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Last Updated:
Jan 3rd, 2010 - 00:09:53
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Question
Miscarriage after depo?
I was on depo for 10 years. I loved it, as it prevented the debilitating migraines I would get frequently and had no menses, which had been very heavy and painful. I took my last shot in September '06, cycles returned in March '07, and became pregnant in August '07. However, I lost the baby at 8 weeks. At the end, when we still had a heartbeat, my progesterone levels were very low (9). U/S showed that there was a normal looking corpus luteum, but I suspect that it was not producing adequate progesterone.
Could this be the case? I would like to conceive again, but can this be detected early enough to make a difference? I am told that because this is my first, I have to have 2 more babies die before any one will bother to do any testing, which is unbelievably cruel.
Melanie
Answer
Dear Melanie,
I am very sorry for your loss. The most common cause of early miscarriage is a genetic anomaly with the child—there is nothing that can be done in these cases to prevent miscarriage.
We suspect, though, that there are early pregnancies that are lost due to inadequate progesterone production by the corpus luteum. The corpus luteum is what is left over from the follicle in your ovary after it ruptures during ovulation. The corpus luteum is responsible for progesterone production in the first trimester, after which the child’s placenta takes over this role.
We have recent strong study evidence that progesterone supplementation after the first trimester prevents pre-term delivery in high-risk pregnancies. Many of us also suspect that progesterone similarly prevents some miscarriages during the first trimester—though we don’t have the studies to prove this as of yet. In any case, progesterone supplementation is very safe, so there seems little down-side to providing it, especially to women such as yourself who have already experienced a miscarriage.
I would recommend that you find a local doctor who would be willing to supplement you with progesterone during your pregnancy. There are many protocols that are used to do this. Some doctors simply start progesterone (by pill or vaginal capsule) as soon as the woman becomes pregnant. I use the protocol developed by Dr Thomas Hilgers at the Pope Paul VI Institute in Omaha, Nebraska. Dr. Hilgers’ protocol relies upon measuring your progesterone levels every 2 weeks during your pregnancy, and providing supplementation with progesterone by injection (two shots per week) based upon your progesterone levels. Thus, as soon as you get pregnant, we would check a blood test to assess your progesterone level, then start supplementation as dictated by Dr. Hilgers’ protocol.
Dr. John Gisla
John Gisla, MD, NFPMC is Board Certified by the American Academy of Family Physicians,
and Certified as a Medical Consultant for Natural Family Planning and NaPro Technology
by the Pope Paul VI Institute. He is on staff at Mercy of Folson Hospital and on the NFP Advisory
Board for the Diocese of Sacramento. He has been married ten years and has two daughters and a son.
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