Impending miscarriage and doctor won't help

[CLSDoc]

I am currently 4+2. My hcg started doubling every 38 hours, then 48 hours, now 54 hours. They remain quite low at 99 (4+1). My progesterone has dropped from 29.7 (nearly) to 22.6 (about 7ng). My breasts are back to normal but cervix remains high and temp is still up. I know this means miscarriage is impending, although GP is driving me insane saying my numbers are still encouraging. I asked for progesterone support but they spoke to gynae who say they never give it. This will be my third early miscarriage in 4 months, due to, I assume, low progesterone.

I feel so angry that there may be a solution here and the doctors won't help me. I'm so sad that this pregnancy won't end in a baby again. I'm so worried that if they won't support my progesterone that I'll never have a successful pregnancy.

Just wanting some support while I wait for the bleeding to start really...

Sounds tough for you. What is your history? I'm assuming you've had multiple losses to warrant these tests? It's possible there is nothing the Dr can do to help.

I've had 2 early miscarriages. So this is the third pregnancy in 4 months. I asked for my progesterone at d21 as I have terrible acne and the miscarriages. They've ruled out pcos.

What was your day 21 progesterone level?

If you have three miscarriage the GP should be referring you to recurrent miscartiage clinic where a specialist can advise you.

It was 29.3 at day 21. I have an appointment with them in March which they arranged after my second mc, but that will be too late for this one I suspect. And the gynaecologist told my GP that they do not and will not give progesterone.

Is private an option for the prescription?

I'm not aware if any evidence for the use if progesterone in this situation.

There is no real evidence. I get why they won't prescribe it based on this, but just feel let down. I have looked into private but it seems a bit late for this one. Also can't get a private appointment for another 2 weeks, by which I think I'll have already miscarried.

29.3 isn’t particularly low - mine was 26 and I didn’t need supplements. I’m not sure there’s much evidence that supplements prevent miscarriage anyway.

I agree with your GP that if your hCG is rising and you are not bleeding then it’s still possible that you might not be miscarrying.

But @CLSDoc would you trust a private Dr who prescribed something for which there is no evidence? I understand how heartbreaking this is, but essentially you're asking for something that won't stop you miscarrying. Progesterone is cheap - if it stopped early miscarriages you can bet we'd be using it widely. At 4+2 this is arguably a chemical pregnancy in any case and if you say you have had 3 in 4 months, were the others also CPs?

for you and make sure you get referred to a recurrent miscarriage clinic if this is a true third miscarriage.

My tests are still getting darker so I don't think it's happened yet. Just waiting for the progesterone to fall low enough I suppose. I just want to feel like I'm doing something to help I suppose. I've calmed down a lot over the weekend and have resigned to "what will be will be". It's not over yet, so I'm just hoping that this little one sticks and grows.

I’ve had many conversations with fertility specialists over the years and the general consensus is that you can’t read much into a progesterone test result because progesterone levels go up and down through the day, and so results will vary depending on when the test is taken .

If hormone levels (both HCG and progesterone) are low then it may indicate a failing pregnancy, but it’s much more likely that the failing pregnancy is causing low levels than low levels are causing the pregnancy to fail. That’s why progesterone isn’t routinely prescribed.

OP, I know what it is like to want certainty and some control. But unfortunately with pregnancies you just have to wait it out and hope for the best. I’ll keep an eye out for you, and very much hope that in a few months you’ll be posting about a normal, progressing pregnancy. In the meantime, if there is anything you can do to distract yourself, then do it. Worrying isn’t going to help. Best of luck, I’ve everything crossed for you.

I didn't think 29 was low at all?

In my experience the local recurrent miscarriage clinic will give you sod all. I preferred a throw-the-book-at-it approach and had progesterone and steroids prescribed privately - if I’d lived near the consultant could have been on the NHS.
Not sure what previous poster means by a “true” miscarriage. If someone has had three very early pgs that failed that warrants investigation.

and baby aspirin, forgot that.

I've had 7 early losses and 1 ectopic in 18 months, I don't have low progesterone as such but the reoccurant miscarriage clinic have suggest for now whilst we have ongoing investigations we can try progesterone but as the research is 'sketchy' it cannot be provided in the nhs so we pay for a private prescription and I take it from 1dpo.

Would it be an option to speak with them about a private prescription and show them there is really recent evidence for the use of progesterone for this reason?
However the nhs say it is not conclusive enough as it's only a marginal lead.

Also I didn't need a private appointment for my prescription I contacted my specialist nurse by email and she left my prescription for me to pick up on my ward (I'm a nurse)

There is clear evidence that progesterone supplementation does not help prevent miscarriage. It’s a shame because it would be an easy solution, and it is a natural response to want to try anything in that situation.

As a previous poster said - it’s not low progesterone causing a pregnancy to fail but the other way round - a failing pregnancy and hcg leads to the corpus luteum to stop producing progesterone.

I hope your fears are misplaced op, but if this is another miscarriage then you should be investigated properly to see if there’s any clear reason for you having recurrent miscarriages. Good luck.

@Topbiscuit If that was the case then why would my HCG continue rising and doubling every 48-72 hours but progesterone be falling. Seems the other way round to me...

Progesterone is not an accurate indicator in early pregnancy, that’s why they would usually just monitor hCG. I’m not entirely sure why your doctor is checking your progesterone levels tbh - they are usually only done at day 21 to confirm ovulation.

Progesterone should never be measured serially - it’s doesn’t increase in the same way as hcg and just doesn’t give accurate information. A very low progesterone is very likely to suggest a failing pregnancy but apart from that it just doesn’t tell me anything useful.

A 48hr doubling hcg is a good sign, but can keep going up for a while even if the pregnancy has stopped developing normally. We see this when trying to work out if a pregnancy is too early/miscarriage or ectopic. If your hcg is rising >66% every 48 hours that’s a positive sign that I’d be more happy with than a small variation in progesterone.

I’m sorry for your losses and imagine it makes you feel so powerless that you’ll hang onto anything that might possibly give you a chance. Sadly there was a recent large scale study that found progesterone doesn’t reduce the risk of recurrent miscarriage www.miscarriageassociation.org.uk/research/the-promise-trial/ As others have said, while you may still be sadly miscarrying, progesterone numbers rising or falling don’t predict that. Unless your initial result was abnormally low, they tend to flow up and down over the course of a few hours.

@Topbiscuit I hope you're right.

My HCG was:
8 (3+1), 27 (3+4), 54 (3+6), 99 (4+1). I get that these are low levels, but are still increasing at least. I got a 2-3w on clearblue digi at 4+2, so looks like still increasing as they need to be 153 to get 2-3w.

We have been checking my progesterone as I think this is what caused my last 2 miscarriages. It was never to confirm ovulation as I know I ovulate. We continued checking it as it was low at day21, it has remained low since then, dropping at 3+6.

I guess I'll just have to wait and see what happens with this one. For now it's still heading in the right direction, even if slowly. I have a scan booked at 6+4, and if I get to that I'll feel a lot better about things. Just needing to get to 8 weeks for the placenta to start kicking out some progesterone.

I think the title of my post was maybe a bit dramatic in retrospect. This is more threatened that impending, although it still feels inevitable to me. Keep everything crossed for me!!

@AsMuchUseAsAMarzipanDildo The Promise trial looked at "unexplained recurrent miscarriages", they didn't look at the use of progesterone in women who have low progesterone. That doesn't seem to have been looked at yet in a lot of detail unfortunately. I'm holding out hope for this one. I've managed to calm myself down a lot over the weekend, which will help with progesterone on it's own. My boobs are very tender today, so another good sign. My tests are still getting darker. I'm very pessimistic and still expecting the worst, but for now I'm still pregnant and there haven't been any real symptoms to say otherwise or that I'm miscarrying. I have everything crossed for this little baba (mostly my legs!!)...

Well HCG doubling means that something is growing. If it keeps on doubling once you hit around 2000 you might want to do a private scan to ease your mind a little.

I'm not sure the feeling of inpending doom or failed pregnancy means that you're correct. I had that feeling with this pregnancy as well and till now (12 wks) I'm textbook. I remember having the same feeling when I was pregnant last times when I miscarried. I think that those feelings could also just be a symptom of pregnancy, regardless of the outcome.

I hope you will be well.

@CLSDoc - but please remember that it's a chicken and egg scenario. Progesterone lowers during miscarriage which happened because of unexplained reasons or lower progesterone causes miscarriage? The cause/ effect has not been conclusively discovered. So even if there is a miscarriage and progesterone lowers, you can't say conclusively that it was caused by low progesterone...

In fertility circles, it's largely dismissed as hokum that low progesterone is a cause of miscarriage.