Role of progesterone and hCG Treatment in Early Pregnancy

Role of progesterone and hCG Treatment in Early Pregnancy

Once implantation occurs, the pregnancy hormone Human chorionic Gonadotropin (HCG) will develop and begin to rise.

When the egg is fertilized, the corpus luteum will continue to produce progesterone for the developing pregnancy until the placenta takes over around ten weeks. Progesterone is the hormone that helps maintain the pregnancy until birth. Sometimes, the failure of the corpus luteum to adequately support the pregnancy with progesterone can result in an early pregnancy loss. Progesterone inhibits immune responses, decreases prostaglandins, and prevents the onset of uterine contractions.

With both hcg and progesterone levels, it is not he single value that can predict a healthy pregnancy out come. It is more important to evaluate two different values to see if the numbers are increasing. Levels of hCG should be increasing by at least 60% every 2-3 days, but ideally doubling every 48-72 hours. Progesterone levels rise much differently than hCG levels, with an average of 13-ng/ml every couple days until they reach their peak for that trimester. In situation when there is a concern of an ectopic pregnancy or miscarriage, hcg levels will often start out normal, but will not show a significant increase or will stop rising all together, and progesterone levels will be low from the beginning.

Efficacy and Safety of Progestogens as a Preventative Therapy against Miscarriage

The meta-analysis of all women, regardless of gravidity and number of previous miscarriages, showed no statistically significant difference in the risk of miscarriage between progestogen and placebo or no treatment groups and no statistically significant difference in the incidence of adverse effect in either mother or baby.

In a subgroup analysis of three trials involving women who had recurrent showed a statistically significant decrease in miscarriage rate compared to placebo or no treatment. No Statistically significant differences were found between the route of administration of progestogen versus placebo or no treatment.

Authors’ personal opinion is that there is evidence to support the routine use of progestogen to prevent miscarriage in early to mid pregnancy in those patients who have a history or diagnose to have luteal phase deficiency. However, further trials in women with a history of recurrent miscarriage may be warranted, given the trend for improved live birth rates in these women and the finding of no statistically significant difference between treatment and control groups in rates of adverse effects suffered by either mother or baby in the available evidence.