How to supplement PROGESTERONE to aid conception, prevent miscarriage and maintain pregnancy related to Luteal Phase Deficiency (LPD)

What is luteal phase deficiency (LPD)?

LPD exists in some women whereby the ovarian corpus luteum is unable to produce sufficient PROGESTERONE necessary for conception and/or maintaining a nurturing environment for a fetus - necessary through the first 10 weeks of gestation (counted from day 1 of last period) until the placenta takes over production at considerably higher levels. Until then, to aid conception and/or prevent miscarriage, these women may need to supplement PROGESTERONE.

Risks of Supplementing PROGESTERONE during pregnancy

Natural, bioidentical PROGESTERONE is generally safe to use during pregnancy - using up to 60-80 mg of bioidentical PROGESTERONE /day through the 10th week of gestation (i.e. 8th week after ovulation). Doses higher than 100 mg have some side effects, including sleepiness, loss of libido, mild depression, and hormonal imbalances.

PROGESTERONE supplementation  may increase the risk of hypospadias - which is an abnormal placement of the opening at the end of the penis (can be corrected with surgery).

Prometrium ( a natural PROGESTERONE supplement) is categorized as a B drug for pregnancy by the FDA - which means there are no controlled studies finding it harmful in pregnancy. However, a 25-year study of > 2000 pregnancies found no increase in birth defects when using natural PROGESTERONE. (Pope Paul VI institute for the study of human reproduction)

Signs /Symptoms of Low PROGESTERONE in Early Pregnancy

•  Spotting -The most common symptom of low levels of PROGESTERONE and human chorionic gonadotropin (hCG) hormone is bleeding in the first few weeks of gestation. While there can be other causes of this, any spotting that occurs, especially if it is accompanied by cramping, could be an indication of low levels of PROGESTERONE

•  Tenderness - Although blood spotting is the most common indication of possible PROGESTERONE deficiency during early pregnancy, women who have been found to be deficient in PROGESTERONE during pregnancy have reported increased tenderness in the breasts and lower back pain combined with spotting within the first trimester. These symptoms by themselves may not be indicative of low levels of PROGESTERONE , and may be due to other things that are taking place in the body, such as the growth of milk-producing cells and fibrocystic swelling.

PROGESTERONE Levels in Pregnancy

PROGESTERONE levels in early pregnancy ordinarily DOUBLES or TRIPLES during the first several weeks of pregnancy - PROGESTERONE should be produced EVERY DAY during pregnancy (in the regular menstrual period, PROGESTERONE is only produced at ovulation and for about 14 more days).

-   Normally when an egg is fertilized, chemical messengers cause the follicle to increase its production of PROGESTERONE to 30 to 40 mg per day - double or triple what it made during the luteal phase of the monthly cycle when the woman was not pregnant. The level of PROGESTERONE increases gradually until well into the third month of pregnancy. By that time, the placenta is well developed and is producing progressively more PROGESTERONE within the uterus.

-   By the 3rd trimester PROGESTERONE levels rise to > 10-20 TIMES normal amounts - to protect the fetus, levels can be as much as 300mg to 400mg per day.

Low levels of PROGESTERONE during early pregnancy can result in the loss of the embryo

Suggested PROGESTERONE dosage and regimen to promote and maintain pregnancy?

Ensure your thyroid is producing enough thyroid hormones

Adequate levels of circulating thyroid hormones are important for normal reproductive function - these can be ensured by taking a daily dose of iodine.

What kind of PROGESTERONE to use and how to apply it?

Use only Bioidentical PROGESTERONE (concentrated at ~500mg PROGESTERONE / ounce) applied vaginally as first choice (or else topically)

-  Synthetic forms (i.e. progestins) have too many health risks

-  Oral doses are only 10% available after processing by liver

-  Herbal PROGESTERONE, such as wild yam, is NOT recommended for this use

Use ONLY Bioidentical PROGESTERONE Cream or gel

Long-term topical use (i.e. applied to skin)  can cause a PROGESTERONE build-up in fatty tissues leading to excessively high blood PROGESTERONE levels -  If you have been using topical PROGESTERONE long-term and maintain pregnancy, this is not a problem, since the pregnancy demands high levels of PROGESTERONE as it progresses into the second and third trimesters. However, if you miscarry, you could be dealing with untimely high levels of PROGESTERONE (as PROGESTERONE is slowly released from fatty tissues in the skin over several months), which would interfere with your natural menstrual cycles.

For information addressing different delivery routes:

PROGESTERONE Delivery route Choices

Doses of PROGESTERONE before and after conception

Dose BEFORE becoming pregnant? - 1/8 tsp (10mg) A.M. and P.M. (a total of 20mg /day) to correct luteal phase deficiency and enable pregnancy in cases where the follicle is still able to “pop”an egg.

•  Begin supplementation the day after ovulation FOR 14 DAYS then stop.   To  figure PROGESTERONE start date, count back 14 days from when your next period is due (Day 1). Alternatively, use a fertility monitor to accurately ascertain when you ovulate.

Family Planning Tools

As soon as pregnancy is confirmed, a woman at risk for miscarriage should start using natural USP PROGESTERONE (in cream or vaginal suppositories)

•  Gradually increase supplemental PROGESTERONE dose from 20 mg up to 60 mg (or if necessary, even 80 mg) PER DAY.

•  Whatever dose you are on, it should be split into at least 3 applications to more closely emulate the natural PROGESTERONE production from the ovarian corpus luteum - PROGESTERONE lasts about 7 hours in the system.

Do not miss a dose by forgetting or running out of supplies - YOU COULD MISCARRY

•  Keep supplemental PROGESTERONE with you at all times and apply 20 mg PROGESTERONE immediately if you experience any cramping - in an effort to stave off a miscarriage.

You must continue taking PROGESTERONE for at least 8 weeks after ovulation i.e. 10 weeks gestation - at which time the placenta should be producing enough PROGESTERONE to maintain the pregnancy. During the last trimester, PROGESTERONE production in the placenta increases to a level that supplemental PROGESTERONE becomes superfluous.

Resume one month after delivery to prevent post-partum depression - at 20 mg per day. Natural PROGESTERONE is useful for post-partum depression, which many women experience after childbirth. Serum allopregnanolone levels are significantly lower in women experiencing postpartum "blues" -allopregnanolone is a metabolite of PROGESTERONE;  Multiple studies confirmed that PROGESTERONE supplementation via IUD's did not adversely affect breast-feeding.

References

John R. Lee, M.D. and Virginia Hopkins, BEATING INFERTILITY - Getting Pregnant and Staying Pregnant: You Can Try This at Home Online Link