Progesterone for recurrent miscarriage

by Natalie
(Los Angeles, California)

Hi Wray - You were kind enough to provide answers to me in another thread, and now that I have more details, I wanted to ask a few more questions. I miscarried a few days ago just shy of 7 weeks. This is my third miscarriage - the first two were extremely early, at just over 4 weeks. The difference this time is that I spent months correcting my low progesterone with vitex and acupuncture. My level came up enough that my doctor initially prescribed 100mg progesterone suppository at night as a "precaution". My 21-day level was nice and high, but by day 25 I was experiencing period-like cramps and felt I would miscarry if nothing was done. My doctor retested, and my progesterone level had dropped, so she put me on 200mg twice a day starting on day 28. The cramping stopped right away and my initial symptoms of estrogen dominance resolved within two days. But then at 6 weeks 2 days, my normal white discharge turned brownish-pink. I thought it was irritation from a yeast infection, but increased the progesterone to 200mg three times a day just to counter the anxiety I was feeling. Then at 6 weeks 4 days, I noticed a tiny amount of red spotting in the morning. This increased throughout the day, period-like cramps started again in the afternoon, and although I remained on the higher dose and rested all day, I miscarried that night.
So, now I'm wondering, 1) Was the 200mg/2xday dose possibly started too late, so that it delayed miscarriage but didn't prevent it? Could implantation have been adversely affected by that 6 day window during which my progesterone levels were dropping?
2) I still experienced moderate morning nausea and fatigue even on 200mg/2x day, though less so than on the lower dose. Should my dose have been higher until the nausea and fatigue were completely gone?
I told my doctor about your forum and Dr. Dalton's work - she is very supportive and will prescribe as much progesterone as I want to take. She was thinking I may need 3x day from the start just to keep my levels constant. Regardless of dose, next time I will start as close to ovulation as possible. Prior to IUI, I am monitored closely via ultrasound, so I know when I am about 12-24 hours from ovulation.
I also checked my vitamin d lab work at your recommendation, and my level was 46 ng/ml, so I am going to increase my supplementation and have that rechecked until it is up to at least 70.
So, lastly, I have two more questions: 3) Some of my options for progesterone are 200mg/3x day, 400mg/2x day, or 400mg/3x day. Do you know of any benefit to dosing 3x day versus 2x? Is there a particular dose you would recommend given my history?
4) Since I have to wait two cycles before trying again, would it be beneficial to take progesterone from ovulation to menstruation in order to further clear my estrogen dominance prior to our next try?
Thanks so much in advance - I felt so lost on this topic until I found your forum. And now that I'm more informed, my doctor is right on the same page with me. I just cannot thank you enough for getting this crucial information out there!
Best regards,
Natalie

Comments for Progesterone for recurrent miscarriage

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Dec 01, 2013
Progesterone for recurrent miscarriage
by: Wray

Hi Natalie I'm sorry to hear about your miscarriage. I can't remember everything that was discussed in our previous conversation, but it seems you've been going for IUI, and this was your third attempt. Vitex won't increase progesterone levels at all, all it can do is bring Prolactin levels down if that is high, see here. It can help with luteal phase dysfunction, with subsequent problems in embryo implantation, see here. But because it has a mild oestrogenic action, levels of 17 beta-oestradiol can increase. One study found mild ovarian hyperstimulation syndrome occurred in the luteal phase, see here. I have no experience with acupuncture so can't say if that would help, beyond possibly stimulating ovulation and hence progesterone production. If there is luteal phase dysfunction, progesterone itself would the the better option. An early luteal rise is essential for a successful implantation, see here. Another essential is the surge of progesterone which occurs prior to ovulation, this will ensure there is an early luteal rise of progesterone. This surge comes from the brain, see here, here, here and here. Progesterone begins rising 50 hours prior to ovulation, rising exponentially 12 hours before. So if you don't naturally get that rise, then you should make sure you use progesterone within that 12 hour window. Continued below

Dec 01, 2013
Progesterone for recurrent miscarriage Part 2
by: Wray

Hi Natalie To my mind it would be essential to use progesterone until your next IUI. Please get your vitamin D level up high fast, it's safe to go to 40,000iu per day, see here. I also suggest you go on a Ketogenic Diet. Studies in IVF patients have found a high fat, moderate protein and low carb diet increase implantation, see here. Progesterone levels drop after about 13 hours, so it's essential to use it at least twice a day. More frequently will mean it doesn't get a chance to begin dropping. You might like to read this comment here. She was given Cyclogest 3 x 400mg/day. It's a very long page, put Cyclogest in control find. And try getting a copy of the The Better Baby Book. Thanks so much for the kind words, and I'm delighted your doctor is so supportive. Take care Wray

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