Pre-pregnancy progesterone helps women with recurrent pregnancy loss

January 09, 2017

Women who have had two or more unexplained miscarriages can benefit from natural progesterone treatment before pregnancy, a new a study shows.

Progesterone has been used for infertility for more than 50 years because it helps stabilize the endometrium, the inner lining of the uterus. But the hormone's use has not been well-studied in women who become pregnant easily but have difficulty maintaining pregnancy.

Dr. Mary Stephenson, director of the recurrent pregnancy loss program at the University of Illinois Hospital & Health Sciences System, led the new study. She says recurrent pregnancy loss is common, but very few evidence-based treatment options are available.

"Recurrent pregnancy loss is a heartbreaking challenge for as many as one in 20 women," Stephenson said, "although it is not often openly discussed."

"And while we know a lot about sporadic miscarriage, which is a natural mechanism of the body when there is a chromosome error at conception, we do not know nearly enough about unexplained recurrent pregnancy loss," said Stephenson, who is the Dr. Theresa S. Falcon-Cullinan Professor of Obstetrics and Gynecology at the University of Illinois at Chicago College of Medicine.

Stephenson and her colleagues see more than 200 women each year who suffer from recurrent pregnancy loss, making UI Health one of the largest sub-specialty centers in the U.S. for helping women struggling to maintain pregnancy.

Unlike previous studies, the new, prospective study of progesterone supplementation looked at a large and specific group of patients--116 women who had a history of recurrent pregnancy loss.

Recent evidence has suggested that endometrial glands may play a larger role in early pregnancy than previously thought, so Stephenson worked with Dr. Harvey Kliman, director of the reproductive and placental research unit at the Yale University School of Medicine, who specializes in the endometrium, to identify women with abnormal endometrial development by examining the expression of nuclear cyclin E, or nCyclinE.

Women with abnormal levels of nCyclinE, a molecular marker for the health of the endometrium, were prescribed progesterone during the second half of their menstrual cycle, when the uterine lining matures in preparation for a possible pregnancy.

The researchers found that natural progesterone, administered vaginally, led to a higher birth rate. Over two-thirds of pregnancies were successful in women who received progesterone, compared to barely half in women who did not receive the hormone.

"We are very pleased to find that these results reinforce the evidence that progesterone could be a very beneficial, inexpensive and safe treatment for many women with a history of recurrent pregnancy loss," Stephenson said.

The results are published in Fertility and Sterility, the international journal of the American Society for Reproductive Medicine.

The positive results suggest a prospective randomized trial is needed to validate the findings, Stephenson said. The results also indicate that molecular markers like nCyclinE could help doctors determine which patients would benefit from progesterone, and at what dose.

"I was very pleased that we could work with Dr. Stephenson on this important project," said Kliman, who is the inventor of the patented test for nCyclinE levels used in the study.

"We initially created the Endometrial Function Test to identify women with infertility," Kliman said. "This study has shown that the EFT can also be an important tool for patients with recurrent pregnancy loss."

Stephenson suggests that women who have experienced recurrent pregnancy loss should discuss possible progesterone supplementation with their doctor, but she strongly recommends "a thorough evaluation of known factors associated with pregnancy loss" before making a treatment decision.
-end-
Other co-authors on the study are Dr. Dana McQueen of UIC and Dr. Michelle Winter of the University of Chicago.

University of Illinois at Chicago

Related Pregnancy Articles from Brightsurf:

COVID-19 has a prolonged effect for many during pregnancy
Symptoms for pregnant women with COVID-19 can be prolonged, lasting two months or longer for a quarter of the women who participated in a national study led by UC San Francisco and UCLA.

Relaxed through pregnancy
A group of researchers from Charité - Universitätsmedizin Berlin have been able to show that maternal psychological wellbeing during pregnancy has a positive effect on newborn infants.

Trajectories of antidepressant medication use during pregnancy
In an analysis of women who started pregnancy when taking antidepressant medications, investigators identified three trajectories of antidepressant dispensing during pregnancy: more than half stopped their treatment, a quarter maintained their treatment throughout pregnancy, and one-fifth discontinued it for a minimum of three months and then resumed it during the postpartum period.

Are women using e-cigarettes during preconception and/or pregnancy?
A new study of 1,365 racially/ethnically diverse, low-income pregnant women found that 4% reported e-cigarette use.

A better pregnancy test for whales
To determine whale pregnancy, researchers have relied on visual cues or hormone tests of blubber collected via darts, but the results were often inconclusive.

Cannabis use during pregnancy
The large health care system Kaiser Permanente Northern California provides universal screening for prenatal cannabis use in women during pregnancy by self-report and urine toxicology testing.

Questions and answers about cannabis use during pregnancy
A new study shows that women have many medical questions about the use of cannabis both before and during pregnancy, and during the postpartum period while breastfeeding.

The effect of taking antidepressants during pregnancy
Exposure to antidepressants during pregnancy and the first weeks of life can alter sensory processing well into adulthood, according to research in mice recently published in eNeuro.

Is ivermectin safe during pregnancy?
Is it safe to give ivermectin to pregnant women? To answer this question, researchers from the Barcelona Institute for Global Health (ISGlobal), an institution supported by 'la Caixa,' conducted a systematic review and meta-analysis of studies that reported cases of accidental exposure to the drug among pregnant women.

Going to sleep on your back in late pregnancy
This study looked at whether going to sleep on your back in the third trimester of pregnancy was associated with average lower birth weights.

Read More: Pregnancy News and Pregnancy Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.