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| Courtesy: Makena |
Supplementation with progesterone
reduces the risk of early pregnancy loss in women with unexplained earlier recurrent
losses according to a Systematic review and meta-analysis published in Journal of Fertility and Sterility.
Women taking progestogens have a 28%
lower risk of miscarriage (RR 0.72; 95% CI 0.53-0.97). and 7% higher chances of live births as compared
to women who did not receive any supplementation. (RR 1.07, 95% CI 1.02–1.15).
The Meta-analysis included 10 trials comprising a total of 1,586 women with history of recurrent
miscarriage.
Two RCTs used natural progesterone
while the rest 8 used progestins like medroxyprogesterone, cyclopentylenol
ether of progesterone, dydrogesterone, or 17-hydroxyprogesterone caproate.
Pooled data did not show statically
significant difference for secondary outcome of the studies like preterm
births, fetal genital malformations and neonatal mortality.
Interestingly, vaginal progesterone
and natural progesterone did not much effect the miscarriage rate while oral,
intramuscular and synthetic form significantly lowered the miscarriage rate.
Intramuscular 17-alpha
hydroxyprogesterone caproate weekly and oral dydrogesterone were both
associated with significant reduction in miscarriage risk.
The authors conclude that because of
limitations RCTs included in this meta-analysis, a recommendation regarding type
and route of progesterone administrations are not possible to make.
Till we have more data from head to
head analysis about route and type of progesterone, synthetic progestogens supplementation
should be started in women with RPL as soon as pregnancy is confirmed.
Recurrent pregnancy loss (RPL) occurs
in ∼5%
of women. Many hematological, anatomic, hormonal, immune and genetic defect have
been attributed in its causation but in most patients extensive evaluation is
not able to pinpoint a cause.
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