Patient's question:
I had an abortion on January 3rd. It's been five months, and I haven't had my period yet. The doctor recommended taking Mifepristone tablets. I took 30 tablets for three consecutive days in May 8th, and then took 30 progesterone tablets for six consecutive days on May 27th. I still haven't had my period. I want to ask if I get pregnant while taking these medications, will it affect the fetus? What should I do? I have a history of abortion, and I haven't given birth yet.Doctor's answer:
Hello! First of all, I wish you a speedy recovery! Below, I will discuss the issue of "luteal function."In the diagnosis of female infertility, doctors often mention the term "luteal phase defect," which leaves many people confused about what exactly causes infertility due to luteal phase defect?
Under normal circumstances, after an ovary releases an egg, the follicle luteinizes to form a corpus luteum, which secretes estrogen and progesterone. The secretion level reaches its peak 7–8 days after ovulation and then rapidly declines 1–2 days before menstruation. If the secretion of pituitary gonadotropins and estrogen is insufficient, the follicle will not develop fully, even though the ovary can still release an egg. However, the corpus luteum may be affected, leading to luteal phase defect.
Luteal phase defect includes luteal phase deficiency and luteal phase shortening. It can cause inadequate development of the secretory phase endometrium, making it difficult for the fertilized egg to implant, or lead to early miscarriage even if implantation occurs. Some women may experience very early miscarriages, with only a delay of 1–3 days in their menstrual cycle. Clinically, it is difficult to detect such miscarriages, which are sometimes referred to as "cryptic pregnancy." Luteal phase defect accounts for approximately 3–8% of infertility cases.
The causes of luteal phase defect may include poor secretion of pituitary gonadotropins or inappropriate timing and coordination of LH/FSH secretion. It can also result from insufficient estrogenic proliferation of the endometrium or a lack of response to luteal hormones. Some factors or causes may be related to hyperprolactinemia. Recent reports suggest that luteal defects often occur during infertility treatment, such as in cases where clomiphene is used to induce ovulation. Although the ovulation rate may be high, the pregnancy rate remains relatively low. Some studies report that luteal phase defect occurs in 20–50% of patients treated with clomiphene. Therefore, when using ovulation-inducing drugs, it is not enough to simply observe whether they can induce ovulation; attention must also be paid to whether the luteal function is healthy after ovulation. This phenomenon can also occur when bromocriptine, HMG plus HCG, or pulsatile GRH is administered. Thus, luteal phase defects after medication must be closely monitored and treated.
Clinical manifestations of luteal phase defect:
Generally, it may include short menstrual cycles, spotting before menstruation, infertility in fertile-aged women, or habitual abortion. To determine whether luteal phase defect is present, basal body temperature (BBT) is typically measured. If the luteal phase temperature is shorter than 12 days, or if the temperature rises slowly, falls early, or has a rise amplitude of less than 0.5°C, or if there is significant fluctuation in the luteal phase temperature, these are all signs of luteal phase defect. However, it is important to note that continuous measurement over 3 menstrual cycles is required to confirm the diagnosis. Additionally, if the endometrium is taken within 12 hours of menstruation and shows poor secretion, it can also serve as a reference.
Treatment for infertility caused by luteal phase defect should be based on the specific cause. Common methods include:
1) Progesterone supplementation therapy: This is the most widely used method. It is suitable for cases with low mid-luteal progesterone levels, poor secretory phase observed in endometrial biopsy, or confirmed luteal phase defect based on clinical observation. Specific methods include:
- Progesterone vaginal suppositories (25 mg): Inserted deep into the vagina or rectum twice daily (morning and evening) by the patient, starting 2 days after the rise in basal body temperature (on day 16 or 17 of the menstrual cycle) and continuing until menstruation.
- Progesterone oil injection: 10 mg administered intramuscularly daily, or 20 mg every other day, starting 2 days after the rise in basal body temperature.
- Synthetic progestins:
- Medroxyprogesterone acetate (2 mg): Taken 3 times daily or 5 mg once nightly, starting 2 days after the rise in basal body temperature.
- Hydroxyprogesterone caproate (125 mg): Administered intramuscularly twice weekly, starting 2 days after the rise in basal body temperature.
The recommended duration for progesterone supplementation therapy is typically to start 2–3 days after ovulation, even for habitual early miscarriage, which should also begin treatment 2–3 days after ovulation. Regarding the duration of medication, some scholars suggest stopping it on day 14 after ovulation to prevent pseudopregnancy, while others recommend continuing until menstruation. If menstruation does not occur after the delay, a pregnancy test can be performed. If pregnancy is confirmed, medication should be continued until the 12th week of gestation. It is important to note that synthetic progestins, whether administered via injection or orally, cannot replace progesterone.
2) Human Chorionic Gonadotropin (HCG): Used before ovulation to induce ovulation and after ovulation to stimulate corpus luteum development, support luteal function, increase progesterone synthesis, and prolong the lifespan of the corpus luteum. The dosage is typically 2,000–3,000 IU of HCG administered intramuscularly every other day for 3–4 doses, or 1,000 IU daily for 7–8 days starting 3 days after ovulation.
3) Clomiphene: While clomiphene-induced ovulation has been associated with poor luteal function in some patients, some reports suggest that for naturally ovulating patients, especially those who do not respond to progesterone supplementation therapy, taking 50 mg of clomiphene daily for 5 days starting on day 3 of the menstrual cycle may improve pregnancy rates.
4) Bromocriptine: Patients with luteal phase defect and elevated serum prolactin levels may benefit from bromocriptine treatment: 25 mg taken 1–2 times daily.
In summary, "pregnancy during progesterone supplementation" does not pose significant issues, and the impact is minimal.
If you find this answer helpful, please do not disappoint my goodwill by failing to click "Accept as Answer."