One of the measurements fertility doctors look at during an IVF cycle is progesterone.
It’s well-settled that low progesterone is a problem and can be a strong indicator of a pregnancy that is likely to fail, depending on when it’s measured.
For women undergoing IVF, and thus receiving some support (shots or suppositories), higher progesterone measurements 14 days after embryo retrieval were associated with pregnancy success:
115 women (26%) had a viable intra-uterine pregnancy at 8 weeks gestation, 80 (18.1%) had an abnormal pregnancy (biochemical, ectopic, miscarriage) and 247 (55.9%) failed to conceive. Women with on-going pregnancies had significantly higher serum progesterone levels (median: 430, 95%CI: 390-500 nmol/l) compared to those who had either an abnormal pregnancy (72, 48-96 nmol/l; P < 0.001) or failed to conceive (33, 28-37 nmol/l; P < 0.001). Receiver-operator curve analysis demonstrated that a single serum progesterone on day 14 post-oocyte retrieval, could highly differentiate between normal and abnormal pregnancies (area under the curve = 0.927, 95%CI = 0.89-0.96; P < 0.0001).
The same thing was shown for women who conceived naturally (it’s easy to forget that women can get pregnant without years and years of invasive medical treatments). This article say for women WITH miscarriage symptoms (i.e. bleeding), low progesterone (below 10) strongly correlated with loss, but HIGHER thresholds (15-20) were not as strong:
For women with symptoms alone, the progesterone test had a higher specificity using a threshold of 10 ng/mL (nine studies with 4689 participants18 20 21 24 26 29 30 3132), rather than higher thresholds at 15 and 20 ng/mL, and predicted a non-viable pregnancy with pooled sensitivity of 66.5% (53.6% to 77.4%), specificity of 96.3% (91.1% to 98.5%), positive likelihood ratio of 18 (7.2 to 45), and negative likelihood ratio of 0.35 (0.24 to 0.50).
Here’s some more information about progesterone (and it’s drop around week 7):
In other words, in early pregnancy, high progesterone levels are good and low progesterone levels are bad:
Viable intrauterine pregnancies can be diagnosed with 97.5% sensitivity if the serum progesterone levels are greater than 25 ng/mL a few days after being late on your period. Conversely, finding serum progesterone levels of less than 5 ng/mL can aid in the diagnosis of a nonviable pregnancy with 100% sensitivity
So, can your progesterone be too high? At least one study suggests that if your progesterone is too high on the day of egg retrieval, pregnancy can be (much) less likely:
Progesterone levels at the time of egg retrieval only were associated with pregnancy outcome. Progesterone levels on the day of egg retrieval were, on average, significantly lower in women who achieved pregnancy (7.8 ng/mL) than in women who did not (10.2 ng/mL). Implantation rates of those with progesterone levels below 12 ng/mL on the day of egg retrieval were 43.9% versus 31.6% in those with levels above 12 ng/mL. Clinical pregnancy rates of those with progesterone levels below 12 ng/mL on the day of egg retrieval were 38.6% versus 20% in those with levels above 12 ng/mL.
Of the women who achieved pregnancy, 75% had progesterone levels less than 10.6 ng/mL. None of the women with progesterone levels greater than 18.1 ng/mL achieved pregnancy. As progesterone levels increased, pregnancy rates decreased. In particular, there appeared to be a steeper decline in pregnancy rates once progesterone levels were above 12 ng/mL. This may suggest that this is a clinically important level beyond which pregnancy is less likely.
These people even offer a handy chart with normal ranges on it:
For day 3 (ie before egg retrieval) you want a progesterone measurement below < 1.5 ng/ml. “An elevated level may indicate a lower pregnancy rate.”
For 7 days post ovulation (or 7 days after egg retrieval) you want a measurement above 15 ng/ml. It explains that “most doctors want to see a level over 10 on a natural cycle, and a level over 15 on a medicated cycle. There is no mid-luteal level that predicts pregnancy. Some say the test may be more accurate if done first thing in the morning after fasting.”
It also says that in the first trimester, a normal range is 10-90 ng/ml, with “Average is about 20 at 4 weeks LMP, and 40 at 14 weeks LMP. It is important to note that while a higher progesterone level corresponds with higher pregnancy success rates, one cannot fully predict outcome based on progesterone levels. Progesterone supplementation is unlikely to help if started after a positive pregnancy test.”
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