title: Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss.
abstract: OBJECTIVE
  To assess the effectiveness of luteal start vaginal micronized P in a recurrent pregnancy loss (RPL) cohort.
  
  
  METHODS
  Observational cohort study using prospectively collected data.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Pregnancy success was an ongoing pregnancy >10 weeks in size.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Illinois Recurrent Pregnancy Loss Program, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois; University of Chicago, Chicago, Illinois. Electronic address: msteph@uic.edu.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Stephenson
authors.affiliation: University of Illinois Recurrent Pregnancy Loss Program, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Dana
authors.initials: D
authors.lastname: McQueen
authors.affiliation: University of Chicago, Chicago, Illinois.
authors.forename: Michelle
authors.initials: M
authors.lastname: Winter
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Reproductive and Placental Research Unit, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Kliman
mesh_terms: D000026:Abortion, Habitual / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D000282:Administration, Intravaginal; D000328:Adult; D019927:Cyclin E / Q000378:metabolism; D004339:Drug Compounding; D004717:Endometrium / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects* / Q000378:metabolism; D011247:Pregnancy; D011374:Progesterone / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D019927:Cyclin E; D005300:Fertility Agents, Female; D011374:Progesterone
keywords: Recurrent pregnancy loss; cyclin E; endometrium; progesterone; recurrent miscarriage