Should not my progesterone level be much higher in case of chemical pregnancy?

Hello,

Welcome to icliniq.com.

You have not mentioned the units of progesterone, which makes it difficult to decipher here with regards to luteal phase defect or deficiency (Ideally, serum progesterone levels in nonpregnant women in the luteal phase is 2 to 25 ng/mL or 6.4 to 89 nmol/L). Considering that you ovulated and got pregnant, Ideally, progesterone levels should have risen as normal first-trimester progesterone levels (9 to 47 ng/mL or 28.5 to 150 nmol/L). With both these reference ranges, your 4.7 was low, indicating a failed pregnancy or a chemical pregnancy. Yet ovulation cannot be ruled out in such a range as this would be a grey area.

However, I feel you should get your partner's semen analysis done to check for semen morphology with the previous history of three chemical pregnancies. In 90 percent of cases for a chemical pregnancy or anembryonic gestation, males are responsible.

Also, you have not mentioned if you have aborted completely. You should be nine weeks plus already, and if there has been no fetal pole still, then spontaneous abortion would have ensued. You should ideally wait for three months before planning for pregnancy again to allow the uterus to return to its pre-pregnant state, and also, this would give you time to get your partner evaluated. Progesterone pills are not recommended if chemical pregnancy has been confirmed by ultrasound already because as long as you would take progesterone, bleeding would not happen.

I am unsure from your query whether you have undergone a complete miscarriage already or not. And if a repeat ultrasound has confirmed the completion. Clomid is not recommended unless you are starting an afresh cycle for conception.

Please get back to me with details for further help.

Hello,

Welcome back to icliniq.com.

This cycle can be monitored as a dummy cycle (last menstrual period on twenty-eight of the previous month). Ideally, for LH (Luteinizing hormone) surge and ovulation following LH surge with the help of ovulation kits (considering follicular monitoring would be cumbersome in COVID-19 era). Then progesterone levels can be repeated after three days post-LH surge (as indicated by the ovulation kit). If the progesterone levels are low, I suggest you start micronized progesterone pills from day 15 to day 25 of this cycle to meet the luteal phase deficiency.

Ideally, a three-month gap should be given from the last miscarriage until planning the next pregnancy cycle. So I would not recommend Clomid (Clomifene) from the next cycle, but you can take it after three cycles. In the meantime, get your partner's semen analysis done.

Feel free to ask further doubts.

Hello,

Welcome back to icliniq.com.

I do not recommend aspirin to nonpregnant women or in the pre-pregnancy state. Aspirin was prescribed to women who had recurrent miscarriages due to thrombophilia and had viable pregnancies (the fetus had a heart rate, but they got aborted before ten weeks gestation).

In your case, all pregnancies were chemical pregnancies; as you mentioned, the cause is unlikely thrombophilia, but mostly, it's the male semen morphology factor. Aspirin is prescribed after fetal heart rate is confirmed to avoid coagulation-induced thrombosis of small placental capillaries, Thereby causing fetal demise as seen in cases of thrombophilia.

So I would not recommend it with folic acid in a nonpregnant state.

I hope this was helpful.

Hello,

Welcome back to icliniq.com.

Suppose your partner was electrocuted in the past. In that case, there are chances that seminal vesicles may have been damaged. And likely cause decreased sperm concentration (oligospermia) or slow-moving sperm (asthenospermia), or morphologically deformed sperm (teratozoospermia). So with this history, his semen analysis becomes mandatory before you can be evaluated in detail for another future planned conception.

I hope this was helpful.