Progesterone Support in Pregnancy

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. 

Check 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.