Found this info in the Beer Centre Booklet that might be helpful:
Introduction
Progesterone is first produced by the corpus luteum of the ovary and production from this site is
necessary for the first 8 weeks of pregnancy. From implantation of the embryo onwards for 40
weeks the placenta takes over the production of progesterone (see graph). The levels of
progesterone increase dramatically all throughout pregnancy. Progesterone production is
necessary for the safe maintenance of pregnancy and all pregnancies will fail if progesterone
production is too low.
Many women with infertility, implantation failures and/or miscarriages produce low levels of
progesterone as seen in the bottom line of the graph. These women require progesterone
supplementation to bring them into the safe levels (see thick line, which indicates mean values,
on graph and limits of two standard deviations of the mean). Based on my experience in treating
autoimmune women, this supplementation must continue until the 16th week is completed.
Progesterone-like steroid medication has a variety of effects on the immune system. This type of
medication
1. Blocks inflammation that can lead to scarring and damage to the placenta
2. Blocks the T cells and the B cells (lymphocytes) that can cause rejection of the placenta
3. Blocks the natural killer cells from releasing factors such as tumor necrosis factor (TNF)
that can damage the placenta and the lining of the uterus
4. Prevents lymphocytes from wandering into the placenta, sticking there and doing damage
5. Causes an increase in HCG production by the placenta, and HCG and progesterone block
the killing power of NK cells
6. Prevents prostaglandin production by the uterus and stops contractions from occurring
7. Causes the cervix to produce a cervical plug that is rich in antibodies, which prevent
germs and viruses from gaining access to the baby and the placenta
When progesterone supplementation is given to a mother, its half life in the blood is very short.
In four minutes it begins to be excreted rapidly into the urine. The most efficient route to take the
progesterone to insure the best blood levels and the longest survival of the progesterone in the
blood is to use vaginal suppositories. The next best route of administration is to take injections of
progesterone. The least effective is to take the progesterone by mouth
Progesterone Replacement Therapy
The following are my recommendations for progesterone replacement during
the cycle of conception and during pregnancy.
1. Progesterone vaginal suppositories 25 mg twice daily. Start on day 16 of the cycle of
conception or two days following ovulation. Continue this medication until a positive
pregnancy test (see below). Stop the medication if menses starts and the pregnancy test is
negative. Many women have bleeding with implantation and stop the progesterone
because they feel every thing is over. Stopping the progesterone at this time can damage
the pregnancy. Never stop progesterone until the menses starts and the pregnancy test is
negative. Progesterone replacement therapy in an IVF cycle may differ from this. Talk to
your Reproductive Endocrinologist about plans for progesterone supplementation the
cycle of conception. In couples that are trying on their own to establish a pregnancy, I
recommend that this protocol be used for only three cycles and then take a cycle off.
Progesterone replacement for more than three cycles can interfere with the next cycle in
having a birth control type of effect. There is carry over of the progesterone into the next
cycle and this delays or prevents ovulation. This problem is prevented by stopping the
progesterone for cycle 4 and initiating it again with a positive pregnancy test.
2. Increase the progesterone vaginal suppositories with a positive pregnancy test to 100 mg
every night. Continue this through 16 weeks of pregnancy. Test the b hCG and the
progesterone levels every 3 days until the progesterone levels stay in the normal range
20 and the b hCG levels reach 5,000 or above. At this time a heart beat can usually be
documented by ultrasound.
3. If the vaginal suppositories do not bring the progesterone levels to the safe range then
progesterone is given by injections of 100 mg every day or every other day until adequate
levels are achieved. This supplementation must continue until the 16th week of
pregnancy is completed.
4. Some doctors advise the patients to use Crinone Gel 8 mg daily. This is an excellent and
non messy way to take progesterone vaginally. Patients who use Crinone Gel cannot rely
on progesterone testing of the blood as documented above. Crinone, though effective, is
different enough chemically from progesterone so that it is not detected in the blood by
the progesterone assay. Many patients panic about this.
Many doctors advise their patients that progesterone supplementation is not necessary after 7 or
8 weeks. I do not give this advice since progesterone is produced in ever increasing quantities
throughout pregnancy and enough progesterone is necessary to quiet the potentially killing
autoimmunity in many of the patients that I see. I rely on data in this regard and do not simply
give opinions. If your doctor has different opinions about this please ask him/her for data that
refutes what is listed on here.
Progesterone Levels (ng/ml) During Pregnancy
Mean
+2SD
Autoimmune Patient
21
Allergy To Progesterone
Some autoimmune women develop allergies to their own hormones, including progesterone. The
antibody which they have produced can be detected by looking for progesterone antibodies in the
blood or by doing a skin test which shows the allergy to progesterone. These antibodies further
decrease the levels of progesterone in the blood. The cells responsible for this are the CD 19+5+
cells. By 10 weeks of pregnancy these cells are usually suppressed to normal numbers and the
progesterone allergy is less of a problem. Women with antibodies to hormones require higher
doses of progesterone supplementation than women without this allergy. I also recommend that
women with allergies to progesterone take the Crinone Gel, because it is chemically different
enough from native progesterone such that the allergy does not inactivate it.
Best wishes
Bx
