The Male factor association with Recurrent Miscarriage

Couples suffering from recurrent miscarriage doctors usually focus their attention on the woman when seeking the cause. However recently researchers have started to look into factors affecting men. Sperm has an important role in the development of a healthy placenta able to provide oxygen and nutrients to the baby. The DNA of the sperm contains the important instructions which pass on the father’s genetic code. A recent study at Imperial College London found that sperm from men whose partners had suffered from recurrent miscarriage had twice as much DNA damage compared to the sperm of men whose partners had not. It was also found that numbers of molecules called reactive oxygen species or ROS, were four times higher in men with sperm DNA damage. These ROS are produced naturally in small amounts in the semen to protect sperm from infection but in higher concentrations they can damage the sperm’s DNA. Factors such as obesity, ageing, alcohol, smoking and infection are being investigated as potential causes of increased levels of ROS and therefore DNA damage. If we can find exactly what causes this increase in men then we may be able to find treatments to reduce it.

Progesterone and Miscarriage

The first study to look at the role of progesterone in miscarriage was the PROMISE trial which studied 836 women who had experienced three or more miscarriages. In their next pregnancy, half of the women were given progesterone pessaries and the other half were given a placebo. The study found that overall, there was not a significant increase in live births for the women who had progesterone compared to those who had the placebo. There was however some evidence that the more miscarriages a woman had experienced, the more likely progesterone was to be beneficial. It was concluded that this finding required more research. Next came the PRISM study. This was larger: 4153 women were given either progesterone or a placebo when they presented to the hospital with bleeding within the first 12 weeks of pregnancy. The study showed no benefit in taking progesterone for women who were bleeding who had no previous miscarriages. There was some benefit in taking it for those who had experienced one previous miscarriage and a strong benefit seen for those who had experienced three or more miscarriages. We now advise that women who have experienced three or more miscarriages and have bleeding in early pregnancy are likely to benefit from taking progesterone supplementation. For women who have had one or two miscarriages and experience bleeding in early pregnancy there may be some benefit in taking progesterone. For women who are not bleeding in pregnancy but have experienced a higher number of miscarriages, there may be some potential benefits in taking progesterone. (Reference: Coomarasarmy, A., Devall., A.J., Brosens, J.J. et al. (2020) Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence. American Journal of Obstetrics and Gynaecology. 232 (2) pp. 167-176. Doi:10.1016/j.ajog.2019.12.006.)

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