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As a NaPro provider at MyCatholicDoctor, I will be happy to follow you through your pregnancy to draw serial progesterone levels to ensure your levels are in a healthy range to promote a healthy pregnancy.
Please know you will be responsible to find an ObGyn who will be able to offer you routine prenatal care and to deliver your baby. Most ObGyns do not offer pregnancy progesterone monitoring. However, most of the time, he/she will be willing to work with a NaPro provider. Most obstetricians recommend you have your first prenatal visit when your baby is about 8-10 weeks old.
Progesterone is the primary hormone released during the post-Peak phase of our menstrual cycle. In a normal, healthy pregnancy, progesterone will gradually rise. Progesterone is released from the ovaries, specifically the corpus luteum during the first several weeks after conception. Somewhere around 10-12 weeks it is expected that placenta will take over this role.
Over 30 years of research has been done at the St. Paul VI Institute indicating that progesterone support is important in women who have sub-optimal progesterone levels in their post-Peak phase, prior to their pregnancies. Deficiency in progesterone in the post-Peak phase (ie: a "Luteal Phase Deficiency") is associated with infertility and recurrent pregnancy loss.
Low progesterone during a pregnancy has also been found to be associated with poor pregnancy outcomes, including but not limited to: Placental abruption (abruptio placentae), Placenta previa, premature labor, etc..,
Only bioidentical hormones are used, which can be given orally, vaginally or via an injection. Four "zones" of progesterone levels have been established in response to the data collected over thirty years of research done at the St. Paul the VI Institute. Our goal will be to maintain your progesterone levels in mid-to-upper Zone 2 or mid-to-low Zone 3 as shown in the graph below. The solid black line represents the average progesterone level. Whereas the dotted green lines represent one standard deviation above and one standard deviation below the average progesterone level. The x-axis represents the babies age in weeks.
Your appointments at MyCatholicDoctor with me will be one FULL HOUR in length. Generally speaking, your progesterone monitoring will follow the typical protocol as outlined below. However, every individual is different and your situation may warrant a more individualized schedule.
First Appt: I will take a comprehensive medical history, order a bHCG, blood type, progesterone & estradiol levels, and a thyroid panel (TSH, Free T4, and Total T3) to ensure your thyroid function is optimized for fertility. I will also order an ultrasound. The purpose of the ultrasound is to confirm the baby is within the uterus and to verify a heartbeat.
Women with pre-pregnancy low progesterone are at at higher risk of ectopic pregnancy and poor pregnancy outcomes, including but not limited to: Placental abruption (abruptio placentae), Placenta previa, premature labor, etc..,
An ultrasound is NOT recommended earlier than 7 weeks because oftentimes the heartbeat is still undetectable in normal healthy pregnancies and I don't want to worry you unnecessarily.
The obstetrician you have chosen will see you for your first official obstetrical appointment, during which time he/she will order a full panel of first-trimester obstetrical labs. Typically a full physical exam is performed, including a pelvic exam which may include a PAP test and additional testing as indicated.
It is in your best interest that I do NOT order the full obstetrical laboratory panel nor perform the pelvic exam, because your insurance company will likely only pay for one "official" first OB visit. Obstetricians vary slightly in their preferences for laboratory work-ups, so I prefer to defer to whomever you have chosen to provide your prenatal care and deliver your baby.
Please consider joining me as I pray for you here.
During the first few weeks, I will order bHCG levels every two days (to ensure they are rising appropriately). I will also check your progesterone levels to ensure your levels are staying within Zone 2/Zone 3 on the NaPro pregnancy graph. It is very important that you remember to skip your progesterone dose the night before the lab is drawn. NaPro only provides norms for trough levels. Click the button below for more information.
Second Appt: You will be asked to make another appt with me through MyCatholicDoctor after you have had your 20-week ultrasound and your 20-week office appt with the ObGyn who will be delivering your baby.
Third appt: I will ask you to schedule a final appt through MyCatholicDoctor
when you are between 34 and 35 weeks along. We will discuss you going off your progesterone at that time. It is very important that you STOP taking all progesterone between 36 and 37 weeks, as continuing to take this may delay the delivery of your baby.
Again, only bioidentical hormones supplementation is offered. I commonly prescribe prometrium capsules, which are taken orally. The generic brand is just as good and ot costs much less. Prometrium (micronized progesterone) is truly a bioidendical hormone formulation which can be purchased through a regular retail pharmacy. This medication is generally well-tolerated. Some common side effects are quite pleasant, eg: you may feel more relaxed or sleepy and your might find your mood may improves. Some more unpleasant side effects may be: next-day fatigue, nausea, headaches, or dizziness. Most often the unpleasant side effects can be easily managed by taking the medication right before you lay your head down on the pillow and/or changing to a compounded formulation. Please know prometrium and generic progesterone capsules contain peanut oil, so you CANNOT take this if you have a peanut allergy.
Sometimes the Prometrium or generic micronized progesterone that is purchased will include a package insert which will "warn" of possible birth defects. However, this warning refers to progesterone substitutes that are often prescribed in oral contraception pills, not the bioidentical progesterone we are prescribing. NaPro providers, who were trained at the St. Paul VI Institute, have been safely prescribing micronized progesterone to many, many women to support pregnancies for over 35 yrs and they have not encountered problems.
If the oral medication is not strong enough or if the side effects are bothersome, we can try a vaginal suppository. This will be prescribed for you by a specialty pharmacy called a "compounding pharmacy". You can see a list of compounding pharmacies by viewing Handout #21 here.
Sometimes we will have to use progesterone injections. I will ask you to watch this instructional video and choose someone such as your spouse or a close relative who is willing to administer the injections to you. I would also recommend injections be administered in the upper-outer quadrant of the buttocks (shown in the video) and that you alternate sides. Common side effects of the injections are: soreness, itching and/or mild bruising at the injection site, especially if the injection is done too quickly.
Sharon summarizes the NaPro diagnostic evaluation and treatment management protocols for patients struggling with Infertility & Recurrent Pregnancy Loss. This lecture will discuss NaPro's nuanced hormone panel assessments, types of Luteal Phase Deficiencies, Ovulation Disorder and how NaPro providers will perform follicle tracking to make an accurate diagnosis for our patients.
Listen to Dr. Arri Coomarasamy, MD, one of the most well-known RPL-researchers. Dr. Coomarasamy is Professor of Gynecology and Reproductive Medicine and Director of the Tommy's National Centre for Miscarriage Research in Birmingham, UK, Enjoy this 20-minute VuMedi talk as Dr. Coomarasamy reviews a sub-analysis of his PRISM and PROMISE Trials, two of the largest studies on progesterone and RPL. Dr. Coomarasamy is now giving progesterone to his own patients who have had multiple pregnancy losses.
Enjoy this true case presentation of a 22 year old young women with a history of Recurrent Pregnancy Loss (RPL)) who received a NaPro diagnostic evaluation. The root cause of her RPL was identified and treated. NaPro Technology The patient was able to conceive a pregnancy, which she carried to 38.1 wks and had a successful delivery. NaPro providers are trained to find the root cause of your Infertility or Recurrent Pregnancy Losses.
progestogens in first trimester to prevent miscarriage a systematic review & meta-analysis of RCTs (pdf)
DownloadA Randomized Trial of Progesterone in Women with Recurrent Miscarriages (pdf)
DownloadMicronized progesterone to prevent miscarriage-a critical evaluation of randomized evidence - pdf (pdf)
DownloadProgestogens in women with threatened miscarriage or recurrent miscarriage_ a meta‐analysis (pdf)
DownloadProgesterone decreases preterm birth- An updated meta-analysis incldata from OPPTIMUM study. pdf (pdf)
DownloadProgesterone - preventing preterm birth & adverse outcomes in women with short cervix-meta-analysis (pdf)
DownloadEFFICACY OF 17-α-HYDROXY-PROGESTRONE IN PREVENTION OF PRETERM LABOR IN HIGH RISK PREGNANT WOMEN (pdf)
DownloadSubchorionic hematoma- research status and pathogenesis (Review) (pdf)
DownloadAlpha Lipoic Acid (ALA) effects on subchorionic hematoma- preliminary clinical results (pdf)
DownloadHMWAH_ALA_Mag_Vit B6_Vit D Improves Subchorionic Hematoma Resorption in Women with Threatened Miscar (pdf)
DownloadAlpha Lipoic Acid (ALA) effects on subchorionic hematoma_preliminary clinical results (pdf)
DownloadAlpha lipoic acid in obstetrics and gynecology (pdf)
DownloadBenefits of α‐lipoic acid in high‐risk pregnancies (Review) (pdf)
DownloadCheck out this excellent website! The American Pregnancy Association will walk you through week by week what to look for with regard to the normal physiology of a new baby being conceived and growing through the "embryonic" stage through to the "fetal" stage.
You will also be able to read about the laboratory tests we are doing, as well as what we expect to find in the 1st Trimester ultrasound, done when your baby is about seven weeks old. Please notice bHCG levels are widely variable especially in early pregnancy. The levels you will see on my website are taken directly from the official LabCorp website, which are a bit different from what you will see on this website.
Please remember NaPro has been doing research and treating women for low progesterone in pregnancy for about 35 yrs. Thus, the norms we have published for progesterone levels in pregnancy are much more accurate than what is reported through the American Pregnancy Association.
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