The NaPro Protocol for progesterone support in pregnancy leads to improved outcomes for women with many difficult obstetric problems, including miscarriage
NaPro in Current Pregnancy
Having the support of Monica and NaPro throughout this pregnancy was truly a blessing. This was my sixth pregnancy, but only my second successful one. With a history of early miscarriages I was referred to Monica after finding out we were expecting again. Between progesterone injections and oral capsules I was able to have a very healthy pregnancy. I felt loved and supported the entire time, and I’m so grateful for Monica and her passion for NaPro and helping women and families! ~KG
The NaPro protocol for progesterone monitoring and supplementation in pregnancy has led to significant improved obstetric outcomes for women with the following obstetric history:
(from Table 55-2, p. 728 from the NaPro textbook)
NaPro Support in Pregnancy Process:
NaPro in Pregnancy management includes:
Checking progesterone levels every 2 weeks at progesterone trough level (no progesterone supplementation for 24 hrs prior to lab draw if oral or vaginal dosing; none for at least 72 hours prior to lab draw if intramuscular dosing) throughout pregnancy and supplementing with additional, bioidentical progesterone if in Zone 1 or 2 (below the NaPro normogram mean level).
Dosing route options include oral, vaginal, and intramuscular injection, with preference for intramuscular dosing especially early in pregnancy and if progesterone level is in Zone 1 (lowest Zone). This is considered off-label use of progesterone (off-label prescribing is common in medicine; see articles below for established safety of progesterone in pregnancy). Progesterone dosing generally costs $60-$100/month depending on dose/route.
NaPro support in pregnancy is only a supplement to prenatal care and does not take the place of prenatal visits.
Outcomes: (as of 4/2024)
Since beginning NaPro support in pregnancy with patients in early summer 2022, I have treated over 40 pregnant women with the NaPro protocol, with the following results:
approximately 20 term vaginal deliveries, one term c-section, one delivery at 35 weeks
approximately 20 current, continuing pregnancies at present
*Most of these patients had had previous recurrent pregnancy loss (some up to 6) followed by a term delivery (or currently continuing pregnancy) with this NaPro care, and some also had previous preeclampsia or preterm labor. Some had only one previous miscarriage, and some were referred by their prenatal care provider because of low progesterone level. Some were patients I had treated previously for infertility and then transitioned into NaPro in pregnancy care with healthy, term deliveries.
*A small number of women dropped out of follow up sometime in second trimester. 5 women came into care after already having significant cramping/bleeding, and 3 of these pregnancies successfully continued to term (or are continuing now) after initiating NaPro care (after which cramping/bleeding stopped within 2 days), and 2 of these ended in miscarriage. So far, only two pregnancies have ended in miscarriage when progesterone support was started promptly after a positive pregnancy test.
These are the results of one provider using the NaPro Protocol for a relatively short time, but is consistent with the success reported by other NaPro providers, using this safe and simple protocol for over 30 years. Certainly there are other causes of miscarriage, preterm labor, preeclampsia, etc.
Yet consistent, appropriately dosed, BIOIDENTICAL progesterone has made the difference in countless pregnancies. Bioidentical, actual progesterone, identical in molecular structure to what the human body makes and receptors recognize, is NOT the same as other "progestins," and is far more effective when used promptly and dosed sufficiently. Additionally, bioidentical progesterone does not cost hundreds of dollars per mL, but approximately $20 per 10mL vial or $20-40 for #30 oral/vaginal capsules depending on whether compounded or not. As with other aspects of NaPro care, when it comes to hormones, NaPro providers always use the real thing!
How do I get started?
Simply email: office@functionalfertilitynw.com to schedule
Schedule availability is maintained to quickly accommodate pregnant women seeking the NaPro progesterone support in pregnancy protocol, especially those with a history of previous early miscarriage. No Creighton charting is needed to start NaPro progesterone support in pregnancy.
NaPro in Pregnancy pricing:
Intake visit: $150. This is a medical intake visit and includes a review of medical history and recommendations, and NaPro in Pregnancy care will be initiated if desired, with prescription progesterone, lab orders for monitoring levels, and initial progesterone injection, if appropriate.
NaPro in Pregnancy global fee for management throughout pregnancy : $350 (due within 2 weeks of intake visit if patient decides to proceed with NaPro management). This includes NaPro management for the entire rest of pregnancy, including prescriptions needed, dosing recommendation adjustments every 2 weeks, lab orders as needed, any additional visits or phone calls needed, injection instruction visits for home administration if needed, and complete post-partum depression care if needed. If a patient decides she does not want to proceed with NaPro in pregnancy care after the Intake visit, she is not responsible for the global fee.
All pricing and discounts subject to change.
Additional Resources:
The resources below speak to the safety of progesterone use in pregnancy, and other findings and guidelines that support its use in pregnancy.
Progesterone is not the same as 17α-hydroxyprogesterone caproate: implications for obstetrical practice
~American Journal of Obstetrics and Gynecology, June 2013
The Use of Isomolecular Progesterone in the Support of Pregnancy and Fetal Safety
~Issues in Law and Medicine, Sept 2015
Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence
~American Journal of Obstetrics and Gynecology, Aug 2020
"Therefore, women with a history of miscarriage who present with bleeding in early pregnancy may benefit from the use of vaginal micronized progesterone 400 mg twice daily. Women and their care providers should use the findings for shared decision-making."
Ectopic pregnancy and miscarriage: diagnosis and initial management
Current NICE National Institute for Health and Care Excellence (British) Guidelines:
~Last updated Aug 2023
"Offer vaginal micronised progesterone 400 mg twice daily to women with an intrauterine pregnancy confirmed by a scan, if they have vaginal bleeding and have previously had a miscarriage."