I am a healthy 34 year old mother of one child (age 7). I am trying to conceive and I recently suffered an early miscarriage. The Dr. believed it was due to very low progesterone levels. I also had this problem with my first successful pregnancy. Anyway, I misunderstood my OBGYN's instructions and I started taking progesterone when I tried to conceive (at Ovulation). I was supposed to start progesterone therapy upon a positive pregnancy test. After taking the progesterone for 14 days I started my period and I had terrible side effects from the progesterone. The problem is, I have been able to feel myself ovulate since I was a teenager and ever since I took the progesterone I have not been able to feel ovulation. We have also tried to conceive for three months with out success. Could the progesterone have caused a failure to ovulate? Why all of a sudden would I stop feeling mittelschmerz? Please, we are so frusterated! Any information would be helpful. Thanks!

Low progesterone levels may be due to unhealthy pregnancies, or they may be due to Luteal Phase Defects where one's ovary produces too little progesterone to support even a healthy pregnancy. The best way to treat a luteal phase defect is with Clomiphene Citrate in the early part of the menstrual cycle. Progesterone supplementation at the time of a positive pregnancy test may already be too late (ie: the pregnancy is two weeks from conception at that time) and it has not been shown to work as well. Many women have occasional luteal phase defects, but if one's doctor believes that a progesterone deficiency is present on many or most cycles, treatment is indicated. Taking progesterone at the time of ovulation can interfere with fertilization but not usually with ovulation. Mittelschmertz is a very inconsistent symptom in most women. The absence of it does not necessarily signify absence of ovulation. Moreover, progesterone will not affect future cycles, only the one during which it was used. As miscarriages occur in 20 to 25% of all pregnancies, they are very common and there is no reason to be overly concerned after one early miscarriage. In addition, the average time to conceive is 6 months, so trying for three months is still well within the range of normal. If you believe that you need treatment for a Luteal Phase Defect speak to your doctor about the use of Clomiphene Citrate and its benefits and risks.

Answered by Dr. Lynn Friedman, M.D.