Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject : Participation in survey “Natural progesterone in Secondary Amenorrhea and Immunomodulation”

Spontaneous abortion occurs in about 15% to 20% of pregnancies. Threatened abortion occurs when a mother might be losing her baby at less than 20 weeks' gestation. The symptoms of threatened abortion are vaginal bleeding, with or without abdominal pain, while the cervix of the womb is closed and the baby inside the womb is alive. Progesterone is a hormone that is known to prepare the uterus for implantation of the fertilized egg and suppress uterine contractions until term. Medications that mimic the action of progesterone are known as progestogens. Treatment with progestogens may be effective in reducing the rate of miscarriage in women who have threatened abortion.

Recurrent Pregnancy Loss (RPL) can be defined as three or more clinically recognized consecutive pregnancy losses prior to 20 weeks of gestation from last menstrual period. It affects 1-2% of women. The prevalence is 7.46% among Indian women which is higher as compared to western data. The risk of subsequent miscarriage after first two and three pregnancy losses is 30% and 33% respectively in women without history of live birth.

Progesterone's physiological role is to prepare the uterus for the implantation of the embryo, enhance uterine quiescence and suppress uterine contractions, hence, it may play a role in preventing rejection of the embryo. Inadequate secretion of progesterone in early pregnancy has been linked to the etiology of miscarriage and progesterone supplementation has been used as a treatment for threatened/recurrent abortion to prevent spontaneous pregnancy loss.

Medications that mimic the action of progesterone are known as progestogens. Natural Progesterone (NP) is a natural and bioidentical progesterone.

Progesterone promotes favorable immunotolerance which is crucial for implantation and the contact between the conceptus and the mother. Evidence suggests that exposure to progesterone alone, an allogeneic stimulus is not needed to cause a marked rise in immunomodulatory protein PIBF (Progesterone Induced Blocking Factor).

There is limited real-world data available on the usage of natural progesterone (NP) in management of recurrent pregnancy loss & threatened abortion in India.

This multicentric survey is designed to understand the usage of natural progesterone in the management of recurrent pregnancy loss & threatened abortion in India.

If you agree to participate, you will be required to respond to questions of the enclosed questionnaire. We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this survey. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.