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Cause of Miscarriage
Title: Endocrine abnormalities during the follicular phase in women with recurrent spontaneous abortion
Author: S. Bussen et al.
Address: Wuerzburg, Germany
Source: Human Reproduction 14: 18-20 (January) 1999
Summary: Endocrine abnormalities may be responsible for a large proportion of recurrent spontaneous abortions. Investigating the frequency of this hypothesis, 42 non-pregnant women with a history of recurrent abortion, participated in a case control study. The study group women all had at least 3 pregnancy losses , no parental chromosome rearrangement or uterine abnormality. The control group consisted of 42 nulligravid women with tubal or male factor infertility. Endocrine testing in the follicular phase revealed significant prolactin and androstenedione differences: mean (SD) concentrations - 14.2 ± 6.7 ng/ml vs 10.5± 3.5 ng/ml (95% CI 0.8-6.1) and 2.3 ±0.9 ng vs. 1.7 ± 0.6 ng/ml in the study and control groups respectively. All other endocrine parameters revealed no significant differences. The authors suggest that abnormalities in prolactin and androgen secretion during the follicular phase of the menstrual cycle are associated with recurrent spontaneous abortion. Treatment of the prolactinemia and hyperandrogenism may reduce the miscarriage rate and lead to successful pregnancy establishment.
Comment: Most quote that about 50% of spontaneous pregnancy loss is related to genetic abnormalities of the conceptus. Most of these arise from either chance alone or from dysynchrony of the follicular development, ovulation or fertilization. Inheritable genetic problems are really quite rare even with recurrent loss. Many have attributed pregnancy loss to abnormalities of the luteal phase (progesterone production or endometrial development), the so called luteal phase defect (LPD). The LPD concept of the is naive and outdated. Virtually all abnormalities of the luteal phase are the consequences of follicular phase abnormalities related to either inherent poor egg quality or an altered endocrine environment for folliculogenesis. The above article substantiates this concept.