Should I Take Progesterone After a Second Miscarriage?

I am 27-years-old and just had my second miscarriage. Both miscarriages occurred in the first trimester. My doctor and I discussed trying progesterone with the next pregnancy. He also suggested we wait a few months to try and conceive this time. What do you think?

Question:

The use of progesterone is controversial. If you have not been tested to see if your progesterone level is low, then some would argue that you shouldn't try progesterone because you may not need it. And the odds of you having a progesterone deficiency is relatively low.

On the other hand, the risk of using progesterone appears to be low (if any) and the ability to tell for sure with any one cycle whether the progesterone will be low is limited. In my opinion, it is a reasonable course of action to try it. There are relatively new natural progesterone pills available now.

In some studies, there appears to be a slight increase in the risk of recurrent miscarriage after you have had one, but the increased risk is small. This holds true -- even up to the third miscarriage.

We generally tell patients to wait about three months before trying again on the theory that the lining of the uterus needs to return to normal. There is a little evidence that there may be a slightly increased risk for recurrent miscarriage within one to two months of a prior one, but this has not been well-studied.

The good news is that your chances of having a successful pregnancy are good; the bad news is you may have to try more times than you want to (like you already have) before you get there. If you have another miscarriage, you need chromosome studies and antiphospholipid antibody studies, as well as a look inside your uterus for abnormal shapes to the uterine cavity. While the chances that they will find these problems are small, they would change the approach for treatment with subsequent pregnancies.

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