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Recurrent miscarriage

Can progesterone offer hope?

For those with unexplained recurrent miscarriage, it can be a season of confusion and loss. There may be some hope with news of a new trial called the Promise study, which examines whether progesterone can be used to prevent miscarriage in those with a history of unexplained recurrent miscarriages. The results of this trial should be out in 2013.

There have been 4 randomized trials using progesterone cream to prevent recurrent loss, which show a trend towards the benefit of using progesterone with a 42-69% reduction rate. However, this was not statistically significant except for one trial (1-4).

Unpublished data collected by Dr. Munawar Hussain, subspecialty training fellow in reproductive medicine surgery at St. Michael’s Hospital in Bristol, UK, found that his miscarriage rate was improved with progesterone supplementation. His unpublished data found that in those with 3 previous miscarriages, miscarriage rate with 35%; in those with 4 previous miscarriages, the miscarriage rate was 31%. This was improved compared to historical data showing 45-54% miscarriage rates without any intervention. In his practice, progesterone supplementation was offered to those whose initial progesterone was less than 40 IU/L or their 48 hour repeat progesterone did not rise by an increment of 15%. His unpublished data was mentioned in the British Medical Journal (5).

Two other small trials found a similar benefit. One study used progesterone vaginal suppositories dosed at 50mg/day and was increased according to the endometrial biopsy, and doubled as soon as the pregnancy was established. This study overall found the treated group had 9% loss compared to 42% loss of untreated control group (6). A very small Italian study used 100mg of natural progesterone vaginal cream and also found a lower incidence of miscarriages compared to the control group, albeit a small difference (21% vs 16%).(7)

If you are struggling with this issue, hopefully this will mean help for you in the very near future. Contact us if you would like more information.

1.Swyer GI, Daley D. Progesterone implantation in habitual abortion. BMJ1953;1:1073-7.

2. Goldzieher JW. Double-blind trial of a progestin in habitual abortion. JAMA1964;188:651-4.

3. Levine L. Habitual abortion. A controlled study of progestational therapy. West J Surg Obstet Gynecol1964;72:30-6

4 El Zibdeh MY. Dydrogesterone in the reduction of recurrent spontaneous abortion. J Steroid Biochem Mol Biol2005;97:431-4.

5. BMJ 2011;342:d1914

6. Check JH, Chase JS, et al. Progesterone therapy to decrease first-trimester spontaneous abortions in previous aborters. Int J Fertil. 1987 May-Jun; 32(3):192-3, 197-9.

7.Vignali M et al. [efficacy of the vaginal administration of natural progesterone in patients with recurrent spontaneous hormone caused abortion]. Minerva Ginecol. 2000 sep;52(9):367-74