Expert Opinions on the role of Dydrogesterone in Recurrent Pregnancy Loss

Key takeaways

Esteemed Expert: Dr. Amrita Jaipuriar, Gorakhpur

Esteemed Expert: Dr. Ranjana Khanna, Prayagraj

“In my opinion treatment should be individualized.”

• The problems of oral are nausea, vomiting & drowsiness and with the vaginal the patient is bleeding so the drug can get washed away.

• We should not forget psychiatric problems a patient could be suffering from, renal problems and so many cardiac problems – so a lot of variety of patients where we need to decide whether to give vaginal preparation or where to give oral Dydrogesterone.

• Cochrane 2019 has proved that whatever preparation we give, whatever route we take, progesterones are very effective for preventing the recurrent pregnancy loss especially the early pregnancy losses

“I have seen very good results in RPL with Dydrogesterone”

• With micronized vaginal progesterone we do need very high dosage which can be inhibitory due to patient’s complaints of sleepiness, drowsiness though we can overcome by giving vaginally. Then in the PRISM trial even 400mg inserted twice a day, they did not find any significant advantage over placebo in live birth rates. So we do need something which is more effective and I have had a very very good response with Dydrogesterone.

• Dydrogesterone advantageous as it increases the PIBF & causes increased production of th2 cytokines that help to carry the pregnancy forward, no adverse effects on BP, weight, clotting factor, lipoprotein are seen and renal & adrenal functions are also unaffected.

• In threatened abortion patient is bleeding so with Dydrogesterone 40mg loading dose and then 10mg BD that would be fine.

• For maintenance-after 5 months-NMP would be good. Sustained release preparations of NMP are also available. For Indian population vaginal is not much patient friendly–so individualize the treatment. See her pocket what she can afford and accordingly chose the progesterone.

• Overall effect of progesterone are really good in maintaining the pregnancy and I find Dydrogesterone to be the better choice-also because of the immunomodulatory effects & I have seen very good results in RPL with Dydrogesterone.