Progesterone supplementation in women with otherwise unexplained recurrent miscarriages

Hussain, Munawar; El-Hakim, Samawal; Cahill, David J

doi:10.4103/0974-1208.106335

Cited by 26 publications

(20 citation statements)

References 19 publications

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“…Indeed, as expected, 116 implantation rate after PBMC immunotherapy was over double compared to control 117 (24% vs 10%; table 2) and the result was similar to other studies with interval 21-25% 118 for treated patients [22-24, 26, 27]. 119 Nevertheless, it was commonly accepted that with insufficient P4 production causing 120 miscarriages could be solved simply by an exogenous P4 administration in order to 121 regulate the inflammatory mediators of pregnancy and even for patients undergoing IVF 122 process in fresh or frozen cycles to improve clinical outcomes prior embryo 123 transfer [29,35,36]. Indeed, P4 presents an anti-inflammatory action enhancing Th2 124 cytokines production to maintain pregnancy [37,38].…”

supporting

confidence: 72%

“…Indeed, it is known that P4 is an indispensable 32 factor for endometrium decidualization and for early stage of clinical pregnancy to 33 prepare an adequate immune environment for fetus and low LPL results abnormal 34 ongoing pregnancy [18,19,[29][30][31][32]. 35 Forward, it is increasingly clear that embryo implantation is dependent in one side 36 on immune local mechanisms and in another side on endocrine mechanisms related to 37 luteal P4 synthesis while their interactive reaction is still kept into question for 38 pregnancy achievement. For this reason, while our previous work [22] was based on the 39 implementation of PBMC immunotherapy for RIF patients and proving its efficiency 40 tripling the clinical outcomes, the present work was more focused on demonstrating the 41 correlation between LPL and immunotherapy success highlighting the interactive 42 reaction between luteal P4 synthesis by CL and immune system.…”

Section: Introductionmentioning

confidence: 99%

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Luteal progesterone level correlated with immunotherapy success of patients with repeated implantation failures

Sefrioui

Madkour

Bouamoud

et al. 2019

Preprint

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Immunotherapy using PBMC administration demonstrated relatively its effectiveness to treat RIF patients but it still unclear to explain some miscarriages. Luteal progesterone level (LPL) issued from corpus luteum after embryo implantation stage could be informative basis data to personalize immunotherapy for RIF patients predicting clinical outcomes. This randomized controlled study included 70 patients undergoing ICSI program presenting at least 3 RIF: 39 for Control of untreated patients and 31 for PBMC-test concerning treated patients with immunotherapy. For PBMC-test group, Peripheral Blood Mononuclear Cells (PBMCs) were isolated from patients on ovulation induction day and cultured three days to be administered to intrauterine cavity of patients two days before fresh embryo transfer. LPL was analyzed at day 15 after embryo transfer and clinical outcomes were calculated including implantation, clinical pregnancy and miscarriage rates. Clinical outcomes were doubly improved after immunotherapy including implantation and clinical pregnancy rates comparing Control versus PBMC-test (10% and 21% vs 24% and 45%). In the other hand, this strategy showed an increase over double in LPL (4ng/ml for Control vs 9ng/ml for PBMC-test) while the latter was correlated to clinical pregnancy. Bypassing the effectiveness of this immunotherapy approach for RIF patients, it is directly correlated to LPL proving the interactive reaction between immune profile of the treated patients and progesterone synthesis by corpus luteum. 2 embryo implantation, the major part of implantation establishment is bypassing embryo 3 quality and its genetic integrity highlighting the communication between embryo and the 4 mother. This cross talk is essentially orchestrated by hormonal and immune dialogues 5 November 17, 2018 1/10 in order to assure embryo invasion in the maternal endometrium without rejecting the 6 fetal allograft. Furthermore, it is already known that progesterone (P4) is one of the 7 most important implantation/pregnancy success keys for its effects on the endometrium 8 and early pregnancy survival while its removal results in miscarriage [1-3]. 9P4 is a hormonal key to modulate the maternal immune system by reducing natural 10 killer (NK)-cell activity [4], inhibiting cytotoxic T-cell activity [5], increasing HLA-G 11 production in trophoblast cells [6], increasing suppressor-cell levels [7] and as special 12 mechanism, it is able to induce lymphocyte-blocking proteins production such as 13 progesterone-induced blocking factor (PIBF) [8][9][10][11]. Generally, its anti-inflammatory 14 effect reported by several studies showing that it is essential to modify the cytokine 15 response from pro-inflammatory profile presented by Th1 during embryo implantation 16 to anti-inflammatory profile presented by Th2 for pregnancy maintain [12-16, 18, 19]. 17 Thus, Th1/Th2 unbalance could explain implantation failures in some patients with 18 RIF, RPL or recurrent miscarriages (RM) [20-22]. 19 129(r=0.28) (Table 2). However, 4 ng/ml of LPL was ...

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supporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Luteal progesterone level correlated with immunotherapy success of patients with repeated implantation failures

Sefrioui

Madkour

Bouamoud

et al. 2019

Preprint

View full text Add to dashboard Cite

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“…She had a low 25‐hydroxycholecalciferol level of 10 ng/ml, low vitamin B12 level of 190 picomol/ml. At the time, there was indirect evidence that low dose aspirin and prophylactic doses of low molecular weight heparin could increase the number of live births in women with recurrent miscarriages (Jain et al, ) and progesterone could prevent miscarriage (Hussain et al, ). Therefore, vitamin D, B 12 , progesterone, thyroid hormone replacement, folic acid, aspirin, and lovenox were given during every one of her pregnancies.…”

Section: Discussionmentioning

confidence: 99%

Folate receptor autoantibodies in pregnancy related complications

Shapira

Sequeira

Quadros

2015

Birth Defects Research

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“…The luteal blood flow increases gradually after ovulation, and the corpus luteum becomes one of the most highly vascularized organs in the body [7]. Previous studies have found that insufficiency of the corpus luteum during pregnancy was associated with infertility and spontaneous abortion in the first trimester of pregnancy [8,9]. In addition, blood flow in the corpus luteum is associated with luteal function.…”

Section: Introductionmentioning

confidence: 99%

Luteal blood flow as a predictive factor for methotrexate treatment outcomes in women with unruptured tubal pregnancy

Wang

Pei

Yang

et al. 2020

Preprint

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Background: Blood flow in the corpus luteum is associated with luteal function. However, the impact of luteal blood flow on methotrexate (MTX) treatment in women with unruptured tubal pregnancy has not been reported. The aim of the present study was to observe the impact of luteal blood flow on the therapeutic effect of MTX in women with unruptured tubal pregnancy. Methods: A prospective observational study recruited 129 women with unruptured tubal pregnancy in the First Affiliated Hospital of Xi’an Jiaotong University from September 2016 to June 2018. One hundred and fifteen women were treated successfully with MTX, and women were divided into 2 groups according to luteal blood flow: the poor luteal blood flow group and the abundant luteal blood flow group. The therapeutic effects were compared between the two groups. Results: Women in the abundant luteal blood flow group had a significantly higher serum β-human chorionic gonadotropin (β-hCG) level 4 days, 1 week and 2 weeks after MTX treatment compared with women in the poor luteal blood flow group ( P <0.05). The average diameter of the ectopic mass 1 week, 2 weeks and 3 weeks after MTX treatment in women with abundant luteal blood flow was significantly larger ( P <0.05), and the time of serum β-hCG clearance and ectopic mass disappearance were significantly longer compared with those in women in the poor luteal blood flow group ( P <0.05). Conclusions: Luteal blood flow might be a predictive factor for MTX treatment outcomes in women with unruptured tubal pregnancy, and those with abundant luteal blood flow need a longer recovery time.

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Progesterone supplementation in women with otherwise unexplained recurrent miscarriages

Cited by 26 publications

References 19 publications

Luteal progesterone level correlated with immunotherapy success of patients with repeated implantation failures

Luteal progesterone level correlated with immunotherapy success of patients with repeated implantation failures

Folate receptor autoantibodies in pregnancy related complications

Luteal blood flow as a predictive factor for methotrexate treatment outcomes in women with unruptured tubal pregnancy

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