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Pregnant. Found elevated progesteron level. Taking progesterone suppositories. Any risk on baby?

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Practicing since : 1999
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Hi, I am 24 weeks pregnant and my blood tests just came up that my progesterone is >635 nmol/l. The reference range is 62 - 144 for second trimester.

I did IVF and started taking 400mg progesterone suppositories the day after IVF until 12 weeks. Around week 6-10 I even took 600mg since I had severe bleeding week 4-6. After week 12 I went down to 200mg suppositories. I tried stopping them at 16 weeks but had lots of cramping and they continued them until 20 weeks. I had an ultrasound at 20 weeks and my cervix was 5cm but my recent ultrasound at 23 weeks showed cervix length of 4cm. Between 20 and 23 weeks I generally took around 100mg progesterone suppositories daily, even skipping some days to try and go off of it.

I did a blood test around 21 weeks and my progesterone showed >635 nmol/l. Now I redid the test and same result came up when I took the test at 23 weeks. Is this dangerously high progesterone? What could it mean?

Should I continue the suppositories at 100mg per day? Since my cervix is shortening, I thought I need to continue them, otherwise my cervix might get too short - I know they give them for this purpose to keep the cervix long.

Can something happen to my baby from such high progesterone - I am having a baby boy.

Posted Mon, 4 Mar 2013 in Pregnancy
Answered by Dr. Timothy Raichle 4 hours later
Hello, I would be happy to help you with your question. Thank you for being patient.

The purpose of progesterone during the first trimester is to "mimic" the function of something called the corpus luteum. It is a cyst that produces progesterone during early pregnancy that helps to 'maintain' the pregnancy until it reaches a certain point where it can survive on its own. This is usually about 10-12 weeks. This is not uncommon in IVF and in patients with a history of recurrent miscarriages.

There is no situation where supplemental progesterone is indicated beyond 10-12 weeks except for in patients with an increased risk of early delivery based on some current factor or past obstetric history.

Based on what you are telling me, you do not have an indication to be on progesterone at this time. In fact, the lab suggests that you are over-treating yourself.

A cervical length is not indicative unless it is <2.5cm. A cervical length of 5cm, and then later at 4cm is completely normal. It can appear differently depending on how you are scanned, whether your bladder is full, etc. In other words, going from 5 to 4 is not significant, because they are both greater than 2.5cm. In fact, I do not understand why they obtained the second cervical length exam in the first place.

So, to summarize (and this is not medical advice):
1. You have know indication to be on progesterone that I can identify based on what you are telling me.
2. You do NOT have a shortened cervix, regardless of the different measurements seen. You are not at greater risk for early delivery based on the two cervical lengths obtained.
3. You need a second opinion with another OB/GYN. You are receiving care that is not consistent with known standards of care - it really just does not make sense.

If I am missing something, let me know. If you have additional obstetric history that would help me, also let me know about that as well.

I hope that this helps. Please ask if you have any followup questions and I will get back to you quickly.
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Follow-up: Pregnant. Found elevated progesteron level. Taking progesterone suppositories. Any risk on baby? 14 hours later
Hello Doctor Raichle,

Thank you very much for your detailed response. I think my obgyn told me to continue with the progesterone suppositories also because my uterus and ovaries started cramping up quite severely since I was 18 weeks. It felt like my period would come. These cramps lasted sometimes 12 hours at a time and would come back the next day for another 8-9 hrs etc. There was one week at 22 weeks that I had this cramping pretty much the entire week. I was not dilated though when they checked in the hospital but my doctor was still concerned about premature labor therefore he continued the suppositories at only 100mg daily. Based on this additional information, would that be ok?

Also, is it ok to have such high progesterone during the second trimester? I actually because scared and went to the Labor and delivery dept of my hospital yesterday and they said they do not measure progesterone this late in pregnancy and do not have reference ranges for it. They were not concerned about my result and said my baby looks ok on the monitor so I should not worry. I asked them if I should continue with the suppositories and they said yes. But again, that was just the resident I met in the Labor and Delivery, I could not see a doctor. They said progesterone is safe for the baby and ok to take in my case due to the cramping and higher risk of preterm labor and they further emphasized this result is meaningless and does not matter. Would you agree?

Anytime I had tried to stop the suppositories in the past the cramping went through the roof so I have been told to continue. Since I am having a baby boy though is it possible that it could lead to hypospadias or a similar complication?

Answered by Dr. Timothy Raichle 11 minutes later
Around 20-22 weeks, women often experience discomfort and cramping that we attribute to stretching of the round ligaments, or round ligament pain. Also, progesterone supplementation is not a treatment for preterm labor, but rather for patients who have an underlying risk for preterm delivery. So, the reasons that you were given this medication are not typical. I do not know if it is okay, because it is not used to treat suspected preterm labor. Again, this is reason enough to seek a second opinion.

Progesterone is not considered harmful to the baby, but you are on doses that are greater than what we would normally give to someone under any circumstances. So I really don't think there is harm, but I don't think anyone knows. The answer that you got on labor and delivery (we do not measure progesterone levels) is correct - there is no reason to check them.

Given that there appears to be no risk whatsoever for an early delivery in your case (your cervix is normal!) and they are using progesterone in a way that is NOT a standard of care, and given your concerns about harm to the pregnancy and baby, I strongly urge you to get a second opinion or request an opinion of a high risk specialist. These specialists can comment about the risk to the fetus of continuing this medication.

I hope that this helps. Don't be afraid to ask for another opinion. I do not think you are receiving the best care or counseling. Good luck!
Above answer was peer-reviewed by
Follow-up: Pregnant. Found elevated progesteron level. Taking progesterone suppositories. Any risk on baby? 12 minutes later
Thank you very much dr Raichle, I would definitely try and get a second opinion with a high risk specialist here, I just think it might take awhile before the referral goes through. This is why I went to the hospital yesterday, hoping to see the high risk specialist there, but they did not allow me to XXXXXXX with him when I asked.

At least I am on bedrest now and that helps a little bit with the pain (does not eliminate it though). Sorry, but just to clarify, you mention my dose of progesterone is higher than you would normally give to anyone under any circumstances. But I have been taking 100mg suppository daily, which I think is the lowest suppository out there. I know the pharmacy does not make a lower dose suppository since I checked with them. So why would this be considered a high dose?

Thank you for the very quick response.
Answered by Dr. Timothy Raichle 13 hours later
You are correct, it is the lowest dose available. My point is that you should not be on any progesterone as there really does not appear to be any indication to give this medication to you. It is not how discomfort related to pregnancy is treated. Consider that your pain could be anything from joint pain to constipation. It might be that the focus on "preterm labor" issues is disctracting everyone from dealing with and addressing other causes for your problems.

This is where another opinion comes in. It does not even have to be a specialist, it could just be another OB/GYN.

Good luck.
Above answer was peer-reviewed by
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