Miscarriage Prevention/ Early Pregnancy Loss

The IIRRM believes that every woman who suffers through a miscarriage or early pregnancy loss deserves medical assessment and intervention to minimize her risks of experiencing another. We disagree with the common medical advice to wait until the 3rd loss before any evaluation. 1 Often parents affected are told that the loss is ‘genetic’, though research suggests that abnormal chromosomes in the embryo may explain only 50 – 60% of miscarriages2; tests on the miscarried embryo are rarely performed3.

Various menstrual or fertility charting indicators have been associated with an increased risk of miscarriage. This includes short luteal phase and brown spotting. Further, low progesterone and/or estrogen levels 7 days after ovulation suggest poor luteal phase hormones, likely impaired quality of ovulation, and an increased risk of miscarriage. More research needs to be done and published on these findings, but sufficient data exists to consider these possibilities clinically.4

Various menstrual or fertility charting indicators have been associated with an increased risk of miscarriage. This includes short luteal phase and brown spotting. Further, low progesterone and/or estrogen levels 7 days after ovulation suggest poor luteal phase hormones, likely impaired quality of ovulation, and an increased risk of miscarriage. More research needs to be done and published on these findings, but sufficient data exists to consider these possibilities clinically.5

Supplementing progesterone or other hormones in pregnancy used to be controversial, but is now standard care in many countries and for many situations.6 It has been suggested to reduce the risk of pregnancy loss in a meta-analysis7 for women with multiple miscarriages, although not all studies confirmed this. It is likely that there are common abnormalities that may contribute to why providing progesterone in pregnancy may be helpful. In the studies, there were not specific diagnoses or monitoring of the patients’ blood hormone levels except for their history of recurrent miscarriage. A recent randomized trial suggests that progesterone is most likely to be helpful when supplementation is started in the luteal (postovulatory) phase of the menstrual cycle, prior to a positive pregnancy test8.

Many RRM providers give natural hormone replacement to bring progesterone and/or estrogen levels in the luteal phase into an optimal range. They also often identify abnormal progesterone levels during pregnancy according to a normal curve related to gestational age in healthy pregnancy, developed by the National Center for Women’s Health: National Hormone Lab in Omaha and treat those with abnormal levels and risk factors, to normalize their levels.9

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Normalizing reproductive hormone levels during the luteal phase and during pregnancy will not prevent all miscarriages, but for those women for whom their pregnancy losses are a preventable hormone deficiency, it may reduce the risk of miscarriage. This type of treatment is available with most RRM physicians. Progesterone affects the immune system and may also work for some immune related conditions contributing to pregnancy loss. Treatment and normalization of other hormonal levels is also a treatment offered by some RRM physicians.