ordered towards correcting the problem and restoring normal physiology to a woman’s body.

You can find more information about Dr. Hilgers progesterone supplementation protocol by going to his web site. www.naprotechnology.com

Good Luck, John Gisla, M.D.