VAGINAL PROGESTERONE AFTER TUBAL PREGNANCY

We studied the effect of vaginal progesterone (P) treatment during the luteal phase of patients who had had a tubal pregnancy (TP) and were planning another, in a prospective, randomized, double-blind trial. Th e outpatient clinics of two University hospitals and three central hos pitals had 135 patients treated for tubal pregnancy: 100 with grossly normal fallopian tubes (supposing an accidentally abnormal luteal phas e as a possible etiology of their first TP) and 35 with signs of earli er pelvic inflammatory disease (PID etiology). They were treated with vaginal P (25 mg b.i.d.) or placebo during cycle days 16-24, for 10 mo nths. Serum P levels after a single vaginal or oral dose were compared . The rates of conception, delivery, spontaneous abortion and recurren t TP were recorded, and fetal and placental weight measured. Both vagi nal and oral formulas of P provoked a physiological (24-43 nmol/l) ris e in serum concentrations. P and placebo-treated cycles resulted in a nearly equal number of pregnancies (33/37 resp.). Of the 55 infants bo rn 53 were to mothers without signs of earlier PID (53/100); only 2 (2 /35) to mothers in whom sips had been present. Recurrent TP occurred i n 9% of all pregnancies. Four out of six recurrent TPs were patients w ith signs of PID (4/35), but two were without such signs (2/100): one occurred during placebo and one during P-treated cycle. Prophylactic P treatment of patients at risk of recurrent TP does not improve fertil ity or prevent recurrent TP. This indicates, that the functional etiol ogy of recurrent TP, as compared to infection, is not important.