Miscarriage Prevention
Treating Luteal Phase Defect with Progesterone Supplements
Though most treatments for miscarriage remain scientifically unproven, one study seems to support the benefits of progesterone supplementation for treating recurrent miscarriage.
Progestogen for Preventing Miscarriage ,conducted by D.M. Haas and P.S Ramsey (Cochrane Database of Systematic Reviews. 2008. Issue 2), demonstrated an increase in the rate of successful pregnancies among the treated group of women who had suffered recurrent loss.
Conditions Requiring Progesterone Supplementation
Haas’s and Ramsey’s study suggests the support of progesterone treatment in women who suffer recurrent miscarriage. However, a woman who has not been diagnosed with recurrent loss may seek testing for certain conditions which are connected with repeated miscarriage. Some proposed conditions, such as embryo toxicity and natural killer cells, are unproven and controversial. The primary condition linked to progesterone supplementation is Luteal Phase Defect, a condition in which the endometrium is not sufficiently prepared for implantation and support of the embryo.
Understanding Luteal Phase Defect
The Luteal Phase occurs between ovulation and menstruation. In a normal cycle:
- The follicle stimulating hormone has been released.
- The best egg-containing follicle has been selected to mature.
- The luteinizing hormone has stimulated the follicle to release the egg.
- The luteal phase begins as the remaining follicle becomes the corpus luteum.
During the luteal phase, which should last approximately 14 days, the corpus luteum secretes progesterone. Progesterone, along with estrogen, prepares the endometrium (the lining of the uterus) for the implantation of the embryo. In a woman with LPD, a problem may occur at any stage with the follicle, the developed corpus luteum, or the endometrium. Miscarriage, then, is presumably caused by the failure of the embryo to implant, improper implantation of the embryo or unsuitable nourishment of the growing embryo and fetus.
Diagnosis of LPD
Symptoms of LPD are generally disguised, since a woman with LPD can have regular menstrual cycles. It is during attempts at conception that most women discover the disorder. Inconsistent basal body temperatures after ovulation are one symptom linked to LPD. Women who do not chart basal body temperatures may not discover the condition until they have had repeated miscarriages.
Testing for LPD
There are many ways doctors can test for LPD. A specialist may request
- A blood sample taken at about 7 days after ovulation (10-14 ng/mL or less is indicative of luteal phase defect)
- An endometrial biopsy (removal of a small sample of the endometrium)
- Follicle measurement via ultrasound. [The presence of immature follicles suggests a need for ovulation-stimulating medication, clomiphene citrate (Clomid, Milophene or Serophene), which may be used instead of or in addition to progesterone.]
How and When Progesterone is Taken
Upon the diagnosis of LPD, a patient may be given a prescription for progesterone supplementation, such as Crinone or Prometrium. Depending on the brand, the supplements may be taken orally or inserted vaginally. Miscarriage prevention seems to be unaffected by the brand or route of administration. However, it is essential that the supplementation begin at or just after ovulation and continue up to the 10th or 12th week of pregnancy.
Additional Research Necessary
Many specialists have testimonies to support the success of progesterone treatment for miscarriage. The Haas and Ramsey study seems to support the benefits of this treatment. However, more studies need to be conducted before the scientific community will accept progesterone supplementation as a valid treatment for recurrent loss. In addition, more research needs to be conducted involving the causes of miscarriage, such as Luteal Phase Defect and the more controversial theories.
Additional Resources on Luteal Phase Defect:
- Avoiding Miscarriage by Susan Rousselot (Sea Change Press, 2007)
- Luteal Phase Defect by the International Council On Infertility Information Dissemination (Online Article, viewed August 2008)
