From the Guidelines
Progesterone does not have sufficient evidence to prevent recurrent pregnancy loss, and its use for this purpose is not supported by the provided study. The study by da Fonseca et al 1 focused on the prevention of preterm birth in women with singleton pregnancy and prior preterm birth, rather than recurrent pregnancy loss. Although progesterone has been shown to reduce the incidence of preterm birth at <37 weeks of gestation (28.5% to 13.8%, P = .03) and <34 weeks of gestation (18.6% to 2.7%, P = .002) in this context, its effectiveness in preventing recurrent pregnancy loss is not established by this study. Some key points to consider when evaluating the use of progesterone for recurrent pregnancy loss include:
- The lack of direct evidence from the provided study to support its use for this specific indication
- The potential benefits of progesterone in other obstetric contexts, such as preterm birth prevention, as demonstrated by da Fonseca et al 1
- The need for comprehensive evaluation of women with recurrent pregnancy loss to identify underlying causes that may require alternative treatments. In clinical practice, the decision to use progesterone for recurrent pregnancy loss should be made on a case-by-case basis, taking into account the individual patient's medical history, underlying causes of recurrent loss, and potential benefits and risks of progesterone therapy.
From the Research
Evidence for Progesterone in Preventing Recurrent Pregnancy Loss
- The use of progesterone supplementation in preventing recurrent pregnancy loss is mentioned in several studies 2, 3, 4.
- A study published in 2024 suggests that vaginal progesterone supplementation may be considered in patients experiencing vaginal bleeding during the first trimester 2.
- Another study from 2017 mentions that progesterone supplementation is used as an empirical treatment for unexplained recurrent pregnancy loss 3.
- A 2020 study notes that available treatments for recurrent pregnancy loss target putative risk factors, including endometrial dysfunction, which may be addressed with progesterone supplementation 5.
- A 2018 study specifically examines the role of progestogens, including progesterone, in preventing pregnancy loss and finds a beneficial effect in luteal-phase support, threatened miscarriage, and recurrent miscarriage 4.
Effectiveness of Progesterone Supplementation
- The 2018 study reports that progestogens are associated with a higher rate of live births or ongoing pregnancy in the progesterone group, with an odds ratio of 1.77 (95% CI 1.09-2.86) 4.
- The same study also finds that progestogens are effective in treating threatened miscarriage, with a reduced odds ratio of 0.53 (95% CI 0.35-0.79) 4.
- A meta-analysis cited in the 2018 study shows a 28% increase in the live birth rate with progestational agents in recurrent miscarriage (relative risk 0.72,95% CI 0.53-0.97) 4.