Possible progesterone deficiency

[LionsandBears]

hi all. Was wondering if anyone has been dx with a progesterone deficiency and how it was handled?

My GP has been very supportive of me exploring possible causes of our missed mc. We found out at 10w2d that bub had died. It was estimated bub died at 8w4days. I've had chromosone testing (normal), blood clotting testing (normal). DH has also been tested for chromosone issues, but we need to wait for the results. Bub was tested after the D&C, but due to delay since death, results were inconclusive.

The main thing I think may be related (assuming it wasn't a chromosone issue, which we'll never know) is it could be progesterone. My LP is usually around 11 days. That's longer than would normally considered a LP defect, but it rarely gets more than 12 days, so I'm wondering if it's borderline. (this last cylce, it was 10 days) Talking to the GP, we thought maybe the corpus luteum wasn't strong enough, so wasn't enough progesterone - bub died in the time the placenta takes over from the corpus luteum. However, can't rule out something else being wrong with bub or the placenta.

I've had CD21 testing 2 years ago - results were OK. Don't know if 2 years makes any difference at my age or not

I was supposed to have an appt with a Gyn to talk about it today, but he was delivering a baby, so it's been delayed a couple of weeks. My GP agrees it wouldn't kill me to take progesterone pessaries next time anyway, as it wouldn't do any harm.

Has anyone been dx with LPD or needed to take progesterone? What's involved? When do you start? How long do you take them for?

TIA

[Inanna]

I am sorry for your loss my love...

Progesterone deficiency as a cause for miscarriage is one of those things that is argued ad infinitum...

Whilst I don't believe it can be disagreed that it plays a part it presents as a very early loss - basically the Mamas body just doesn't produce enough progesterone to sustain the embryonic stage and the pregnancy is lost.

Missed miscarriage happens sadly more often than any of us would like to imagine - and generally is caused by chromosomal issues in the baby - it is thought. When a pregnancy is lost & not diagnosed for some time - it can be impossible, as you have found to find a cause.

It is highly unlikely that a loss such as yours was caused by a progesterone deficiency. Typically with hormonal problems the embryonic pregnancy is lost heralded by bleeding. In miscarriage the progesterone begins to decrease prior to a decrease in HCG.

When the luteal phase of a cycle is less than about 11-12 days it sometimes is termed as a luteal phase defect. This can cause early loss - or "chemical pregnancy" when the pregnancy is confirmed but is lost soon after - usually prior to 6 weeks. This does occur because the luteal phase is not long enough - as an affect the progesterone levels begin to drop prior to the embryo implanting.

I understand how hard it is to want answers and not be able to find them. I encourage & support you to keep questioning, keep asking all that is on your mind and seek out a care provider that listens to you and acts on your intuition.

Sending you loving support...

Fly freely little baby...

[LionsandBears]

Thanks for your reply and your support- I thought LPD would result in early losses too. However, I thought, maybe progesteron is high enough for implantation, but not high enough to help let the placenta take over.

Typically with hormonal problems the embryonic pregnancy is lost heralded by bleeding. In miscarriage the progesterone begins to decrease prior to a decrease in HCG.

I didn't know this.

I do feel like I'm clutching at straws a bit, but I figure, if it can't hurt, then maybe try it anyway?

I'm really pleased I have a GP who's so supportive - having had 2 m/c herself she can relate and her philosophy is not to wait for recurrent m/c's before testing (her words: it would be sadistic to do that). However, she wants me to talk to a Gyn before doing anymore hormone testing. I also know using progesterone won't guarantee anything - my GP had another client who after 2 m/c, used progesterone - baby stuck but was born with a trisomy and died at 5 months (she did go on to have a healthy baby later).

I realise every pregnancy is a roll of the dice. I just hope doing something may prevent this ever happening to us again. Also, "doing something" makes me feel like I have some kind of control over things.... which this m/c has taught me is so not the case

[Inanna]

I would recommend a CD21 test. This is a blood test taken 7 days after ovulation (thus the 21 as "the perfect" woman ovulates on day 14 ). This will show what your progesterone is and will indicate if it is at a good level to sustain a pregnancy. That is something really simple that you can do and something that an obstetrician would probably do...

Good luck honey...

[blackduckies]

Hi I don't know lots on the subject cause it is quite hard to get answers and facts

I have a short cycle a bit like your slef and my losses have been put down to that fact that the embryo does'nt have time to implant properly. Although I did have 3 children and 3 losses before my last baby..None of my babies have ever been tested, none offered??? majorty of my losses were before I came to BB so I had no idea.. after my 4th loss I started to look for answers and went to see a series of FS.. we had a lot of testing done none showing any problems!!! So with help from my FS my cycle was lengthend out to a 28day cycle and I finally fell pregnant, I was put on progesterone pessaries which I used till 14 weeks, I still had spotting/bleeding which is something that has happened in all my pregnancies, but the baby stayed.

I recently fell BFP unexpectedly and without the care of an OB until 8 weeks decided to get my GP to moniter all my levels, they all were rising nicely, then one day I got some very slight spotting , I went to get my levels tested to find that my HCG was going up really well but my progesterone had dropped... only a bit... but a problem.. over the next 2 days my levels dropped nearly in half, bleeding increased. I went to ED and after a lot of issues and being very determined was finally prescribed progesterone pessaries, I then drove to Melb to fill my script and used one while sitting in the car We have'nt looked back my levels started rising again bleeding lessesn, is now discolouration. Just had another US baby is a bit over 10 weeks great HB very active and looking good, I feel safe and the baby looks so good I can't imagine that he/she won't make it.. My OB, has told me the jury is out on progesterone, but was happy to give me another script as it also does no harm and I will continue to use it till 14 weeks like last time..
Unlike the OB and docs I have no doubt..... I believe progesterone works

Best advice I can give, is be determined, doctors often don't have the answers ...they don't have the vested interest you do in your baby, trust your instincts read everything you can get your hands on and if you feel it might help use the pessaries, get them..they don't do any harm..

Best of luck, I hope you find the answers you need.

[LionsandBears]

Thanks Pam

I'm yet to be able to see th Ob/Gyn, but don't see how it could do any harm. I found that interesting that the HcG was rising, but the progesterone was falling.

btw - how did your FS help your cycle increase to 28 days - and did that include an increased LP?
I'm taking Vitex again, but not seeing much change yet - I know it takes a few months.

Cheers
Tash

[NaeNae]

I am so sorry to hear of your loss Tash.

I think its absolutely wonderful that you have found a Dr who has had you in for testing rather than waiting for recurrent miscarriages occur.

I think if you want to use pessaries to go for it, but like anything you need to be aware that there is no guarantees that these will work or that there is even anything wrong with your body at all.

I appreciate the need to look for something to be wrong to help explain the loss. It helps to have a reason why these things happen.

From my own personal journey, sometimes its just crap luck. Sometimes there is no reason why things happen the way they do. No reason whatsoever why an otherwise perfectly healthy pregnancy fails. And sadly there is no miracle cure to ensure that things don't happen again. Its just the way it goes.

For a fortunate few they do get answers though and i am glad you have someone who is prepared to help you so early in the piece. Thats kind of support is so important and I hope you do get the answers you seek. Not that I hope they find something wrong with you iykwim.

I really really hope you do get your answers - just don't hold your breath - sadly sometimes these things really do just happen for no apparent reason.

In the meantime - sending you love and hugs and strength

Nae x x x

[satya]

Unfortunately with most miscarriages you will never get a reason why. I think that's why most doctors wont investigate until you've had 3. It's also very common to have just one m/c, less common to have 2, and even less common to have 3 or more.

Generally once you hit 35 you have a higher risk of miscarrying. The risk increases with each year.

I had loads of tests done and everything came up normal. All my losses were early & my LP was 11-12 days. My progesterone was always within normal limits when tested. No reason could be given for my first m/c when I was 31. My last two ten years later were put down to age factors. I gave up on getting answers & the next pregnancy (which was unplanned) stuck.

I've read that progesterone goes down before HCG does but that doesn't necessarily mean that taking progesterone will sustain the pregnancy. Sometimes it does, but sometimes it doesn't.

[Inanna]

Satya.
Progesterone does fall prior to HCG. So if HCG levels are being done and they double as hoped but the progesterone (which is measured with serial hcg tests) begins to fall this does not augur well for a pregnancy.
Conversley sometimes those HCG levels don't double quite like they shoudl but the progesterone remains stable or rises - there is more hope for the pregnancy then.

Satya is absolutely right - very often no cause can be found for losses in the first trimester (sadly also for later losses and stillbirths this is also true).

Wishing you a sticky sticky baby my love..