Can progesterone help with Conception and Fertility problems?

I have so many women writing about just this problem. As it’s something dear to my heart (I had five miscarriages before having my daughter) I have put together a paper on progesterone and conception and how to use it during pregnancy. You'll find this below together with a chapter from one of Dr Dalton’s books on the role progesterone plays during pregnancy.

Following that I've listed a few papers (with links) on miscarriage and stress. These tend to be heavy on the science so don't expect to be entertained! However, they do 'complete the picture'.

Here's my paper...

Progesterone, Conception and Miscarriages

Progesterone plays a major role during the two weeks after ovulation, prior to the fertilised egg implanting in the uterus. It is also vital for maintaining pregnancy.

Monthly cycles can vary from as little as twenty one days to as long as thirty six, the average being twenty eight.

The first half of the monthly cycle is known as the follicular phase, and it can range from seven days to twenty-one days. Progesterone is present in extremely small amounts, oestrogen and follicle stimulating hormone (FSH) being the dominant hormones.

At the beginning of this phase, in response to FSH made by the pituitary gland, a few to several hundred eggs start developing. Each egg is contained in a cyst called a Graafian follicle, which starts making oestrogen, this in turn causes the egg to grow and mature. Oestrogen also stimulates the endometrium (lining of the uterus) to grow and thicken. When one or possibly two eggs are fully developed they rise to the surface of the ovary and appear as small 'blisters'.

When the egg has reached maturity, another hormone called lutenising hormone (LH) is released by the pituitary. Approximately twenty four hours later this causes the Graafian follicle to rupture releasing an egg, commonly known as ovulation. The follicle, which is now called the corpus luteum due to its yellow colour, starts producing progesterone, which it does for the next fourteen days, progesterone is now the dominant hormone. This part of the cycle is known as the luteal phase and under the influence of progesterone the lining has stopped growing, instead becoming a spongy layer ready for the egg to embed itself.

All women, irrespective of the length of their cycle, should start ovulating about fourteen days before the next menstruation. If shorter, there is insufficient time for the endometrium to be readied for the embryo to implant, this is known as a defective luteal phase. If the corpus luteum does not make sufficient progesterone during these fourteen days, it will also result in a defective luteal phase. It appears to be a problem found in many women now and could well be due to the large amounts of oestrogen in the environment.

How to use progesterone to extend the luteal phase

A low dose of progesterone will not help. Research has shown that between 100-200mg of progesterone should be used, which is 3-6ml of Natpro. It should not be used before ovulation, as that will prevent it occurring and therefore prevent any chance of falling pregnant. In other words progesterone can act as a contraceptive.

It must only be used at ovulation if pregnancy is the aim.

How to check when ovulation has occurred

Taking temperature readings or using a mini microscope will help to check for ovulation, the mini microscope is more reliable, as temperature can vary from as little as 0.5 degrees to 5 degrees. Saliva or vaginal mucus is used for the test, by dabbing a small amount on the end of the microscope. During the follicular phase, the pattern formed by the saliva/mucus is spotty, as ovulation draws near a fern like pattern starts emerging, becoming completely fern like when ovulation has occurred, returning to the spotty pattern almost immediately. See 'How to determine the structure of dry saliva crystals' (a new window opens).

Pregnancy

It must be remembered that fourteen days is necessary for the lining to mature enough to receive a fertilised egg. If bleeding does occur, it means the egg has not been fertilised or the luteal phase was not long enough. The progesterone should then be stopped and only started again at the next ovulation. If bleeding does not start fourteen days later, it is possible that fertilisation has occurred.

On no account must the cream be stopped at this stage, otherwise it could precipitate a miscarriage.

If there is no menstruation and pregnancy is confirmed, the cream should be continued, using between 3 to 6 ml each day until the fourth month. After the critical stage has passed the progesterone can be continued till birth, this is particularly important if pre-eclampsia is a possibility. And after the birth too, particularly if post natal depression occurs. Or it can be tapered off slowly, reducing the amount over a month or two depending on the amount that was being used ie. if 3 ml is being used reduce to 2 ml over the first two to three weeks and to 1 ml over the next two to three weeks.

Please monitor symptoms, and if spotting, headaches, water retention or nausea should occur increase the dose and continue using it till birth. In some women water retention and a rise in blood pressure sometimes occurs in the last one to two months, please increase the dose if this should happen.

It is the first three, possibly four months that are critical. 25% of miscarriages occur during the first six weeks when the child is still in the embryo stage. The risk drops to 8% after eight weeks, when the child is now termed a foetus.

During this time the placenta is growing and after about two months starts making progesterone, while ovarian production starts declining. If at this point placental production is insufficient to meet the demands of the growing foetus a miscarriage can occur. It is therefore advisable to continue with the supplemental progesterone until at least the third month. All being well the placenta continues to make progesterone in increasing amounts until birth, when it drops abruptly with the expulsion of the afterbirth, as the placenta is now generally termed. (see post natal depression).

It is essential to continue the cream over this critical phase.

It is also essential to bear in mind that stress can cause a miscarriage. The rise in cortisol in response to the stress, results in a drop in the progesterone level, this in turn can lead to spotting or a miscarriage. To prevent this, as soon as any stress is felt, increase the amount of cream till it has passed.

Fertilisation

One of the most important things to remember about conception is the life span of the sperm and ovum. The average life of the sperm appears to be two to three days, sometimes longer, but the ovum only lives twelve hours and in rare cases twenty four hours. All research points to a greater success in conception if intercourse takes place in the one to two days prior to ovulation, when the fern like pattern is almost complete. This allows time for the sperm to travel through the uterus and up the Fallopian tubes to meet the egg before it becomes over mature or it dies. One of the problems with an over mature egg is it diminishes the chances of fertilisation, can result in a miscarriage or result in foetal abnormalities. The health of the future child is dependant on these factors.

The nearer intercourse takes place to ovulation, the greater the chances of conception.

To recap...

• Progesterone must only be used at ovulation if pregnancy is the aim
• Take temperature readings or using a mini microscope to help check for ovulation
• On no account must the cream be stopped if conception is suspected, otherwise it could precipitate a miscarriage
• It is essential to continue the cream over the first 2-3 month critical phase, particularly the first 2 months
• It is also essential to bear in mind that stress can cause a miscarriage
• The nearer intercourse takes place to ovulation, the greater the chances of conception
• Use between 100-200mg of progesterone, which is 3-6ml of a 3.3% cream.

Chart taken from Dr Dalton's book "Once a Month"...

Levels of progesterone during the menstrual cycle and pregnancy

Here's the link to the chapter from Dr Dalton’s book 'PMS The Essential Guide to Treatment Options' on the role progesterone plays during pregnancy.

Additional information

Nutrients

The growing foetus adds an extra burden on the mother, so it is essential to make sure all nutrients the foetus needs are available. Research has indicated that a lack of Omega 3 as the foetus is growing can possibly cause ADD in childhood.

Please consider taking the following each day...

• 5ml Omega 3 fish oil or 15 to 60ml flax oil
• 5ml Evening Primrose oil with 10% GLA
• 1000-2000mg vitamin C
• a good vitamin B complex with extra folic acid bringing this up to 1200mcg/day to prevent spina bifida
• 5 000-10 000 IU vitamin A
• 2 000IU vitamin D3 (cholecalciferol)
• 100-1000 IU vitamin E as d-alpha tocopherol (mixed)
• if candida is suspected take the probiotics Lactobacilus acidophilus and Bifidobacteria bifidum, with at least five billion bacteria per dose
• if constipation becomes a problem add the soluble fibres such as apple pectin, guar or xanthan gum and ground linseed to drinks or food
• Please note: If pregnant or breastfeeding take no more than 10,000 IU of vitamin A

Diet

Food should be natural, unprocessed and if possible organic and include both protein and fibre.

The Metabolic Typing Diet is an excellent means of obtaining lasting health. The diet is the product of many years of detailed research and looks at the many ways the body metabolises food. It is based on the obvious but hitherto little understood fact that each individual has a unique metabolism.

'Metabolic Typing', as the name suggests, is an analytical process that defines each individual's unique nutritional requirements by determining how they metabolise food and categorising a person according to their needs.

To find a qualified practioner go to the source...

William L. Wolcott, the founder of The Healthexcel System of Metabolic Typing and author of The Metabolic Typing Diet (Doubleday, 2000)

...this link will take you (in a new window) directly to Healthexcel's online directory of Metabolic Typing practitioners which lists (at time of writing) several hundred in 25 countries.

Small frequent meals are often a help for blood sugar imbalances. After a large meal there is a temporary drop in the level of progesterone, due to an increased metabolic clearance rate of that hormone, so symptoms can become worse for a while.

Food should be natural, unprocessed and if possible organic and include both protein and fibre, particularly the gel forming fibre such as apple pectin, guar gum and oat bran as these have been shown to stabilise blood sugar, as has unrefined buckwheat.

As a substitute for sugar use xylitol, isomalt or stevia. Stevia is a natural extract from the plant Stevia rebaudiana, a member of the daisy family, native to Paraguay. The extract is 200-300 times sweeter than sugar, but has none of the drawbacks and does not affect blood sugar in any way. The fresh or dried leaves are easier to use and taste better. Xylitol and isomalt are sugar alcohols, which look and taste like sugar, but are metabolized by the body at a much slower rate, they have respectively 2.4 and 2.1 calories per gram. A beneficial affect is their ability to reduce pathogenic bacteria and to act as a prebiotic for the good bacteria, a drawback is the high cost. If used in large quantities they can cause flatulence and have a laxative affect.

Avoid...

• sugar
• all forms of processed foods containing sugar
• refined grains, particularly wheat
• carbonated drinks, including the 'diet' drinks
• biscuits
• cakes
• white breads
• canned foods
• sauces
• sweets
• large meals
• all forms of artificial oestrogen
• oxidised fats, i.e. margarine, refined oils, saturated fats and fried foods, in particular fried animal protein
• non organic milk
• stimulants such as coffee, black tea

Read all labels on containers, especially those for food and cosmetics. Look for natural alternatives to body care products, many contain high levels of endocrine disruptors and carcinogens.

Processed food contains preservatives, colourants, flavourants, sweeteners, especially avoid aspartame, known to cause lupus and epilepsy.

Avoid fluoride, long term exposure causes brittle bones. Use natural alternatives to household cleaners, which are some of the most toxic chemicals we regularly come into contact with.

Avoid golf courses, especially when fertilising or spraying, a higher level of chemicals are used on them than on farms.

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Here are the research papers on miscarriage and stress...

Progesterone supplementation to prevent recurrent miscarriage and to reduce implantation failure in assisted reproduction cycles
Authors: Nardo, Luciano G. 1; Sallam, Hassan N. 2
Source: Reproductive BioMedicine Online , Volume 13, Number 1, July 2006 , pp. 47-57(11)

Stress and Pregnancy Loss: Role of Immune Mediators, Hormones and Neurotransmitters Author: Arck P.C.
Source: American Journal of Reproductive Immunology, Volume 46, Number 2, August 2001, pp. 117-123(7)

Hum Reprod. 2000 Jun;15 Suppl 1:46-59.
Progesterone inhibits in-vitro embryotoxic Th1 cytokine production to trophoblast in women with recurrent pregnancy loss.
Choi BC ,Polgar K ,Xiao L ,Hill JA

Human Reproduction 2005 20(7):2035-2036; doi:10.1093/humrep/deh877
Recurrent miscarriage and embryonic loss
Jerome H. Check
Professor Obstetrics and Gynecology, Division Head of Reproductive Endocrinology & Infertility, Robert Wood Johnson Medical School at Camden, 7447 Old York Road, Melrose Park, PA 19027, USA

Human Reproduction 2005 20(8):2325-2329; doi:10.1093/humrep/deh888
Exposure to bisphenol A is associated with recurrent miscarriage
Mayumi Sugiura-Ogasawara 1,4 ,Yasuhiko Ozaki 1,Shin-ichi Sonta 2,Tsunehisa Makino 3and Kaoru Suzumori 1
1Department of Obstetrics and Gynecology, Nagoya City University Medical School, Nagoya, 2Department of Genetics, Institute for Developmental Research, Aichi Human Service Center and 3Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan

American Journal of Obstetrics and Gynecology
Volume 188, Issue 2 , February 2003, Pages 419-424
doi:10.1067/mob.2003.41
Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: A randomized placebo-controlled double-blind study *1
Eduardo B. da Fonseca MD, Roberto E. Bittar PhD, MD, Mario H. B. Carvalho MD and Marcelo Zugaib PhD, MD
From the Obstetrics Clinic, University of São Paulo Medical School.
Received 9 January 2002; revised 12 June 2002. Available online 26 February 2003.

BJOG: An International Journal of Obstetrics and Gynaecology
Volume 112 Issue s1 Page 57-60, March 2005
To cite this article: GC. Di Renzo, A. Rosati, A. Mattei, M. Gojnic, S. Gerli (2005)
The changing role of progesterone in preterm labour
BJOG: An International Journal of Obstetrics and Gynaecology 112 (s1), 57-60.
doi:10.1111/j.1471-0528.2005.00586.x
The changing role of progesterone in preterm labour

Int J Fertil. 1987 May-Jun;32(3):192-3, 197-9.
Progesterone therapy to decrease first-trimester spontaneous abortions in previous aborters.
Check JH ,Chase JS ,Nowroozi K ,Wu CH ,Adelson HG

Akush Ginekol (Sofiia). 2004;43(5):22-4.
Utrogestan and high risk pregnancy
[Article translated from Bulgarian]
Marinov B , Petkova S , Dukovski A , Georgiev G , Garnizov T , Manchev V , Kolarov G , Iunakova M .

Emory University Health Sciences Center
Main Category: Mental Health News
Article Date: 09 Feb 2005 - 8:00 PST
Sex hormone metabolite reduces stress, anxiety in female rats

Brain Res (2005) 1043: 76-86.
Progesterone regulation of catecholamine secretion from chromaffin cells.
SM Armstrong ,EL Stuenkel
Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109-0622, USA.

Neuroendocrinology 1998;67:269-274 (DOI: 10.1159/000054322)
Acute Estradiol and Progesterone Administration Reduced Cardiovascular and Catecholamine Responses to Mental Stress in Menopausal Women
Graziano Del Rio a, Antonino Velardo b, Renata Menozzi b, Giuseppe Zizzo b, Valeria Tavernari b, Maria Grazia Venneri a, Paolo Marrama b, Felice Petraglia c

Horm Behav (2004) 46: 467-73.
Acute progesterone can recruit sex-specific neurochemical mechanisms mediating swim stress-induced and kappa-opioid analgesia in mice.
WF Sternberg ,EJ Chesler ,SG Wilson ,JS Mogil
Department of Psychology, Haverford College, Haverford, PA 19041, USA.

Exclusive from New Scientist Print Edition.
10:30 12 November 2004
Andy Coghlan
Stress can make pregnant women miscarry
Charité, University of Berlin
The Miscarriage Association, UK
Society for Endocrinology, UK

Dept of Environmental Health, Harvard School of Public Health, Boston, MA, USA
Lin Wang, W Wang, C Chen, A G Ronnennberg, X Xu, X Wang,
Department of The Mary Ann and J. Milburn Smith Child Health Research

"Stress is also known to inhibit the pulsatile release of follicle stimulating hormone and luteinising hormone, leading to impaired follicular development. Because synthesis of progesterone is increased in the luteinised follicle following ovulation, stress induced impairment of follicular development could potentially alter progesterone synthesis and release. Progesterone is thought to play an important role in dysmenorrhoea. Menstrual pain occurs only in ovulatory cycles, and progesterone has been shown to affect both the synthesis of prostaglandins PGF2a and PGE2 6 and the binding of these prostaglandins to myometrial receptors. Prostaglandins affect uterine muscle and vascular tone, and an imbalance of prostaglandins has been linked to the occurrence of dysmenorrhoea. Besides progesterone, stress related hormones, including adrenaline and cortisol, also appear to influence prostaglandin synthesis, which suggests that stress may have both direct and secondary effects on prostaglandin concentrations in the myometrium."

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