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

Abstract：

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.

journal_name

Fertil Steril

journal_title

Fertility and sterility

authors

Stephenson MD,McQueen D,Winter M,Kliman HJ

doi

10.1016/j.fertnstert.2016.11.029

subject

Has Abstract

pub_date

2017-03-01 00:00:00

pages

684-690.e2

issue

3

eissn

0015-0282

issn

1556-5653

pii

S0015-0282(16)63029-7

journal_volume

107

pub_type

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