What is progesterone?
Progesterone is a steroid hormone initially secreted by the corpus luteum, an area in the ovary that develops after ovulation.
Progesterone prepares the endometrium, the lining of the uterus, for implantation and a possible pregnancy. It also prevents contraction of the uterus, and during pregnancy, it is being produced by the placenta and maintains the pregnancy until birth.
Prior to ovulation, progesterone levels are very low. They increase right after ovulation and reach levels above 10 ng/ml usually by 5-7 days after ovulation.
Can progesterone supplementation improve your pregnancy outcome?
There is no clear agreement among doctors whether giving progesterone early in pregnancy will improve pregnancy outcome.
Many doctors feel that measuring progesterone levels in the blood is helpful when trying to find out if you ovulated or not. Progesterone levels are low if you do not ovulate, and after ovulation (mid-luteal, middle of the second half of the cycle) progesterone levels in a nonpregnant patient are generally at least 8-10 ng/ml. Much lower levels usually mean you did not ovulate though some doctors believe in something called 'luteal phase defect' which can prevent you from becoming pregnant.
There are differences in opinion as to what to do if progesterone levels are low after ovulation or early in pregnancy.
A luteal phase defect does not prevent you from becoming pregnant, but it makes the process less likely to happen and makes the likelihood of miscarriage higher. The addition of progesterone, as a catch-up therapy, is unproven. Some doctors don't believe luteal phase defect is real: the strongest argument is a patient studied in Texas who had a biochemical inability to make "normal levels of progesterone" and who successfully carried her pregnancy without therapy.
There are differences in opinion as to what to do if progesterone levels are low after ovulation or early in pregnancy. Some doctors suggest giving progesterone (pills, shots, or suppositories) but many others do not treat unless you have IVF or injectable ovulation medications or if there has been proof of a pre-existing low progesterone in non-pregnancy cycles and there are immune issues leading to miscarriages.
Many doctors feel that low or falling progesterone levels early in pregnancy are a sign of a failed pregnancy which cannot be stopped by giving progesterone supplements.
When you ovulate there is an area in the ovary called "corpus luteum" which is responsible for the production of progesterone. Progesterone levels rise after ovulation, and the rise can usually be detected about a week after ovulation. There are no "normal" progesterone levels after ovulation.
- Progesterone levels can change from one day to the other, from one hour to the next, from one laboratory to the next.
- After you eat, progesterone levels can drop by as much as 50%, that's why the blood test should be done in the morning and before you eat.
- Even on the same day women may have different levels.
- Progesterone levels are usually well below 5-10 ng/ml without ovulation.
- If you are pregnant, progesterone levels are usually at least 10-12 ng/ml to have a better chance of a good pregnancy outcome and most doctors like to see progesterone levels around 16-18 ng/ml or more though there are many successful pregnancies with lower levels.
- With an ectopic pregnancy, progesterone levels are lower when compared with an intrauterine pregnancy.