A Review of Progesterone Treatment for Infertility: Does it Work?

A Review of Progesterone Treatment for Infertility: Does it Work?

Jackie Vinyard M.S. Health Sciences | June 21, 2017 | Getting Pregnant

Progesterone is commonly prescribed to women who experience multiple miscarriages, have signs of having a short luteal phase and those who are receiving artificial reproductive technology (ART) treatments. Progesterone treatment, however, is controversial and the medical community still has a lot to learn about progesterone, including how to test for deficiencies and what side effects there may be.

About a decade ago Dr. John Lee published reports that conventional hormone replacement therapy (HRT) did not work and posed a health threat to women. His findings caused an uproar but a couple of years later, research proved him right. The evidence that HRT caused cancers, such as breast or womb cancer, was strong. He found that natural hormone therapy was much more effective and safer, but some current research challenges the effectiveness of natural progesterone.  Some studies show synthetic progesterone to be more effective and other show natural progesterone to be effective and with less side effects.  

With all this confusion, what is known about progesterone for women trying to get pregnant and does it work?

 

Why Do Women Take Progesterone?

For women in their fertile years with normal cycles, progesterone will be released during the second half of the cycle. The release of progesterone happens as the egg migrates down the fallopian tube.

Progesterone is essential for maintaining a pregnancy. It is responsible for increasing the vascularity of the endometrial lining and stabilizes the endometrium in preparation for embryo implantation. Progesterone also protects the embryo and fetus by interfering with natural killer cells during the first stages of pregnancy (source).   Additionally, progesterone may reduce risk of premature birth in some women. 

An ongoing lack of progesterone can lead to complications from non-harmful (but annoying) abnormal bleeding to more serious complications such as endometrial cancer.
 

 

Is Having Low Progesterone a Common Problem?

Having low progesterone is not a common problem, but it is commonly used for infertility. People use it frequently when confused about pregnancy loss and is used in conjunction with artificial reproductive therapy (ART). 

 

Why is the Diagnosis is Unreliable?

Unfortunately, unlike a pregnancy test that will give  a clear yes or no answer, progesterone levels can change in a 24 hour period. Also, one month may show low levels of progesterone, but the next month may display absolutely normal levels. ”Using a single blood progesterone level to assess luteal phase progesterone adequacy is akin to looking out of the window once to determine how much it has rained all day,” says Dr. Vishvanath Karande.  

Also, according to Dr. Lee, even if you took regular blood tests over several months, the test may be incorrect for you may have low progesterone in your tissues but not in the blood stream.

 

What are Symptoms of Having Low Progesterone? 

Having anovulation or irregular cycles is one of the most clear signs of a hormonal imbalance. In particular to progesterone, having a short luteal phase may indicate low levels of progesterone as well as recurrent miscarriages.  Premenstrual spotting is also a sign of low progesterone levels, however, spotting can also occur during ovulation, which is perfectly normal.

It's important to know that having a short luteal phase as a cause of infertility is controversial. Many women with short luteal phases have no problems with infertility and supporting a pregnancy. Research currently shows mixed results in support of progesterone treatment as a solution. 

Other side effects of having low progesterone are exactly the same as other health conditions  and the result of certain lifestyle choices such poor sleep and diet. These symptoms include anxiety,  mood swings, low sex drive and insomnia. 

Here is a Hormone Balance Symptom Check quiz by Dr. Lee. Keep in mind, however, that you should not self diagnose.  If you suspect you have a hormonal imbalance, talk to your doctor. 

 

How Can I Test for Low Progesterone at Home? 

By counting your the days of your luteal phase: 

In order to learn if you have a short luteal phase, you need to know the exact day you ovulate. You will count the days from the day you ovulate until the first day of menstruation.  A regular luteal phase lasts about 11-14 days. Less than 10 days is considered a short luteal phase. 

By tracking your basal body temperature: 

Low basal body temperature during the luteal phase is also another indication of low progesterone.  If you take your daily basal body temperature and your temperature does not go up and stay up until you start your period, this may indicate low progesterone levels. You will need to do this test for several months to determine a pattern. Note: this test has significant room for error and for many women, is cumbersome to do each day.

Charting your cervical mucus: 

Progesterone helps to dry up cervical mucus during the luteal phase. A significant amount of cervical mucus during the luteal stage may be a sign of low progesterone (or an infection...). 

 

What if I have a Regular Period but Multiple Miscarriages?

There is evidence that even in women who appear to have regular periods but unable to sustain a pregnancy are able to improve pregnancy rate with vaginal or oral suppositories containing progesterone. 

In certain studies, the pregnancy rate was more improved with vaginal progesterone than more commonly used follicle maturing drugs, eg, clomiphene citrate or gonadotropins (source). 

The predicted risk of miscarriage in a future pregnancy remains about 14 percent after one miscarriage. After two miscarriages the risk of another miscarriage increases to about 26 percent, and after three miscarriages the risk of another miscarriage is about 28 percent (source).  

What this indicates is that it’s hard to be clear on whether a progesterone treatment was responsible for treating recurrent miscarriages or if it was due to statistical chance. Review of multiple studies, however, suggest that progesterone does indeed help women who have a history of recurring miscarriages (source).

 

Is Treatment with Progesterone Appropriate?

Even if a proper diagnosis is not possible, for some women, progesterone treatment is appropriate.

 

Can you Heal from Low Progesterone Naturally?

Yes, it is possible but this depends on what is behind the cause of low progesterone. If there is another underlying medical condition causing low progesterone, such as insulin resistance, that will need to be treated first.

There are many things that can lead disrupting hormonal imbalance including if you perform extreme exercise, have too low or too high body fat, poor diet  or are under a lot of stress. If you have one or more of those issues listed and you remedy the issue(s), the hormonal balance should be corrected. Many toxins in our everyday products can also disrupt hormonal balance. 

Click Below on Toxins to Avoid while Trying to Conceive and to learn more about how toxins may impact your fertility

 

Can I Treat Myself with Creams?

While natural progesterone most likely does not have negative consequences, you should not use self-treat. Self treating yourself with progesterone could delay your period. If you are trying to conceive, that means it will delay ovulation. Next, progesterone can build up in your tissues so even once you stop taking it, it may takes several months for your body to get rid of the access progesterone. Read below for possible side effects. Read here for one woman’s story on what she experienced with taking too much natural progesterone.

 

Are there Side Effects to Taking Progesterone?

It is possible to experience negative side effect by taking progesterone.  The side effects depend on what type you are taking. Vaginal progesterone, for example, may or may not cause tissue irritation. Talk to your doctor about the different side effects based on your prescription recommendations. 

 

Has Research Shown Progesterone to be Helpful?

Some research has found progesterone to be helpful and others have found no difference between the placebo groups and progesterone groups.  Some research supports progesterone to be helpful in certain cases such as multiple miscarriages, short luteal phase, in ART and for preventing preterm labor. Yet several questions remain about how effective progesterone is for different issues and there is still not a clear answer to whether synthetic versus natural progesterone is better.

For example, vaginal synthetic progesterone has been found to be beneficial for women who experience multiple (3 or more) unexplained early pregnancy loss but not for prevention of sporadic miscarriages and not with natural progesterone (source).  A different review, however, of findings from various studies, suggests natural progesterone administered orally as Sustained Release (SR) formulation to have significant beneficial role in LPD, LPS in ART, BOH & for preterm labour (source).

Currently it’s hard to pinpoint exactly what requires progesterone, how to diagnose progesterone, whether to use natural or synthetic progesterone, as well as timing and amount to administer.  

 

Conclusion

“Making the diagnosis of low progesterone as an issue to infertility is still a mystique,” -Dr. Aptekar, MD FACOG

Dr. Don Aptekar, who has been delivering babies for over 30 years, recommends  “when dealing with pregnancy you should not use anything lightly." Should you be prescribed progesterone, however, Dr. Aptekar explains that the evidence of using progesterone so far shows that there is little to no risk of adverse effects.

Research overall points to successful treatment with progesterone supplementation for some women. 

 

 

References and Resources: 

  • http://www.healthywomen.org/content/article/low-progesterone-symptoms
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436586/
  • https://www.ncbi.nlm.nih.gov/pubmed/21975790
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695240/
  • http://www.inviafertility.com/blog/blog/infertility/drvkarande/progesterone-deficiency-diagnosis-treatment-infertility/
  • https://www.ncbi.nlm.nih.gov/m/pubmed/27887710/