Low Progesterone and Fertility
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
Progesterone is the dominant hormone of the second half of the menstrual cycle, produced by the corpus luteum after ovulation. It prepares the uterine lining for implantation, maintains the pregnancy in its early stages, and supports the development of the embryo until the placenta takes over production at around 10 weeks. Low progesterone — whether absolute or relative to oestrogen — is one of the most common and most treatable hormonal imbalances affecting fertility.
Signs of Low Progesterone
The most common signs include: spotting before the period (brown or pink discharge in the days leading up to menstruation), a short luteal phase (less than 10 days between ovulation and menstruation), recurrent early miscarriage, difficulty sustaining a pregnancy after IVF embryo transfer, premenstrual symptoms including anxiety, mood swings, and breast tenderness, and heavy or prolonged periods. A blood test on day 21 of a 28-day cycle (or seven days after confirmed ovulation) is the standard way to measure progesterone levels.
Causes of Low Progesterone
The corpus luteum — the structure that produces progesterone — forms from the follicle after ovulation. Its quality is directly related to the quality of the pre-ovulatory follicle. Factors that reduce progesterone production include poor follicular development (associated with low AMH, PCOS, or thyroid dysfunction), elevated prolactin, chronic stress (cortisol suppresses progesterone production), and nutritional deficiencies — particularly vitamin B6, zinc, and vitamin C.
TCM Understanding
In traditional Chinese medicine, the luteal phase is the kidney yang phase of the cycle. Progesterone is the biomedical expression of kidney yang — the warming, supportive energy that sustains the uterine lining and early pregnancy. Low progesterone almost always reflects kidney yang deficiency, sometimes compounded by liver qi stagnation (stress impairs the smooth transformation at ovulation and reduces corpus luteum quality) or spleen qi deficiency (insufficient qi to support the warming function).
Acupuncture
Research has shown that acupuncture increases progesterone levels in the luteal phase by improving corpus luteum function and supporting the HPO axis. Treatment timed in the luteal phase — typically two sessions between ovulation and the expected period — is most effective for supporting progesterone specifically. I combine this with follicular phase treatment to ensure the pre-ovulatory follicle develops as strongly as possible.
Chinese Herbal Medicine
Kidney yang tonifying herbs and formulas are the primary treatment for low progesterone in TCM. You Gui Wan (Restore the Right Kidney Pill) and Jin Gui Shen Qi Wan are classical formulas for kidney yang deficiency. Key individual herbs include Tu Si Zi, Du Zhong, Xu Duan, and Ba Ji Tian. I prescribe luteal phase formulas as a separate prescription from the follicular phase formula, switching between them at ovulation. Pharmaceutical-grade granules from Sun Ten in Taiwan throughout.
To discuss low progesterone and cycle support, contact me or book a consultation in Wokingham.
