Doctors Lounge - Gynecology Answers
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Forum Name: Obstetrics
Question: Low Progesterone Cause of Miscarriage?
|mrsj2 - Tue Apr 01, 2008 3:21 pm||
I lost a baby at 5 weeks one week ago in the emergency room. I am 37 and have a healthy 14 month old at home. I have had 2 miscarriages in the last 2 months. With this new pregnancy, I insisted on HCG and progesterone testing when I got a positive home test. My first HCG was 8 and progesterone was 10.6. 2 days later HCG was 38 and two days after that 299. I was put on 100 mg of Prometrium 2 times per day. One week later on a Sunday I started bleeding and cramping, not heavy. Went to the ER. My cervix was closed, HCG was 4623 and the fetal sac was visible. Dr. said this was consistent with 4/12 to 5 weeks pregnant. I went home, bled all night with large, lemon size clots. Went back to the ER, and HCG was now 980. Ultrasound confirmed the fetal sac was gone. Dr. removed the baby as my cervix was open and most of the lining was already gone.
Here is the question: My progesterone was never drawn after the first time when it was low. Was not even drawn at the hospital. I was only given an oral pill, never suppositories which I have read can help save a pregnancy with low progesterone. Is it possible the low progesterone caused the miscarriage ( or even both of them)? Should I insist on the suppositories and repeat progesterone blood work in the next pregnancy? When should progesterone be tested during a regular menstrual cycle to determine whether or not is is low? Can progesterone become low in a person who has had a normal, healthy pregnancy before? Anything you can tell me would be helpful. Thank you.
|Debbie Miller, RN - Wed Jul 09, 2008 4:22 pm||
I'm sorry about your loss. Unfortunately, despite our best efforts and good care, it is estimated that nearly 25% of pregnancies end in miscarriage, often before the woman even knows she is pregnant. It is believed that it is often related to chromosomal abnormalities that cannot result in a healthy baby and so miscarriage is the kindest result even though it doesn't seem so kind to you. It does often occur even after you have had a healthy pregnancy.
Low progesterone can be related in some cases. If it was a sure thing we would be able to give it to all women and prevent miscarriage, but it just doesn't work that way. If the fetus is not developing, progesterone will do nothing to help and it's nature's way to get rid of the unneeded blood and placental tissue. Progesterone helps to prepare the uterus to sustain the pregnancy until the placenta takes over and produces its own.
Since you have had two miscarriages you may want to consult with a specialist to see if extra measures might be indicated. Usually it is prometrium that is given but there are other causes for some women to lose a pregnancy such as clotting factor problems. These women are sometimes prescribed low dose aspirin or heparin injections. The women who can benefit from such intervention are not the majority who experience miscarriage but usually after a woman has suffered a couple of them it is worth checking into anyway. I wish we could do more to prevent this heartache.
If you see a specialist in pregnancy loss, you will know that you are getting the best treatment that is possible but there is no guarantee here. If the doctor decides progesterone might be helpful it will likely be given without necessarily checking levels.
Best wishes in your future.
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