Vaginal Progesterone Did Not Improve Live Birth Rates in Women with Recurrent Miscarriage

Summary and Comment |
November 25, 2015

Vaginal Progesterone Did Not Improve Live Birth Rates in Women with Recurrent Miscarriage

  1. Robert W. Rebar, MD

Nonetheless, the chances of subsequent live birth remain as high as 70%.

  1. Robert W. Rebar, MD

Despite intensive research in recurrent miscarriage, most cases remain unexplained and no treatment modality has proved effective. In a multicenter trial in Great Britain and the Netherlands, researchers examined whether treatment with vaginal progesterone would improve live birth rates among women with unexplained recurrent miscarriage (defined in this study as loss of 3 or more pregnancies). A total of 836 participants were randomized to receive vaginal progesterone suppositories (400 mg twice daily) or placebo beginning no later than 6 weeks' gestation and extending through 12 weeks' gestation.

In intention-to-treat analysis, the rate of live birth after 24 weeks' gestation was 66% in the progesterone arm and 63% in the placebo arm (relative rate, 1.04).

Comment

Although this well-conducted study is at odds with a recent Cochrane report suggesting that progesterone lowers rates of subsequent miscarriage (Cochrane Database Syst Rev 2013; 10:CD003511), the results should not be surprising. Until the causes of unexplained recurrent miscarriage are determined, any single therapeutic modality is unlikely to be uniformly effective. Moreover, based on data that subsequent miscarriage rates are similar whether two or three or more prior losses have occurred (Fertil Steril 2013; 99:63), these authors applied a more conservative definition of recurrent miscarriage (3 or more losses) than is commonly used (2 or more losses). Still, couples and their clinicians should be buoyed by knowing that the chances of subsequent live birth have remained at 65% to 70% in virtually all trials, regardless of therapy.

Editor Disclosures at Time of Publication

  • Disclosures for Robert W. Rebar, MD at time of publication Editorial Boards Contraception (Deputy Editor); EndoText (Section Editor) Leadership positions in professional societies American Society for Reproductive Medicine (Member Practice Committee)

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Reader Comments (1)

LC Kee Physician, Family Medicine/General Practice

I would like to know if the "progesterone" used was bioidentical

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