You can’t beat this cure-all for recurrent miscarriages, but 90% of surrogate moms use it wrong!
This article is about progesterone, whether it is injection progesterone, vaginal micronized progesterone, or dextroprogesterone, their role is to provide luteal support.
Surrogate mothers are missing them whether they have an early miscarriage, or recurrent miscarriages for birth control.
Many traditional doctors will prescribe progesterone if they see a surrogate mother in any condition, such as bleeding, low progesterone, or stomach pain, and progesterone must be the first to go.
So is progesterone a placebo or does it really work like a million bucks? This side of the article is to understand this very familiar but may you hear and feel strange drug – progesterone.
01 Progesterone is low, supplemental progesterone really works?
Many surrogate mothers may have encountered such a situation, just pregnant found vaginal bleeding, went to the hospital to do a round of tests, only progesterone is low.
Seeing such a result, many doctors will suggest that surrogate mothers take dextroprogesterone or progesterone to protect the fetus.
In fact, in the actual clinical situation, there are many such cases, pregnancy bleeding, check the blood results of progesterone is very low, but HCG value is very normal. The blood is drawn again to check the progesterone, and the result of the retest is often normal again.
Due to the instability of progesterone and the different methods of examination, there will often be a deviation in the results of the phenomenon, so the general surrogate mother’s early pregnancy test needs to be combined with progesterone HCG together.
If only the progesterone is low and HCG is normal, it is most likely a checking error and should be rechecked or based on HCG results.
Progesterone is produced because of HCG stimulation, so as long as HCG doubles normally, low progesterone levels may just be an artifact.
Therefore, low progesterone levels are not the cause of the miscarriage, but more likely due to the miscarriage, low progesterone is just the result of the miscarriage, and simply supplementing with progesterone will not work without addressing the underlying problem.
It should be noted that progesterone supplementation can still play a role in preserving the fetus, but the point of action does not lie in supplementing progesterone levels, but in the following aspects.
02 Mediating Gestational Immunity to Promote Maternal-Fetal Tolerance in Surrogate Mothers
Earlier studies have suggested that progesterone can promote the production of progesterone-induced closure factors through activation of maternal lymphocytes, thereby decreasing NK cell activity, promoting Th2 shift and increasing the number of asymmetric antibodies, and ultimately exerting an anti-miscarriage effect.
There is evidence that Th2-type cytokines predominate in normal gestational surrogate mothers, and that patients with miscarriage and preterm labor have significantly lower levels of closure factors than normal gestational surrogate mothers.
If progesterone is insufficient to stimulate lymphocyte production of closed factor, increased expression of Th1-type cytokines can lead to pregnancy failure.
Studies on peripheral blood mononuclear cells of surrogate mothers with recurrent miscarriages have shown that progesterone can directly inhibit the production of Th1 cytokines IFN-g and TNF-α by lymphocytes, and up-regulate the production of Th2 cytokines IL-4 and IL-6, leading to a shift from Th1 to Th2 cytokines, thus regulating the Th1/Th2 balance.
03 Increased endothelial perfusion
Previous studies have suggested that patients with recurrent miscarriage have significantly higher uterine artery resistance and significantly lower subendothelial vascular flow and flow indices than controls.
Nitric oxide levels in the blood can increase blood flow and decrease uterine artery resistance to blood flow.
In the human umbilical vein endothelial cell model, diazepam significantly increased endothelial nitric oxide production and endothelial nitric oxide synthase activity.
This suggests that diazepam may play a pregnancy-protective role by inducing endothelial cell nitric oxide production and increasing uterine blood flow.
04 Inhibition of uterine contractions
The direct cause of embryonic miscarriage is uterine contraction, and studies have shown that dextrogestrel inhibits high potassium and oxytocin-induced uterine smooth muscle contractions.
An in vitro study using the uterine smooth muscle of pregnant rats as a test specimen showed that the inhibitory effect of dextrogestrel on oxytocin-induced uterine smooth muscle contractions was not affected by mifepristone.
In other words, dydrogesterone maintains uterine myometrium quiescent through multiple synergistic mechanisms that rapidly and directly inhibit uterine smooth muscle contraction, and oxytocic medications do not influence the onset of this effect.
During IVF, surrogate mothers undergoing fresh embryo transfer are often faced with a hyperestrogenic endometrial environment, which can lead to myometrial hyperexcitability, which can be detrimental to embryo implantation.
Deferiprone, through several synergistic mechanisms, can maintain the myometrium quiescent and promote embryo implantation in a restful environment.
05 Improvement of endometrial tolerance in surrogate mothers
The endometrial tolerance of the surrogate mother is the key to embryo implantation, and the number of cytoplasmic primordia is an important symbol of tolerance.
The formation of cytoplasmic protrusions is very dependent on progesterone, and their expression is highly correlated with the level of progesterone; the higher the level of progesterone, the more abundant the cytoplasmic protrusions.
Progesterone supplementation can modulate the appearance of cytoplasmic primordia, further regulating endometrial tolerance and clinical pregnancy, and reducing the incidence of pregnancy loss.
In a clinical study of patients with polycystic ovary syndrome, pretreatment with oral dextroprogesterone in the cycle before ovulation combined with dextroprogesterone luteal support therapy after ovulation in the current cycle increased intrauterine content receptivity to improve pregnancy outcomes in patients.
06 Discontinuation time for progesterone supplementation
Progesterone supplementation does not have to be maintained until the end of pregnancy, but needs to be discontinued at the appropriate time. In general, patients with early recurrent miscarriages generally require luteal support until 12-16 weeks of gestation.
In the most conservative cases, the medication should be used until 1-2 weeks after the gestational week of the last miscarriage.
If you have a history of late recurrent miscarriage in your case, then you will need to be medicated until at least 28 weeks of gestation.
However, during this period if you have not been showing signs of preterm miscarriage and your ultrasound is normal, you can also stop the medication at the appropriate time, but you should still keep a watchful eye on it.
