Progesterone and Miscarriage: Can Progesterone Supplementation Prevent Miscarriage?

Double board certified OBGYN and REI, Dr. Natalie Crawford, discusses progesterone supplementation for those with recurrent pregnancy loss. This is a complicated topic and a lot of it has to do with timing and medical history.

Questions answered:
What happens in the luteal phase?
Why is the corpus luteum so important?
What is the importance of progesterone?
What do studies say about supplementing progesterone to prevent miscarriage?
When is the best time to start supplementing progesterone?

Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, Gupta P, Dawood F, Koot YE, Atik RB, Bloemenkamp KW, Brady R, Briley A, Cavallaro R, Cheong YC, Chu J, Eapen A, Essex H, Ewies A, Hoek A, Kaaijk EM, Koks CA, Li TC, MacLean M, Mol BW, Moore J, Parrott S, Ross JA, Sharpe L, Stewart J, Trépel D, Vaithilingam N, Farquharson RG, Kilby MD, Khalaf Y, Goddijn M, Regan L, Rai R. PROMISE: first-trimester progesterone therapy in women with a history of unexplained recurrent miscarriages - a randomised, double-blind, placebo-controlled, international multicentre trial and economic evaluation. Health Technol Assess. 2016 May;20(41):1-92. doi: 10.3310/hta20410. PMID: 27225013; PMCID: PMC4904188.

Coomarasamy A, Harb HM, Devall AJ, Cheed V, Roberts TE, Goranitis I, Ogwulu CB, Williams HM, Gallos ID, Eapen A, Daniels JP, Ahmed A, Bender-Atik R, Bhatia K, Bottomley C, Brewin J, Choudhary M, Crosfill F, Deb S, Duncan WC, Ewer A, Hinshaw K, Holland T, Izzat F, Johns J, Lumsden MA, Manda P, Norman JE, Nunes N, Overton CE, Kriedt K, Quenby S, Rao S, Ross J, Shahid A, Underwood M, Vaithilingham N, Watkins L, Wykes C, Horne AW, Jurkovic D, Middleton LJ. Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT. Health Technol Assess. 2020 Jun;24(33):1-70. doi: 10.3310/hta24330. PMID: 32609084; PMCID: PMC7355406.

McLindon LA, James G, Beckmann MM, Bertolone J, Mahomed K, Vane M, Baker T, Gleed M, Grey S, Tettamanzi L, Mol BWJ, Li W. Progesterone for women with threatened miscarriage (STOP trial): a placebo-controlled randomized clinical trial. Hum Reprod. 2023 Apr 3;38(4):560-568. doi: 10.1093/humrep/dead029. PMID: 36806843; PMCID: PMC10069850.

#progesterone #recurrentpregnancyloss
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Fertility doctor, Natalie Crawford, MD is a double board certified OBGYN and REI, and co-founder of Fora Fertility, a boutique fertility practice in Austin, Texas.

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Sharing fertility facts to educate women about trying to conceive, getting pregnant, ovulation, fertility treatments, IUI, IVF, becoming a doctor, life as a woman in medicine, and more.

[eveharris]

After years of infertility and miscarriages, my doctor prescribed progesterone after confirmation due to spotting. Sadly, I lost those twins at the end of 1st trimester. A couple years later, I conceived again and remember feeling implantation. Same stabby pain as ovulation. I decided to take progesterone immediately and not wait for a positive test. After so many losses, I was finally able to stay pregnant. I also have thyroid issues and other autoimmune conditions that perhaps was making it impossible for me to stay pregnant. I learned and leaned so much on YT during the trials of infertility and hope this comment can help someone.

[emilypoole]

Thank you for this info- I've have four losses (3 chemical, one 19 week), and lots of first trimester bleeding in my live births. After watching this, I quickly notified my OBGYN, and she agrees! So we're starting progesterone after my next ovulation, which will be our first month TTC after our 19 week loss in February. I'm feeling pretty optimistic, educated, and excited about these coming months!

[erinbelmont]

I had two miscarriages back to back within a few months of one another. One at 6 weeks and one at 8 weeks. Currently 8 weeks pregnant and taking progesterone and everything seems to be going well!

[namechoosingissilly]

I had three early term miscarriages then finally a full term pregnancy after starting progesterone after ovulation. When we decided to try for another baby I started on progesterone after ovulation and when we got pregnant it stuck. Maybe it helped, maybe it didn’t, but I wasn’t risking not taking it the second time. Turns out I also have a unicornuate uterus but I don’t believe that should matter… And I don’t think I’ve ever measured ‘low’ on a progesterone levels test. Pregnancy is such a crazy process.

[LetsBeHealthy_]

@natalie crawford, Wow, what an incredible video! 🌟
Your talent and passion shine through every frame, and I'm in awe of the effort and creativity you put into this. It's evident that you pour your heart and soul into your content, and it truly shows. Nice one.

[kaitlynlowery]

It has helped me very much, but that’s because I used to get overly stressed and it would usually cause miscarriages. But since starting progesterone it’s been great.

[natalieshevchenko]

Can you please elaborate on the possible risks for the baby and the mom when taking progesterone in early pregnancy? Also the difference between synthetic and natural progesterone pills

[OksanaNovozilova]

This was so very useful, thank you very much, Natalie ❤

[lexiereder]

I heard you say that you should start taking vaginal suppository twice a day of progesterone on day three after ovulation but I didn't see where you said how many days to do this for. Thanks so much for sharing this info! Lots of respect for you ❤

[GoldenAngel-]

I also had 2 miscarriages now I'm taking this 😢as I'm currently pregnant

[sandracoelho]

As always great info backed by scientific evidence! My question for you: your opinion on progesterone intake in case of spotting before period? No evidence of endometriosis, PCOS, uterine polyps, etc.. Thank you

[impactfully]

Great information. Thank you so much for sharing 👏

[t.i.f.f.a.n.y_m]

Thanks always for your content. I'm on progesterone and about 5.5 weeks pregnant. My HCG levels aren't doubling every couple days, but increasing 75-80%. It's got me in my feelings. I've been trying to stay emotionally neutral and not fully consider myself pregnant until I hear a heartbeat in a few weeks. Any videos on HCG levels?

[jessicalumbard]

This is so incredibly helpful! My mother had 3 miscarriages and the only two live births she had were because she started taking the left over progesterone from her previous miscarriages as soon as she found out she was pregnant. My husband and I are going to start trying to conceive here soon and I have been trying to get into the doctor to ask if this is something I should be concerned about but I can’t be seen until I get a consult from my primary care, and their first appointment isn’t for another month.😅 so it’ll probably be 2 months before I can ask these questions. (Military healthcare 🙄) I’ll definitely be looking up these studies to read up on them!

Do you know if there is any evidence of a genetic factor is progesterone issues?

Thanks!!

[tammycalhoun]

I have a bit of ER situation, hoping to help my daughter. I had a history of low progesterone myself and suffered 5 miscarriages. My first daughter made it but I did have some spotting each time. My period might have happened then all the pregnancies after that kept mishearing and the OB I went to kept telling me at each miscarriage. The statistics are six out of 10 pregnancies and the miscarriage. It got to the point where I finally asked him if he knew how many times he had actually said that to me. And also common thing I would hear is well you know there’s probably something wrong with the baby blah blah blah. So then the door closed on that OB when I found myself pregnant again, fortunately opened up on another back then had some knowledge about this whole progesterone thing and immediately had my serum progesterone checked, which I had was at 12.3. The daughter that I’m talking about is that pregnancy and I believed it was because of him that I finally got my second child those seventh pregnancy. I was able to have two other children after that while taking progesterone and having my levels checked regularly. My last child that I did this thing routine I gave birth to naturally at the age of 42. my daughter who is now 25 almost 26 is now on this little roller coaster of low progesterone but the OB is saying that it’s not a problem. Last Tuesday she went from an 11.5 and by Friday was 7.1 to me that is too low. She had a sonogram yesterday that showed that she is seven weeks pregnant though she thought she would be about four days ahead of that, I don’t know if that’s a problem or not. The doctor also explain that a study has recently come out where they had a control group. Some women who took progesterone some who did not through the pregnancy and had comparable levels of progesterone throughout the pregnancy and it did not make a difference at all for those who were taking the progesterone and those who did not take it. Immediately told her that I wasn’t, but that I was a study all by myself and that every pregnancy I have where I did not have progesterone for my low levels did not make it and those that I did have progesterone for for those levels made it. Needless to say, I am very upset right now though my daughter seems to be doing OK. We told her that we will pay out-of-pocket if we have to and then she clarified that there is a very high price for even vaginal suppository is $100 a pop according to her. I’m still waiting to hear what my daughter‘s bloodwork was yesterday and to see if the doctor will at least prescribe the progesterone. My daughter is concerned about it, but this doctor put her at ease that she’s not too concerned I am the opposite. I am not at ease and I do not want my daughter to go through something I did, when it can be prevented, I believe. Also 26 years ago when I was on progesterone to have her, I got my progesterone from a natural store that made the compound themselves. This doctor is telling me that we can get this at a local Walgreens if she sends the prescription which I have never heard of a chain like Walgreens doing compounds like this. Otherwise, the doctor seem very knowledgeable, but I do wonder if you have heard of the study at all and are know anything about it. Apparently the insurance companies don’t want to cover it now that the study has come out. I think this is going to have a very significant impact on women who like me, and now my daughter have trouble producing the progesterone themselves.

[yanasosnovskaya]

thank you so much explaining it from studies perspective and science !

[jessicamcneil]

Has any difference been seen with taking oral progesterone vs. vaginal progesterone?

[Genok]

What about with smaller dose of progesterone? My doctor has me starting on just 200mg at positive test. Would this make a difference at all? It's half of the 400 mg you mentioned in the studies.

[nicole]

When I mentioned this to my doctor she said I don’t need to take progesterone because I’m able to get pregnant. However I’ve had 3 miscarriages. 1 chemical and 2 missed miscarriages. Not sure if I should listen to this doctor or get a different doctor.

[heathersparkles]

If an embryo is abnormal, will progesterone supplements prevent it from miscarrying?