The infertility journey presents with varying levels of difficulty. For some conceiving their child is often easier than others. All challenges along the fertility journey are very unique. Supporting hundreds of patients through their fertility process I have seen that while there are common underlying feelings, everyone’s experience through this process is unique. So when a patient finally overcomes all of these obstacles and finally achieves a successful pregnancy, the focus shifts to protecting the pregnancy. How can we help to reduce the risk of miscarriage for these patients who have had to overcome tremendous obstacles to make it this far?
What causes Miscarriage?
Miscarriages are divided in to two different categories: euploid and aneuploid. Euploid means that the number of chromosomes are correct in the cells and aneuploid means there is an imbalance (usually an extra chromosome - and in some cases multiple extra or too few chromosomes). The majority of aneuploid pregnancies terminate in miscarriage as the pregnancy is unviable due to the DNA imbalance. Aneuploid pregnancies usually make up about 50% of the miscarriages. The risk of aneuploidy increases with age, so patients conceiving after the age of 40 are at an increased risk for an aneuploid miscarriage.
Euploid miscarriages are often the result of other factors: hormone imbalance, luteal phase defect with low progesterone, thyroid conditions, certain auto-immune conditions, dysbiosis of the uterine microbiome, among others.
Can Progesterone Prevent Miscarriages?
The use of progesterone does not appear to reduce the risk of aneuploid miscarriages. There are other interventions which have early studies showing that they may decrease the risk of aneuploidy, such as micronutrients in the preconception phase.
Progesterone can, whoever, decrease the risk of miscarriage for Women who have recurrent Euploid miscarriages. Two large studies published recently looked at many patients that presented with early 1st trimester bleeding and found that the use of a vaginal progesterone suppository at 400 mg, 2x a day was able to reduce the risk of miscarriage.
Who can Benefit the most from progesterone treatment?
Patients with the greatest reduction in miscarriage rates were patients who had previous miscarriages or those who presented with 1st trimester bleeding before starting progesterone therapy. For patients who had 1 previous miscarriage and presented with bleeding, using progesterone led to a 75% live birth rate (compared to only 70% if placebo was used) and those who had 3+ miscarriages and presented with bleeding had a live birth rate of 72% with progesterone (vs 57% with placebo).
Reference:
1. Coomarasamy, A., Devall, A. J., Brosens, J. J., Quenby, S., Stephenson, M. D., Sierra, S., Gallos, I. D. (2020). Micronized vaginal progesterone to prevent miscarriage: A critical evaluation of randomized evidence. American Journal of Obstetrics and Gynecology, 223(2), 167-176.
This article is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor. Please discuss with your healtcare provider and only make changes to your medications regimen if recommended by your doctor and under their guidance.