QuestionHello,
I am a 33 year old healthy female. My first pregnancy last year ended in miscarriage at 7 weeks. I did not require a D&C. I was told by my OB that I can start trying right away and I got pregnant again right after. I did not have a period in b/w the miscarriage and 2nd pregnancy. The second pregnancy ended in miscarriage at 4-5 weeks. I had a w/u which included normal estradiol,FSH at day 3 of my cycle and then normal progesterone day 21 cycle along with normal thyroid and no autoimmune etiology. A hysterosalpingogram was normal. I did not have karyotyping performed yet(mine or husband's done yet).
We are going to start trying to conceive again soon. I have had 2 normal cycles. I was given an rx for Crinone, but it was not covered by insurance so I was given an rx for compounded Progesterone intravaginal tablets 25 mg QD. I called the OB to verify the dose b/c I thought upwards of 200 mg QD were used for recurrent miscarriage, but he said that was the traditional intravaginal dosing used. I understand that the bioavailability of oral progesterone is much less so higher doses need to be used, but is the 25 mg QD compounded enough? I do not have a "luteal phase defect" per se or low progesterone, but I asked to try the progesterone b/c I felt it would not hurt even though the evidence based data for recurrent miscarriage is lacking.
Thank you in advance!
AnswerHello Maggie from the U.S. (Massachusetts),
25 mg vaginally is not sufficient. The vaginal tablet that has been approved by the FDA specifically for infertility/luteal phase support is the same compound as the oral progesterone and is 100 mg. We (infertility specialists) recommend 1 tablet 3 times per day for a total dose of 300 mg per day of the vaginal tablet. Crinone 8% is only once per day because it is a concentrated formulation specifically for the vagina. There is no equivalent for it.
I might also advise that you take a low dose aspirin tablet (81 mg) per day to help with endometrial blood flow.
The good news is that most patients that have recurrent miscarriages are eventually successful and two miscarriages is not enough times to give you the diagnosis of recurrent pregnant loss.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf. I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal. If interested, contact me via my email at info@montereybayivf.com. This service will allow you to have your own personal on-demand infertility expert
