Role of Progesterone in Preventing Recurrent Abortions

Published in Panorama



The Role of Progesterone in Preventing Recurrent Abortions


Recurrent or habitual abortions are affecting 1% of women in any general population today. This means, these women will have three spontaneous miscarriages in a row, says Dr.Nasser El Beih , Consultant Gynaecologist and Obstetrician, Zulekha Hospital, Sharjah. “It is obvious these women will need investigations before they can become pregnant again and the problem is compounded by the fact that when you investigate them fully, only in 50% of cases, are we able to identify the cause for the recurrent abortions. Which means you are left with a big proportion of women whom you want to help but cannot. However, recent researches suggest that these women could have some form of progesterone deficiency, contributing to habitual abortions.”

Is it that some categories of women are prone to abortions? Who are these women and what are the factors contributing to abortions? A variety of factors are responsible for abortions, explains Dr.Ulrich Honemeyer, Specialist in Gynaecology and Obstetrics, Welcare Hospital. “Chromosomal anomalies are known to be the single most common cause of spontaneous abortion. There are many unrecognized chromosomal disorders which are not hereditary. They occur in the early cell division of the fertilized eggs and the earlier they happen, the more severe they are, their consequences for all the following cell divisions. This is a self defense of nature to abort a damaged organism. This is what happens in a very high number of very early abortions, which means, these abortions hardly go over the menstruation period. That is, the menstruation may be a little late in appearing and may occur more severe than normal – but in reality, it may be an abortion!”

Elaborating on other factors involved in abortions, Dr.Honemeyer explains, “There are cases of viral infection or infections which are known to be responsible for causing abortions. The symptoms of the infection which the mother suffers, may not be so severe, yet it will cause too much harm to the embryo and induce an abortion. However, in such cases, it can be traced back by taking a sample of the mother’s blood for analysis and identifying the antibody situation and thereby trace the abortion-inducing infection.”

In addition to chromosomal abnormalities and infections, malfunctioning immunological system of the mother, may lead to abortions, explain the doctors. Dr.Honemeyer explains, “Pregnancy is a very special situation for the body. Normally we do not tolerate tissue which is different from our own body’s tissue; we reject this tissue. The pregnant mother has to suppress the rejecting impulses of her own body against this embryo. Nevertheless, the rejection can happen. One such factor contributing to this phenomenon is the Antiphospholipid Antibody Syndrome. So, if we have someone with recurrent abortions, we will definitely not forget to check on this problem.”

Emphasizing the immunological malfunction, Dr.Nasser explains, “We must appreciate that 50% of the foetus is from the father and hence this problem with the mother’s immune system which rejects the foetus. This is where progesterone has been shown to play a crucial role in enabling the mother’s immune system to accept this ‘foreign’ body. In the presence of progesterone, lymphocytes in the blood plasma of the pregnant women, produce an immunomodulatory protein known as progesterone induced blocking factor (PIBF). PIBF mediates the immunomodulatory and anti-abortive effects of progesterone and thus helps successful pregnancy. So if there is deficiency of progesterone in the pregnant women, progesterone supplements can be given and pregnancy can be successfully carried to term.”

Dr.Nasser once again emphasizes the core issue with respect to progesterone in averting abortions, “Unfortunately, a number of studies which have tried to correlate the link between progesterone deficiency and habitual abortions, have included chromosomally abnormal babies in their studies. And a chromosomal abnormality cannot be corrected by any medication once the embryo has been created. So giving progesterone supplements to these women carrying chromosomally abnormal babies, will be useless! Therefore, ideally, to show the positive correlation between progesterone deficiency and habitual abortions, it is absolutely necessary that studies should consider a large number of women, aborting chromosomally normal babies, who when given progesterone supplements, to on to deliver successfully.”

Another contributory factor to habitual abortion involves abnormalities of the uterine cavity, which may be corrected by hysteroscopic surgery, adds Dr.Honemeyer. Dr.Nasser elaborates, “There may be anatomical problems in the woman’s reproductive system where the cavity of the womb may not be big enough to accommodate the growing baby.”

Dr.Nasser adds, “The tendency to abort also occurs in women who have a blood-protein or platelet defect leading to hypercoagulability and thrombosis. Also, women who have medical conditions like diabetes, thyroid disorders, endocrinological problems like polycystic ovaries, may be prone to abort.”

In recent times, the chief cause of recurrent abortions or early loss of pregnancy, is attributed to luteal phase failure resulting in a deficiency of progesterone, the pregnancy enhancing hormone. Dr.Nasser explains, “The corpus luteum of the ovary is responsible for producing progesterone. Progesterone performs certain important functions including stimulating the growth of a smooth lining in the uterus for the fertilized egg to grow and develop and generally maintain pregnancy. Progesterone is not only essential for conception but also imperative for the survival of the fertilized egg and the foetus throughout gestation.

Progesterone is produced from the Corpus luteum of the ovary for the first 12 weeks of pregnancy and then by the placenta. However, if during any of these phases, progesterone is not produced in sufficient quantities, the woman can abort.”

Dr.Nasser opines that spontaneous abortion rates are positively correlated with advancing maternal age. Explaining this phenomenon, Dr.Honemeyer reveals, “It is actually that the chance of becoming pregnant is lower with advancing maternal age. Also, when the pregnant woman is over 35 years of age, there is a little higher risk for chromosomal abnormalities; of course, there are certain chromosomal abnormalities which do not go along with normal pregnancy and will lead to an abortion.”

What is the kind of help that these women can be given?
Dr.Honemeyer elucidates, “Where the cause can be traced to immunological problems, we may give immune globulins to take care of the situation until about 6-7 weeks of pregnancy. For women showing Antiphospholipid Antibody Syndrome, we may give low dose aspirin, about 75 mg a day, from the beginning of the pregnancy until 32 weeks. This low dose of aspirin will not have any adverse or harmful effect on the foetus. Low dose Heparin, also helps women who have the blood-protein or platelet defect which causes hypercoagulability and thrombosis.”

Progesterone supplements as injections, tablets, suppositories or creams should be given where the cause is identified possibly as arising due to its deficiency, say the doctors.

Dr.Honemeyer adds, “If I have a patient who had lost an earlier pregnancy, then I will, as a routine, give her progesterone supplement. Progesterone is a natural substance and there is no risk or harm that it can cause, either to the mother or to the growing foetus. It may increase a few undesirable symptoms of pregnancy in the mother as nausea and sleepy too. We do not want to miss that percentage in which an abortion might be due to a corpus luteum insufficiency. So we do advocate progesterone supplements for women who have already had an abortion at least once, and to those pregnant women who develop symptoms of imminent abortion like vaginal bleeding.”

On a reassuring note, Dr.Honemeyer reveals, “One is none. One abortion does not reduce their chance for another fine and uncomplicated pregnancy at all. But the risk group are those who abort twice. It is very important that these patients go in for genetic counseling before they decide to go in for another conception. They require complete evaluation by a specialist in genetics.

Dr.Honemeyer emphasizes, “Above all this, one of the most important aspect in dealing with the situation is providing loving care to these patients. That is why, we recommend that these patients with 2 or 3 abortions in a row, be hospitalized when they are pregnant again, as it is proved by scientific studies that hospitalization of patients with recurrent abortions is one of the most effective tools in the treatment of the problem.”


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