Low progesterone at 13 weeks

Rebecca

0 Posts
Reply Low progesterone at 13 weeks Posted on: Sep 24, 2011 at 8:32am
Hi Dr. Braverman,
I'm pregnant for the 7th time, and I'm 13w0d today. This is the furthest I've ever gotten; most of the other pregnancies have ended between 6-8 weeks, and we only have an explanation (chromosomal abnormality) for one. (I have a variety of issues - pcos, hetero Factor 5, hetero MTHFR, thyroidectomy due to Hashimoto's - that are being treated w/metformin, low-dose aspirin, Lovenox, folgard, close monitoring of my thyroid levels.)

This pregnancy is from an FET, and my progesterone levels are lower than the RE would like at this point, but since I'm 13 weeks, their office says they can't continue to treat me, and my perinatologist doesn't believe in progesterone supplementation after the 1st trimester.

On 3 prometrium (100 mg) per day, my levels were 11 with my initial beta, then dropped to 7.5 at 5w0d. That day, I began bleeding, and I think I lost the 2nd embryo (we had 2 transferred). By 5w3d, my progesterone level was down to 5.8, and they started me on 1 cc of PIO daily in addition to the suppositories.

I had bleeding on and off until 8 weeks, but I've had ultrasounds every week since 6 weeks (and for a few weeks, twice a week since I was super nervous and anxious), and every time the heart rate was very good and growth was measuring either exactly on target or 1 day over/under. (Usually over or on target - there was only 1 ultrasound where it was measuring a day under.) And every time the ultrasound tech and perinatologist have said that everything looks perfect, exactly as they would expect.

Because of the bleeding and low levels early on, the RE weaned me slowly. I was at 35 at 10 weeks before going off anything. At that point, they started weaning me, and I went to 39, back to 35, down to 19.7, up to 21.6, down to 21.3, and then today, after being off everything for 2 days, down to 17.45.

The RE would like to see it be at least 20, but from what I've found online, at 13 weeks it should be closer to 40. The perinatologist says she never measures progesterone after the first trimester, but from what I've read online, there are women who have benefited from taking it through the second and sometimes even third trimesters.

This will likely be my last pregnancy if this doesn't work, and I'm worried about losing the pregnancy because of low progesterone. What level do you normally like to see for progesterone at this point in a pregnancy? Am I justified in my concern or just over-reacting?

Thank you,
Rebecca

Dr. Braverman

2016 Posts
Re: Low progesterone at 13 weeks Posted on: Sep 26, 2011 at 8:23pm
The reason the perinatologists never prescribe progesterone is because they do not deal with RPL cases. I have seen several cases of loss with low placental production of progesterone and have kept these patients on supplementation until 20 weeks. so although without knowing your case I can not make recommendations for your care I do not think it is out of line to continue progestorone in cases where the losses are associated with low placental production of progestorone or possibly due to rapid clearance.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.