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Tuesday, March 8, 2016

Fertility Friday: Progesterone Probably Won't Prevent Miscarriage, But Aspirin May Work

Miscarriages, besides being emotionally draining, are common and often not well understood. Progesterone has to support an early pregnancy. It is the signal for the lining not to shed, and the progesterone is produced by the corpus luteum of the ovary. Nature has designed a back up, the placentl production of progesterone to replace any lack of ovarian progesterone production. It's always been thought that very early on in the first days to couple of weeks of pregnancy there just isn't enough placenta to support that uterine lining and prevent it from shedding. Yet as the pregnancy progresses, a healthy pregnancy will have a healthy placenta making enough progesterone to support the pregnancy if the early low progesterone can be overcome. The question on progesterone is complicated. If the ovary and the placenta are not doing their jobs, the question has been can we use supplemental progesterone be able to sustain a healthy fetus that might miscarry without a good progesterone level. Older studies from the Cochrane data base supported using progesterone, but then  PROMISE trial didn't support the use of progesterone to prevent miscarriage. In this trial they used vaginal suppositories, and both this group and the control group had virtually identical out comes. Some fertility experts  were just not not  so quick to abandon progesterone as a therapy as it is an extremely safe treatment, and relatively modest in cost as well.

Much interest then was stirred by the possibility that aspirin would be the way to go rather than use supplemental progesterone in a woman who has had a miscarriage. Blood thinning was thought to work with either heparin or aspirin. But it seemed that aspirin was the safest. So low dose aspirin is the new way to prevent a second and third miscarriage is to begin aspirin before becoming pregnant has now been shown to be effective in one study.This group studied women of ages 18 to 40, who had had one or miscarriages, and those who miscarried at any point. Beginning low dose aspirin therapy before conception increased conception rates by 28% in women with a history of only one pregnancy loss second miscarriage such as checking the lining of that baby bed (the uterus) is ready including hormonal checks and infection checks February 2014 Fertility and Sterility 

And again the newest 2017 research says that in fact progesterone may be the way to go. In an article by the group including Saccone G, Schoen C, Franasiak JM, Scott RT Jr, Berghella V and published in Fertil Steril. 2017;107:430-438, they specifically were interested in looking at the use of progestogen in unexplained recurrent pregnancy loss (RPL), which is diagnosed when a woman miscarries more than two subsequent pregnancies.

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