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Progesterone (PROG), has a relative molecular weight of 314.47 g/mol. It is a gonadal steroid hormone insoluble in water but easily soluble in organic solvents. Endogenous PROG is mainly produced by the corpus luteum of the ovary during the luteal phase, but can also be produced by the placenta and adrenal gland. During early stage of gestation, maternal blood PROG mainly comes from the corpus luteum of the ovary. Meanwhile, a small amount of PROG is synthesized and secreted by placental villi. As the placenta grows, the villi increases and the PROG production of the placental villi increases gradually as well. By the 8th week of pregnancy, PROG can basically replace the function of the corpus luteum and PROG levels will continue to rise thereafter.

Biological functions of Progesterone (PROG)

PROG has the functions of maintaining gestation, controlling ovulation, blastocyst implantation, uterus and mammary gland development, and inhibiting estrogen on uterine epithelial proliferation. Endogenous progesterone can transform the endometrium from the proliferative phase to the secretory phase, promote the maturing and shedding of the endometrium, and maintain the menstrual cycle. In addition, during the early stage of gestation, PROG can regulate the differentiation of endometrial stromal cells, promote the development of implanted blastocysts, stabilize the endometrium and play a role in preventing miscarriages.

Clinical significance of Progesterone (PROG)

A. Prediction to threatened miscarriages

PROG maintains the balance of intracellular sodium and potassium ion concentration by affecting the permeability of uterine smooth muscle cell membrane. PROG also reduces the excitement of uterine smooth muscle and its sensitivity to oxytocin, provides a stable environment for the development of fertilized ovum in the uterus, and maintains gestation. Low progesterone levels in pregnant women can lead to threatened miscarriages or miscarriages. Therefore, serum PROG detection has certain clinical application value in predicting early stage threatened miscarriages and preventing miscarriages.

B. Diagnosis of ectopic pregnancy (EP)

Compared with women with normal pregnancy, patients with ectopic pregnancy (EP) have lower trophoblast function, poor embryo development and decreased ovarian corpus luteum function. Serum PROG and β-human chorionic gonadotropin (β-hCG) levels were low in EP patients, but their vascular endothelial growth factor (VEGF) levels were significantly elevated. Combined detection of PROG, β-hCG and VEGF can be used for clinical diagnosis of early stage ectopic pregnancy. Studies have revealed that PROG is an effective indicator for diagnosis of EP, and the sensitivity, specificity, accuracy of combined detection of PROG, β-hCG and VEGF are significantly better than those of individual indicators.

C. Detection and treatment of infertility caused by corpus luteum insufficiency

Corpus luteum insufficiency is a common cause of infertility. Inadequate follicular development leads to corpus luteum insufficiency and low progesterone levels. Insufficient secretion of PROG during the luteal phase, resulting in insufficient endometrial development to support embryo implantation and pregnancy, which may eventually cause infertility or miscarriage. Serum progesterone level has a certain reference value in the diagnosis of infertility. In addition, timely supplementation of exogenous PROG through oral or intramuscular injection can effectively treat infertility caused by corpus luteal insufficiency.

D. Treatment of in vitro fertilization caused corpus luteum dysfunction

Progesterone can be used in the treatment of corpus luteum dysfunction caused by in vitro fertilization. In vitro fertilization combines the use of PROG with gonadotropin-releasing hormone analogs (GnRH-a) to induce superovulation. GnRH-a's excessive suppression of the pituitary gland will affect the secretion of luteinizing hormone (LH) and further causing insufficient PROG in the luteal phase. Insufficient PROG will affect the development of endometrium, embryo implantation, and reduce the pregnancy rate of in vitro fertilization. Appropriate doses of exogenous progesterone can provide a suitable pregnancy environment for the luteal phase, avoid ovarian hyperstimulation syndrome, maintain and increase the rate of pregnancy.