Would Progesterone Therapy Help Me?
Question
My name is Meghan, and I am hoping that you can help me with a fertility issue. My husband and I have been trying to conceive for nearly a year. I have been charting my temperatures and monitoring my cervical mucus during this time and have yet to become pregnant. Over the past 4 months, I noted a decrease in the length of my luteal phase from a typical 14 days to 9-11 days. It appears that I ovulate, as I see a temperature shift; however, I did have blood work the past two cycles in the post-peak phase, showing a progesterone amount around 8, which is a bit low. The physician that I am currently seeing has suggested Clomid, but I am concerned. Can progesterone replacement therapy assist with conception, in my case? And if so, what is the typical dosage administered? I understand that it is generally administered post-peak days 3-12? Should bloodwork be done again after this phase in order to see if miscarriage can be prevented?
Thank you for your assistance.
Meghan
Answer
Last Updated: June 3, 2014
I hope that I can help you with a potentially very complex situation. The good news is that you have already done most of the work and are far ahead in trying to conceive. So keep that good news in mind!
For some reason your luteal phase, the time after ovulation until the next menstrual flow, has shortened. You don’t say that you are having any spotting during this time. Also, you don’t say when the progesterone level was drawn in the luteal phase but I will assume that it was post-peak day 7. A level of 8 ng/ml at that time would definitely be low but normal on post-peak day 11 and slightly low on post-peak day 3. This is according to the research at Pope Paul VI Institute in Omaha NE using their lab.
It would be important to know several things first. What are the levels of progesterone throughout the luteal phase? Are they starting off normal and never achieving normal height or are they dropping off early? What are the estrogen levels doing throughout the whole cycle? These levels can help in understanding whether the follicle is normal or if the receptors are working correctly, etc. Yes, a temperature shift can point to ovulation but temperature shift doesn’t tell how well you are ovulating. For example, is the follicle big enough to produce enough estrogen and progesterone. Is the left over follicle, the corpus luteum, functioning well enough and long enough to maintain the lining of the uterus for continued pregnancy.
Yes, progesterone is used in many cases to assist in achieving and maintaining pregnancies. And yes, if progesterone is needed to be used in achieving then it must be checked during the pregnancy. Again, Pope Paul VI Institute has done all of the research and has standardized the normals for progesterone levels during pregnancy. The amount used depends on the woman’s levels to begin with and what it takes to get her levels into the normal range.
Clomid (clomiphine citrate) can be used for achieving pregnancy. Clomid is used early in the cycle on days 3-5 and stimulates follicle production. Again, at the Pope Paul VI Institute, they advocate a low dose regimen of 25mg at first then move up from there. This is for women who have regular cycles and working ovaries which sounds like you have. There are much fewer multiple births using a low dose regimen.
There are other medications that can be used depending on where exactly the problem lies in your situation. Some would consider HCG to be used mid-cycle which helps both estrogen and progesterone levels. Also, one would wonder if your thyroid is normal. Additionally, your husband needs to have an exam and sperm count.
I hope that this helps you and that this information will help you become pregnant!
Sincerely, Gretchen V. Marsh, D.O.
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