Does first trimester progesterone prophylaxis increase the live birth rate in women with unexplained recurrent miscarriages?

doi:10.1136/bmj.d1914

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Arri Coomarasamy, clinical reader and consultant in reproductive medicine and gynaecology1,
Ewa G Truchanowicz, PROMISE trial coordinator1,
Raj Rai, senior clinical lecturer and consultant in obstetrics and gynaecology2

¹School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
²Department of Surgery and Cancer, Obstetrics and Gynaecology, Imperial College London, London W2 1TG, UK

Correspondence to: Dr A Coomarasamy, Academic Unit (University of Birmingham), Birmingham Women’s Foundation Trust, Birmingham B15 2TG a.coomarasamy{at}bham.ac.uk

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: all authors hold a grant from the Health Technology Assessment programme (NIHR, HTA 08/38/01) for the PROMISE trial (ISRCTN 92644181); no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Miscarriage is the commonest complication of pregnancy, occuring in one in six clinically recognised pregnancies.1 Recurrent miscarriage is the loss of three or more consecutive pregnancies. Women with recurrent miscarriage (in contrast to women with sporadic miscarriage) tend to lose genetically normal pregnancies.1 After comprehensive investigation, a cause for recurrent miscarriage is identified in less than half of couples.1 Most couples are therefore labelled as having unexplained recurrent miscarriage.

Progesterone, secreted by the corpus luteum and the placenta, has a central role in maintaining a pregnancy.1 It is theoretically plausible that progesterone supplementation may reduce the risk of miscarriage in women with a history of recurrent miscarriages, and the first trial using progesterone for such women was published in the BMJ in 1953.2 This …