Elsevier

Fertility and Sterility

Volume 107, Issue 3, March 2017, Pages 684-690.e2
Fertility and Sterility

Original article
Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss

https://doi.org/10.1016/j.fertnstert.2016.11.029Get rights and content
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Objective

To assess the effectiveness of luteal start vaginal micronized P in a recurrent pregnancy loss (RPL) cohort.

Design

Observational cohort study using prospectively collected data.

Setting

Not applicable.

Patient(s)

Women seen between 2004 and 2012 with a history of two or more unexplained pregnancy losses <10 weeks in size; endometrial biopsy (EB) performed 9–11 days after LH surge; and one or more subsequent pregnancy(ies). Women were excluded if concomitant findings, such as endometritis, maturation delay, or glandular-stromal dyssynchrony, were identified on EB.

Intervention(s)

Vaginal micronized P was prescribed at a dose of 100–200 mg every 12 hours starting 3 days after LH surge (luteal start) if glandular epithelial nuclear cyclin E (nCyclinE) expression was elevated (>20%) in endometrial glands or empirically despite normal nCyclinE (≤20%). Women with normal nCyclinE (≤20%) who did not receive P were used as controls.

Main Outcome Measure(s)

Pregnancy success was an ongoing pregnancy >10 weeks in size.

Result(s)

One hundred sixteen women met the inclusion criteria, of whom 51% (n = 59) had elevated nCyclinE and 49% (n = 57) had normal nCyclinE. Pregnancy success in the 59 women with elevated nCyclinE significantly improved after intervention: 6% (16/255) in prior pregnancies versus 69% (57/83) in subsequent pregnancies. Pregnancy success in subsequent pregnancies was higher in women prescribed vaginal micronized P compared with controls: 68% (86/126) versus 51% (19/37); odds ratio = 2.1 (95% confidence interval, 1.0–4.4).

Conclusion(s)

In this study, we found that the use of luteal start vaginal micronized P was associated with improved pregnancy success in a strictly defined cohort of women with RPL.

Key Words

Recurrent pregnancy loss
recurrent miscarriage
progesterone
endometrium
cyclin E

Cited by (0)

M.D.S. has nothing to disclose. D.M. has nothing to disclose. M.W. has nothing to disclose. H.J.K. is the inventor of a patent related to the monitoring of endometrial glandular development.