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DOI: 10.1055/s-2000-13725
Endocrinopathies Associated with Recurrent Pregnancy Loss
Publication History
Publication Date:
31 December 2000 (online)
ABSTRACT
Repeated pregnancy wastage is defined as the loss of three consecutive pregnancies at less than 20 weeks of gestation and fetal weight less than 500 g. This article provides guidelines to evaluate endocrinopathies associated with recurrent abortions. Thyroid disorder, although usually obvious, has a high frequency in the female population and should be evaluated and treated, if revealed. Recent studies indicate that thyroid antibodies, even in the absence of abnormal thyroid function tests, may be related to pregnancy loss. Diabetes mellitus should be controlled. Luteal phase defects should be sought and, when consistently documented, treated with clomiphene citrate or progesterone supplementation. Bromocriptine may be added to the treatment of a patient with hyperprolactinemia prior to testing for luteal phase defect. An understanding of the stress and anxiety in these couples should always be considered and included in the treatment style of the physician.
KEYWORD
Luteal phase defect - repeated pregnancy wastage - thyroid - hyperandrogenism
REFERENCES
- 1 Roman E. Fetal loss rates and their relation to pregnancy order. J Epidemiol Community Health . 1984; 38 29-35
- 2 Clifford K, Rai R, Regan L. Future pregnancy outcome in unexplained recurrent first trimester miscarriage. Hum Reprod . 1997; 12 387-389
- 3 Gilchrist D M, Livingston J E, Hurlburt J A, Wilson R D. Recurrent spontaneous pregnancy loss: investigation and reproductive follow-up. J Reprod Med . 1991; 36 184-188
- 4 Peters A J, Lloyd R P, Coulam C P. Prevalence of out-of-phase endometrial biopsy specimens. Am J Obstet Gynecol . 1992; 166 1738-1745
- 5 Soules M R, McLachlan R I, Ek M, Dahl K D, Cohen N L, Bremmer W J. Luteal phase deficiency: characterization of reproductive hormones over the menstrual cycle. J Clin Endocrinol Metab . 1989; 69 804-812
- 6 Jacobs M H, Balasch J, Gonzalez-Merlo J M. Endometrial cytosolic and nuclear progesterone receptors in the luteal phase defect. J Clin Endocrinol Metab . 1987; 64 472-478
- 7 Daya S, Ward S. Diagnostic test properties of serum progesterone in the evaluation of luteal phase defects. Fertil Steril . 1988; 49 168-170
- 8 Wentz A C, Kossoy L, Parker R A. The impact of luteal phase inadequacy in an infertile population. Am J Obstet Gynecol . 1990; 162 937-943
- 9 Balasch J, Fabreques F, Creus M, Vanrell J A. The usefulness of endometrial biopsy for luteal phase evaluation in infertility. Hum Reprod . 1992; 7 973-977
- 10 Daly D C, Walters C A, Soto-Albers C E. Endometrial biopsy during treatment of luteal phase defects is predictive of therapeutic outcome. Fertil Steril . 1983; 40 305-310
- 11 Navot D, Bergh P A, Williams M. An insight into early reproductive processes through the in vivo model of ovum donation. J Clin Endocrinol Metab . 1991; 72 408-414
- 12 Downs K A, Gibson M. Clomiphene citrate for luteal phase defect. Fertil Steril . 1983; 39 34-38
- 13 Cooke I D, Morgan C A, Parry T E. Correlation of endometrial biopsy and plasma progesterone levels in infertile women. J Obstet Gynaecol Br Commonw . 1972; 79 647-650
- 14 Shepard M K, Senturia Y D. Comparison of serum progesterone and endometrial biopsy for confirmation of ovulation and evaluation of luteal function. Fertil Steril . 1977; 28 541-548
- 15 Tulppala M, Stenman U H, Cacciatore B, Ylikorkala O. Polycystic ovaries and levels of gonadotropins and androgen in miscarriage: prospective study in 50 women. Br J Obstet Gynaecol . 1993; 100 348-352
- 16 Stanger J D, Yovich J L. Reduced in vitro fertilization of human oocytes from patients with raised basal luteinizing hormone levels during the follicular phase. Br J Obstet Gynaecol . 1993; 2 385-390
- 17 Howles C M, Macnamee M C, Edwards R G. Follicular development and early luteal function of conception and non-conceptual cycles after human in vitro fertilization: endocrine correlates. Hum Reprod . 1987; 2 17-21
- 18 Sagle M, Bishop K, Ridley N. Recurrent early miscarriage and polycystic ovaries. Br Med J . 1988; 297 1027-1028
- 19 Homburg R, Aramar N A, Eshel A, Adams J, Jacobs H S. Influence of serum luteinizing hormone concentrations on ovulation, conception and early pregnancy loss in polycystic ovary syndrome. Br Med J . 1988; 297 1024-1026
- 20 Barbieri R L, Makris A, Randall R W, Daniels G, Kistner R W, Ryan K J. Insulin stimulates androgen accumulations in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab . 1986; 62 904-910
- 21 Horie K, Takakura K K, Imai K, Liao S, Mori T. Immunohistochemical localization of androgen receptor in human endometrium, decidua, placenta and pathological conditions of the endometrium. Hum Reprod . 1992; 7 1461-1466
- 22 Reshef E, Lei A M, Rao C V, Pridham D D, Chegini N, Luborsky J L. The presence of gonadotropin receptors in the pregnant uterus, human placenta, fetal membranes and decidua. J Clin Endocrinol Metab . 1990; 70 421-430
- 23 Montero M, Collea J V, Frasier D, Mestman J. Successful outcome of pregnancy in women with hypothyroidism. Ann Intern Med . 1981; 94 31-34
- 24 Stagnaro-Green A, Roman S H, Cobin R H, El-Harazy E, Alvarez-Marfany M, Davies T F. Detection of at-risk pregnancy by means of a highly sensitive assay for thyroid antibodies. JAMA . 1990; 264 1422-1425
- 25 Pratt D, Novotny M, Kaberlein G, Dudkiewicz A, Gleicher N. Antithyroid antibodies and the association with non-organ-specific antibodies in recurrent pregnancy loss. Am J Obstet Gynecol . 1993; 168 837-841
- 26 Kutteh W, Yetman D, Carr A, Beck L, Scott R. Increased prevalence of antithyroid antibodies identified in women with recurrent pregnancy loss but not in women undergoing assisted reproduction. Fertil Steril . 1999; 71 843-848
- 27 Mills J L, Simpson J L, Driscoll S G. NICHD-DIEP Study: incidence of spontaneous abortion among normal women with insulin-dependent diabetic women whose pregnancies were identified within 21 days of conception. N Engl J Med . 1988; 319 1617-1623
- 28 Miodovnik M, Lavin J P, Knowles H C. Spontaneous abortion among insulin dependent diabetic women. Am J Obstet Gynecol . 1984; 150 372-376
- 29 Greene M F, Hare J W, Cloherty J P. First trimester hemoglobin A! and risk for major malformation and spontaneous abortion in diabetic pregnancy. Teratology . 1989; 39 225-231