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Last Updated:
Oct 18th, 2007 - 19:05:31
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Question
I am between 4 and 5 weeks pregnant. The ultrasound showed a heartbeat. My doctor is concerned, however, because between my two blood tests, my progesterone levels did not increase and I have had some minor spotting (which has since stopped). He has perscribed a vaginal course of Prochieve 8% and I would like to know:
- the risks in not taking this are
- why would he perscribe this if I have a viable fetus
- at this phase what is the expected benefit that the increased progesterone will yield?
Thanks!
Julia
Answer
Dear Julia;
Congratulations on your pregnancy. I know how stressful it can be when your doctor raises the possibility that there may be some problem with your pregnancy.
It is not uncommon for progesterone levels in early pregnancy to rise slowly. You do not mention how much time elapsed between your first and second progesterone levels, but if it had been a week or two, then it may not be suggestive of a problem. In general, the levels of progesterone in the first trimester rise, but from one test to the next, there may be a plateau.
That being said, your doctor is correct to check progesterone levels and respond to them. More and more research has been showing that progesterone support, especially when provided to women with high-risk pregnancies, prevents preterm (premature) birth. We don't have proof, yet, that early progesterone support prevents early miscarriage, but many peri-natologists and high-risk OB practitioners have long suspected that it does--and have provided progesterone support in one form or another.
I do not use Prochieve, and cannot therefore give you first-hand information about this product in particular. It is a natural progesterone product in a gel-like vehicle that is provided vaginally. For pregnancy support, I use natural progesterone compounded in oil, injected intramuscularly; or is some cases, progesterone vaginal capsules. I use the protocol developed by Dr. Thomas Hilgers. Dr. Hilgers' protocol provides for checking progesterone levels every 2 weeks, and adjusting the level of support based upon these blood levels throughout the pregnancy. It sounds like your doctor has a similar idea; I am supportive of this approach.
The only risk of progesterone is associated with the manner of its delivery. That is, injected progesterone could be associated with infection, bleeding or pain at the injection site; vaginal progesterone could be associated with irritation of the vaginal membranes by the vehicle in which the progesterone is dissolved. There is no risk from the progesterone itself--it is the same hormone that your body (or your baby's placenta) is producing itself in order to support the pregnancy. It is perfectly safe and has no side effects itself.
The benefit hoped for is the sustaining of the pregnancy and prevention of a miscarriage in the case that your own body is not producing enough progesterone itself. Your child may be perfectly "viable" and in good health--but if there is not sufficient progesterone circulating to sustain your pregnancy, then you are likely to miscarry or deliver prematurely. Providing extra progesterone "supplements" your own supply, and may help sustain your pregnancy.
I hope this is helpful.
Best, John Gisla, MD
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.
© Copyright 2005 by CANFP
The information on this page and web site is for informational purposes only,
and is not a substitute for medical diagnosis and treatment by a physician.
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