December 3, 2015

Progesterone Therapy In Women with Recurrent Pregnancy Loss

Progesterone Therapy In Recurrent Pregnancy Loss

 

The fundamental importance of progesterone to pregnancy has been known since the pioneering work published in 1946 by the late Dr. Georgiana Segar Jones in the Journal of the American Medical Association. Progesterone has many interesting and important effects that are critical to pregnancy not only hormonal in nature but also potentially immunosuppressive.

Progesterone supplementation has been used for decades to treat women with a history of recurrent pregnancy loss. A recent study published in the prestigious New England Journal of Medicine proved (at lest according to the authors) that progesterone was no more effective than a placebo in treating women with a history of unexplained miscarriages. A scientific-medical study, however, is only as good as the study design used to test an hypothesis in this case, the efficacy of progesterone in preventing a subsequent miscarriage in women with a history of miscarriages. Unfortunately, this study does not prove anything except that progesterone supplementation has little effect on pregnancy outcome once pregnancy has been confirmed.

Therefore, this study was horribly flawed for the simple reason that progesterone therapy was not initiated until after a positive pregnancy test. In order to properly test the author’s hypothesis regarding progesterone efficacy, their study design should have insured that progesterone was initiated after ovulation but prior to implantation during a conception cycle. Also, the authors made no attempt to correct for chromosomal abnormalities in the miscarriages of those both taking and not taking progesterone. These important study design flaws seriously weaken the authors’ conclusion and reminds us that in order to get a study published in the medical literature, one simply needs three friendly and sympathetic reviewers ignoring study design flaws. Whether progesterone therapy is truly effective or not in treating recurrent pregnancy loss is still open to question and should be tested in a properly designed trial.

If you are experiencing recurrent pregnancy loss, please contact us, we can help!

 

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Joseph A. Hill, III, M.D.

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility