The monitoring of progesterone levels during early pregnancy has now created a chaotic clinical situation. It has also become a “disaster area” for pregnant women to panic, over-medical treatment, and irregular medication. What is the law of progesterone secretion during early pregnancy? What are the possible conditions for progesterone deficiency? What is the significance of serum determination of progesterone? Let’s take a look at it.
Does you need to monitor progesterone frequently during pregnancy?
The answer is that it is not recommended to monitor progesterone frequently.
When the long-awaited pregnancy arrives, the expectant mothers are both excited and nervous. In particular, there has been a history of miscarriage or biochemical pregnancy, but this pregnancy is a big enemy, for fear of any mistakes.
Search online, add According to some doctors’ suggestions, it seems that progesterone levels can predict and monitor the process of pregnancy. Some pregnant women keep pumping blood to check progesterone. If the value is “low” or a little change, they will be extremely anxious and desperately add progesterone. It seems that progesterone is the lifeline for successful pregnancy.
The current irregularities in the monitoring of progesterone and the application of progesterone have caused panic and confusion among patients.
Progesterone is important for maintaining fertility
Recent studies have shown that the physiological role of progesterone in fertility is unquestionable. In early pregnancy, it is secreted by the corpus luteum of the pregnancy, which promotes the decidualization of the endometrium for good embryo implantation conditions; and induces immune protection mechanisms to prevent the embryo from being “rejected” by the mother; it also reduces the sensitivity of the uterine smooth muscle. The role of “safety”.
Under physiological conditions, it is sufficient for humans to maintain serum progesterone levels of only about 20-30 ng/ml during early normal pregnancy (within 12 weeks of gestation).
And the levels of progesterone detected vary greatly from person to person, even from person to person, and the peak of progesterone pulse, the function of progesterone receptor, the use of progesterone, etc. Related, there are obvious individual differences.
People monitor progesterone levels during early pregnancy because of fear of miscarriage, fear of pregnancy loss due to lack of progesterone. Can supplementing progesterone really prevent and treat abortion? What kind of serum progesterone level needs to be supplemented with progesterone? In response to this problem, various researches and analyses have been conducted over the years, resulting in many different conclusions and controversies.
The cause of spontaneous abortion is complex, and about 50% is a random error in the fetal villus chromosome, which is aneuploidy. Other recognized causes include uterine malformations, anticardiolipin syndrome, endocrine factors, thrombophilia, etc. Some abortions occur as incidents. If they occur more than twice in a row, they are called recurrent miscarriage.
It seems that only the cause of endocrine factors may be related to progesterone deficiency, which is the basis for the use of progesterone. Endocrine factors include diabetes, insulin resistance, hypothyroidism, and ovulation disorders.
Progesterone deficiency can’t explain anything
1. These mechanisms of endocrine causes include ovulation disorders, thyroid problems, insulin resistance, and so on. Progesterone is produced by the corpus luteum after ovulation and is regulated by LH. Therefore, when the frequency and amplitude of the pituitary LH pulse change, such as ovulation disorders, high prolactin blood, ovulation stimulation, etc., it will affect pregnancy. The secretion of ketones causes progesterone deficiency, and it is clinically possible to supplement the progesterone “preservation”.
But these deficiencies are often not necessarily reflected in the progesterone level. Clinically, some patients with “lower” progesterone levels can still maintain a sustained pregnancy.
2, because of the ovulation reduction and gonadotropin use in assisted reproductive technology, and the loss of granulosa cells during egg retrieval, the ovarian corpus luteum function is significantly incomplete, and the supplementation of progesterone can effectively prevent abortion. The evidence for increasing pregnancy rates is sufficient.
Even so, the determination of progesterone levels does not necessarily reflect luteal function, whether the progesterone supplement is sufficient, and the oral dydrogesterone formulation is not detected in the serum.
3. When we have a threatened abortion, that is, during pregnancy, a small amount of vaginal bleeding, no abdominal pain and other discomfort, the prophylactic amount of progesterone is reasonable.
It is not possible to identify whether it is an intrauterine pregnancy during early pregnancy or to prove whether the embryo is healthy. Although it is observed that the progesterone level is normal, the possibility of continued pregnancy is high, but it depends on 45 days of pregnancy. Whether the gestational sac and fetal heartbeat are visible in the uterine cavity, if the fetal heartbeat is seen, it is the standard of normal pregnancy at that time. The progesterone level is less valuable than the fetal heartbeat.
4, when the pregnancy reaches 8 to 10 weeks, the progesterone secreted by the corpus luteum of pregnancy gradually reduces the failure, gradually replaces the progesterone by the syncytiotrophic cells of the fetal placental villi, and gradually rises until the foot Delivery in the month.
This handover indicates that the stage of luteal support has passed. If the embryo itself is not well developed, the trophoblasts cannot normally secrete progesterone. How to supplement progesterone is useless. If the level of progesterone is low at this stage, this is not the cause of miscarriage, but the consequence of the termination of the embryo.
Progesterone is not recommended as a monitoring indicator during pregnancy
Based on the above reasons, we still cannot use progesterone as a reliable indicator of pregnancy monitoring. As a basis for monitoring and predicting abortion during pregnancy. The above reasons are as follows:
1, serum levels of progesterone levels in the serum fluctuate greatly, and the instantaneous progesterone value does not completely reflect the total amount of progesterone in the blood. The hCG assay assesses pregnancy status.
2. The causes of miscarriage are complicated. The level of progesterone does not effectively prove the evidence of luteal function. For patients with threatened abortion and recurrent abortion, progesterone can be supplemented with progesterone. Then according to the existence of the intrauterine gestational sac and fetal heart, adjust the plan of the fetus.
3. Although studies have suggested that the progesterone level in the successful pregnancy group is slightly higher than that in the abortion group, for the individual, the progesterone level does not accurately predict the pregnancy outcome.
4. For patients who are inevitable abortion after 8 weeks of pregnancy, the decrease in progesterone level is the result, not the cause, and the supplementation of progesterone is irreparable.