Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss
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 p...
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| Veröffentlicht in: | Fertility and sterility 2017-03, Vol.107 (3), p.684-690.e2 |
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| creator | Stephenson, Mary D., M.D., M.Sc McQueen, Dana, M.D., M.A.S Winter, Michelle, M.D Kliman, Harvey J., M.D., Ph.D |
| description | 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 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. |
| doi_str_mv | 10.1016/j.fertnstert.2016.11.029 |
| format | Article |
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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.</description><identifier>ISSN: 0015-0282</identifier><identifier>EISSN: 1556-5653</identifier><identifier>DOI: 10.1016/j.fertnstert.2016.11.029</identifier><identifier>PMID: 28081870</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abortion, Habitual - diagnosis ; Abortion, Habitual - physiopathology ; Abortion, Habitual - prevention & control ; Administration, Intravaginal ; Adult ; cyclin E ; Cyclin E - metabolism ; Drug Compounding ; endometrium ; Endometrium - drug effects ; Endometrium - metabolism ; Endometrium - physiopathology ; Female ; Fertility Agents, Female - administration & dosage ; Fertility Agents, Female - adverse effects ; Humans ; Internal Medicine ; Luteal Phase - drug effects ; Luteal Phase - metabolism ; Obstetrics and Gynecology ; Pregnancy ; progesterone ; Progesterone - administration & dosage ; Progesterone - adverse effects ; Prospective Studies ; recurrent miscarriage ; Recurrent pregnancy loss ; Treatment Outcome</subject><ispartof>Fertility and sterility, 2017-03, Vol.107 (3), p.684-690.e2</ispartof><rights>American Society for Reproductive Medicine</rights><rights>2016 American Society for Reproductive Medicine</rights><rights>Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3949-66739165163f82376a5bb8c50cdaaf3219c76b4524d53efc94ccf03281a84d743</citedby><cites>FETCH-LOGICAL-c3949-66739165163f82376a5bb8c50cdaaf3219c76b4524d53efc94ccf03281a84d743</cites><orcidid>0000-0002-2151-7071 ; 0000-0003-0162-1637</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.fertnstert.2016.11.029$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28081870$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stephenson, Mary D., M.D., M.Sc</creatorcontrib><creatorcontrib>McQueen, Dana, M.D., M.A.S</creatorcontrib><creatorcontrib>Winter, Michelle, M.D</creatorcontrib><creatorcontrib>Kliman, Harvey J., M.D., Ph.D</creatorcontrib><title>Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss</title><title>Fertility and sterility</title><addtitle>Fertil Steril</addtitle><description>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.</description><subject>Abortion, Habitual - diagnosis</subject><subject>Abortion, Habitual - physiopathology</subject><subject>Abortion, Habitual - prevention & control</subject><subject>Administration, Intravaginal</subject><subject>Adult</subject><subject>cyclin E</subject><subject>Cyclin E - metabolism</subject><subject>Drug Compounding</subject><subject>endometrium</subject><subject>Endometrium - drug effects</subject><subject>Endometrium - metabolism</subject><subject>Endometrium - physiopathology</subject><subject>Female</subject><subject>Fertility Agents, Female - administration & dosage</subject><subject>Fertility Agents, Female - adverse effects</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Luteal Phase - drug effects</subject><subject>Luteal Phase - metabolism</subject><subject>Obstetrics and Gynecology</subject><subject>Pregnancy</subject><subject>progesterone</subject><subject>Progesterone - administration & dosage</subject><subject>Progesterone - adverse effects</subject><subject>Prospective Studies</subject><subject>recurrent miscarriage</subject><subject>Recurrent pregnancy loss</subject><subject>Treatment Outcome</subject><issn>0015-0282</issn><issn>1556-5653</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUU2P1DAMjRArdlj4C6hHLi1x0qTpBQlWfEkjcVg4R5nUHTK06ZK0g4Zfv65m-RCnvdiy9ezn98xYAbwCDvrVoeoxzTHPFCtBnQqg4qJ9xDaglC6VVvIx23AOquTCiEv2NOcD51xDI56wS2G4AdPwDYvbZUY3FHl2aS6Obh8iVWPwaYrhF3bFbZr2uBJNEYswUnnETF3cRxf9qciL95hzEWLxcxqRYpi_FQn9khLG-R_kMOX8jF30bsj4_D5fsa_v3325_lhuP3_4dP1mW3rZ1m2pdSNb0Aq07I2QjXZqtzNecd8510sBrW_0rlai7pTE3re19z2XwoAzddfU8oq9PO-le38sdL8dQ_Y4DC7itGQLRkOtjdKaoOYMJck5J-ztbQqjSycL3K5u24P967Zd3bYAltym0Rf3LMtuxO7P4G97CfD2DEDSegyYbPYBo8cukEOz7abwEJbX_y3xQ4jBu-E7njAfpiXRz0iTzcJye7N-fX06kDiab-QdDnWtfA</recordid><startdate>20170301</startdate><enddate>20170301</enddate><creator>Stephenson, Mary D., M.D., M.Sc</creator><creator>McQueen, Dana, M.D., M.A.S</creator><creator>Winter, Michelle, M.D</creator><creator>Kliman, Harvey J., M.D., Ph.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2151-7071</orcidid><orcidid>https://orcid.org/0000-0003-0162-1637</orcidid></search><sort><creationdate>20170301</creationdate><title>Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss</title><author>Stephenson, Mary D., M.D., M.Sc ; McQueen, Dana, M.D., M.A.S ; Winter, Michelle, M.D ; Kliman, Harvey J., M.D., Ph.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3949-66739165163f82376a5bb8c50cdaaf3219c76b4524d53efc94ccf03281a84d743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abortion, Habitual - diagnosis</topic><topic>Abortion, Habitual - physiopathology</topic><topic>Abortion, Habitual - prevention & control</topic><topic>Administration, Intravaginal</topic><topic>Adult</topic><topic>cyclin E</topic><topic>Cyclin E - metabolism</topic><topic>Drug Compounding</topic><topic>endometrium</topic><topic>Endometrium - drug effects</topic><topic>Endometrium - metabolism</topic><topic>Endometrium - physiopathology</topic><topic>Female</topic><topic>Fertility Agents, Female - administration & dosage</topic><topic>Fertility Agents, Female - adverse effects</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Luteal Phase - drug effects</topic><topic>Luteal Phase - metabolism</topic><topic>Obstetrics and Gynecology</topic><topic>Pregnancy</topic><topic>progesterone</topic><topic>Progesterone - administration & dosage</topic><topic>Progesterone - adverse effects</topic><topic>Prospective Studies</topic><topic>recurrent miscarriage</topic><topic>Recurrent pregnancy loss</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stephenson, Mary D., M.D., M.Sc</creatorcontrib><creatorcontrib>McQueen, Dana, M.D., M.A.S</creatorcontrib><creatorcontrib>Winter, Michelle, M.D</creatorcontrib><creatorcontrib>Kliman, Harvey J., M.D., Ph.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Fertility and sterility</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stephenson, Mary D., M.D., M.Sc</au><au>McQueen, Dana, M.D., M.A.S</au><au>Winter, Michelle, M.D</au><au>Kliman, Harvey J., M.D., Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss</atitle><jtitle>Fertility and sterility</jtitle><addtitle>Fertil Steril</addtitle><date>2017-03-01</date><risdate>2017</risdate><volume>107</volume><issue>3</issue><spage>684</spage><epage>690.e2</epage><pages>684-690.e2</pages><issn>0015-0282</issn><eissn>1556-5653</eissn><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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28081870</pmid><doi>10.1016/j.fertnstert.2016.11.029</doi><orcidid>https://orcid.org/0000-0002-2151-7071</orcidid><orcidid>https://orcid.org/0000-0003-0162-1637</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Abortion, Habitual - diagnosis Abortion, Habitual - physiopathology Abortion, Habitual - prevention & control Administration, Intravaginal Adult cyclin E Cyclin E - metabolism Drug Compounding endometrium Endometrium - drug effects Endometrium - metabolism Endometrium - physiopathology Female Fertility Agents, Female - administration & dosage Fertility Agents, Female - adverse effects Humans Internal Medicine Luteal Phase - drug effects Luteal Phase - metabolism Obstetrics and Gynecology Pregnancy progesterone Progesterone - administration & dosage Progesterone - adverse effects Prospective Studies recurrent miscarriage Recurrent pregnancy loss Treatment Outcome |
| title | Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss |
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