Yesterday my doctor uttered a phrase I've heard a few times already. I have low progesterone levels (based on Day 21-23 lab work.) She, however, added a new hook when I told her that it was Day1 and no, I was not preggers yet. Well of course you're not, with your levels the last batch of Clomid wouldn't have worked. What? Excuse me? Well thanks a lot. Couldn't you have mentioned this before I had my hopes up? Is it really that complicated to preface a 38-day period of time with 'count it down and don't dwell on the baby this month.'
Eragh!!! Enough of the feelings and mushiness, let's break it down on a definitive basis.
• What is progesterone? MedicineNet.com defines it as:
Progesterone:
A female hormone and the principal
progestational hormone that is made mainly by the corpus luteum in the
ovary and by the placenta. Progesterone prepares the lining
(endometrium) of the uterus (the womb) to receive and sustain the
fertilized egg and so permits pregnancy. Similarly refers to synthetic
versions of the hormone. Also known as progestational hormone.
As you can see that seems a little more important than my first doctor initially let on. She (Dr. D), just mentioned that I would have to take progesterone as soon as I conceived, but didn't really fully explain why, that I can remember.
I think the doctor mentioned that I had a level of 1? After reading some articles that seems ridiculously low, so maybe she said 10 which is low but not crisisly low. Maybe? Hopefully? This little iVillage chat kind of concerned me:
Progesterone levels vary considerably from cycle to cycle and woman
to woman, both non-pregnant and pregnant. So the levels can only be
averages and they change with the timing of the cycle. In general, the
midluteal (middle of the second half of the cycle) progesterone in a
non-pregnant patient is 8 to 10, but can be as high as 20 ng/ml. In a
pregnancy cycle, it should be greater than 10 to 12 ng/ml to have a
better chance of a good pregnancy outcome, but in general, we like to
see 16 or over.
Everyone you ask will have slightly different numbers. Also there
are differences as to what to do if the levels are low, with some docs
giving progesterone (pills, shots, suppositories) and others not
treating unless there has been some proof of a preexisting low
progesterone in non-pregnancy cycles.
This whole progesterone thing is a bit scary and daunting. The only relief, as you can see here, is that my diagnosis explains quite a few of my mood quirks and cycle problems. The majority of the sites seem to agree that low P-levels make it hard to conceive and harder to maintain the pregnancy without extra progesterone. Translation: High Pregnancy Candidate Risk.
I have found one site, www.ivf1.com, that contradicts the majority of the opinion. It states that a low P-level won't be as detrimental as the general consensus.
Most infertility patients are aware that progesterone is a hormone produced by the ovaries after ovulation. Many have been told be their doctors that if their levels of progesterone are low that they will not be able to become pregnant or sustain a
pregnancy. The current understanding of progesterone indicates that
this is not true.
(Interesting. If that's the case why isn't it supported by a lot of other sites like MayoClinic.com?)
Checking progesterone levels is a reliable way to determine whether a
woman has ovulated. In most labs, a level above 2.5 ng/mL indicates
that ovulation has taken place.
Beyond that, the uses of progesterone levels are "iffy" at best. There is little medical data to support the notion that "low" progesterone levels are associated with infertility or miscarriage. However, progesterone
supplementation is an easy and inexpensive therapy which is thought to
be completely safe. So most infertility specialists will "err on the
side of caution". This means that even though it is likely that most
women who are told they have low progesterone levels probably don't have a problem, the risks of treatment are negligible so why not?
The problem comes from doctors not explaining this philosophy to
patients and instead let them believe that they have this serious
medical problem which will keep them from having a baby without treatment.
From the sounds of things having a level of 1 still isn't that good, but there is hope.
The next stage is continued treatment. My current doctor, Dr. A (Dr. D moved on to family practice) has
doubled my Clomid dosage from 50mg to 100mg for this next cycle. I'm
not sure if the dosage is enough to compensate for the levels or not. I'm being scheduled for another 21-day blood test to check the post
ovulation progesterone levels. She than has me tentatively booking my
next apt, so we can discuss my fertility options to pursue, should this
Clomid round should fail.
Not to self diagnose but I'm seeing that the low P-levels could be a sign of Luteal Phase Defect that is often treatable with Clomid and hopefully isn't the end of the world. Just see eSSORTMENT, can't they be the expert on the subject?
A luteal phase defect is a luteal phase below 10 days. This cannot sustain a pregnancy. This is because the uterine lining begins to break down, bringing on the menstrual bleeding and
causing an early miscarriage. The number one reason for a luteal phase
defect is low progesterone. A doctor can do a progesterone test 7 days
past ovulation to determine exactly how deficient a woman with a luteal phase defect
is. From that point there are several ways of correcting it..
. . . .
Probably the number one way a doctor will recommend to correct a luteal phase defect is through prescription drugs such as Clomid or progesterone suppositories.
(And I'll just stop there because even some details are TMI for my sensitive ears.)
So, what have we learned?
- Researching low progesterone levels is good therapy and educational and helps the sadness that wants to creep in and cripple me. Oops, the emotions are creeping back in.
- Low P levels are treatable.
- It's not the end of the world.
- Darfur, Rebuilding New Orleans, The War in Iraq ... so many issues are bigger than me.