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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 placenta. It's always been thought that very early on there isn't enough placenta to support that lining. Yet as the pregnancy progresses, a healthy pregnancy will have a healthy placenta. The question on progesterone is complicated. If the ovary and the placenta are not doing their jobs, will 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 the PROMISE trial doesn'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 may not be so quick to abandon progesterone as a therapy as it is an extremely safe treatment, and relatively modest in cost as well, and this is a new finding that would benefit from confirmation. But given the fact that miscarriages are so frequent, we have turned to other therapies to try to prevent them.

 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 a new study.They 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 Other tests including an endometrial biopsy and hormone measurements to check on the progesterone levels, and further more evaluating gynecologic problems like fibroids, or  medication use, lack of vitamins or other nutritional deficiencies, chromosomal problems, or perhaps problems with the male sperm count. And if problems are identified then treating them. Some women are ready physically but are not ready emotionally, which is of course critical as well.. But the trouble is that most women do not have anything as specific as a fibroid
that can be treated. So normalizing your nutrition, your rest, and beginning aspirin is the modern way to go when attempting pregnancy after a miscarriage.

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