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Progestogens and Recurrent Miscarriage

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Progestogens in Obstetrics and Gynecology

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Abstract

Recurrent miscarriage is defined as loss of three or more consecutive pregnancies by Royal College of Obstetricians & Gynaecologists (RCOG, Green Top Guideline No. 17, 2011) and loss of two or more pregnancies by The European Society of Human Reproduction and Embryology (ESHRE, Recurrent Pregnancy Loss Guideline, 2017). Recurrent miscarriage affects approximately 1% of couples. Aetiology can be varied and in many cases the cause remains unexplained. Progestogen supplementation has been used for more than half a century for the treatment of recurrent miscarriage in different doses and routes of administration. Progesterone activity is mediated via specific progesterone receptors and is considered crucial for the development of an endometrial environment suitable for implantation. Progesterone regulates endometrial receptivity and induces uterine quiescence. In addition, the immunomodulatory properties of progesterone, controlled by progesterone induced blocking factor (PIBF), also seem to be important for the maintenance of early pregnancy. In women with RM there may be a degree of immunological intolerance, progesterone may benefit these women by altering the immune response to the embryo. Despite multiple favourable meta-analyses on the use of progestogens in RM, further evidence is being deemed necessary. This is the second edition of the chapter and all the studies published since 2015 have been reviewed and added to this chapter.

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Authors and Affiliations

  1. Genesis Fertility and Laparoscopy Centre, Hyderabad, India

    Narmada Katakam

  2. Manchester Metropolitan University, Manchester, UK

    Luciano G. Nardo

  3. Reproductive Health Group, Centre for Reproductive Health, Cheshire, UK

    Luciano G. Nardo

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  1. Narmada Katakam
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Correspondence to Luciano G. Nardo .

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Editors and Affiliations

  1. Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Howard J.A. Carp

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Katakam, N., Nardo, L.G. (2021). Progestogens and Recurrent Miscarriage. In: Carp, H.J. (eds) Progestogens in Obstetrics and Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-030-52508-8_5

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