Oral micronized progesterone versus human menopausal gonadotropins for the treatment of repeated early pregnancy loss due to luteal phase insufficiency

Abstract

Objective: Luteal phase insufficiency (LPI) is an important cause of repeated early pregnancy loss (REPL). The condition has traditionally been treated with progesterone supplementation during the luteal phase with varying degrees of success. An alternative approach to increase the plasma progesterone concentration during the luteal phase is proper ovulation induction in these patients. The aim of this work was to compare human menopausal gonadotrophin (hMG) stimulation to luteal phase progesterone supplementation in the treatment of patients with REPL due to LPI. Design: A group of patients with repeated early pregnancy loss due to luteal phase insufficiency (midluteal plasma progesterone of <10 ng/mL were treated with hMG therapy for 3 cycles. They were matched to a similar number of patients with the same condition treated with micronized progesterone supplementation for 3 cycles. The patients were matched for age, body mass index and number of miscarriages. The end points were the occurrence of pregnancy as well as the miscarriage rate. Materials/Methods: We have studied 72 patients with a history of 3 or more first trimester abortions confirmed by ultrasound or histopathology. All patients had a midluteal plasma progesterone concentration of less than 10 ng/ml. They were divided into 2 groups, each group consisting of 36 patients. The patients were matched for age, body mass index and number of miscarriages. Patients belonging to the first group (group A) were treated with hMG, while patients belonging to the second group (group B) were treated with micronised progesterone 400 mg/day starting on day 14 of the cycle until 14 weeks of pregnancy or until menstruation had started. The treatment was repeated for 3 cycles. Results: The mean (+/−) midluteal plasma progesterone concentration increased from 7.26 (+/−6.00) to 34.74 (+/−17.93) ng/mL in group A (p <0.0001) and from 6.61 (+/−6.61) to 20.91 (+/−7.52) ng/mL in group B (p <0.001). Thirty pregnancies resulted: 20 in group A (55.6%) and 10 in group B (27.8%). Three patients from group A (15%) and 5 patients from group B (50%) miscarried before 12 weeks, while the rest of the patients in both groups continued beyond 14 weeks. The differences between both groups in pregnancy rates (p <0.02) and in miscarriage rates (p <0.05) are statistically significant. Conclusions: It is concluded that hMG is superior to luteal phase supplementation with oral micronized progesterone in the treatment of patients with repeated early pregnancy loss due to LPI. Supported by: Alexandria Fertility Center.