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Important Study Shows Progesterone Does Not Prevent Miscarriages
Recurrent miscarriages remain a challenge for patients and Reproductive Medicine physicians. Three quarters of all first trimester miscarriages are due to genetically abnormal embryos. These embryos lack the required 46 chromosomes needed for an embryo to develop into a healthy baby.
This week in the prestigious New England Journal of Medicine a landmark trial was published looking at the effectiveness of progesterone treatment in preventing miscarriages. The study was beautifully designed. 836 women with at least three previous miscarriages without an identified cause were randomized to receive either progesterone vaginal suppositories or a placebo starting early in pregnancy. There was no difference in the live birth rate between the two groups showing that progesterone treatment is not effective in improving outcomes in women with recurrent pregnancy loss.
This study is important. Many women feel they are responsible for their unsuccessful pregnancy. Often genetically abnormal pregnancies have low progesterone levels and patients often believe that if they had used progesterone in early pregnancy it would have changed the outcome. This excellent European study gives reassurance to all of our patients that low progesterone is likely not the cause of recurrent miscarriages. At the same time, a thorough evaluation for recurrent miscarriage is always recommended. These tests include antiphospholipid antibodies, parental chromosome testing, evaluation of the uterus, and maternal egg testing.
There has been a transformative change in the treatment of recurrent miscarriages. As a majority of miscarriages are due to genetically abnormal embryos, it is possible to perform in vitro fertilization and embryo biopsy, thereby ensuring that a single genetically normal embryo is transferred.