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Recurrent Miscarriage and Folliculo-Luteal Function

  • György Siklósi
Chapter

Abstract

During the analysis of epidemiological data, we reached the conclusion that the causes that are being most widely investigated at present (anatomical, immunological causes, thrombophilia, etc.) cannot be the real cause of recurrent miscarriage (RM) or that they are only the causes in less than 3 % of cases. We presumed that the cause of RM is folliculo-luteal insufficiency (FLI), which causes RM through insufficient placentation. However, this is unsupported by current diagnostic methods.

In unselected patients with recurrent miscarriage, we measured significantly lower progesterone (P) levels compared to the physiological (13.6 ± 3.3 and 29.3 ± 3.1 ng/ml). We normalised folliculo-luteal function by clomiphene citrate and/or dexamethasone treatment before conception (average luteal P >23 ng/ml). In pregnancies conceived with physiological FLF (N = 494, after 2–10, averagely 3.0 abortion), there was a decrease of an order of magnitude compared to the untreated control group regarding the occurrence of abortion (4.8 % and 39.4 %), preterm birth (2.5 % and 45.0 %) and IUGR (0.7 % and 19.8 %). In the two groups, abortion occurred in 3 % and 31.5 % after two abortions and 6.5 % and 46.2 % after three or more abortions.

When we investigated the relationship between FLF and pregnancy outcome, we found significant (p < 0.001) differences in the average luteal P and oestradiol (E2) values measured in the conception cycle between pregnancies ending with abortion, preterm birth and mature birth. We demonstrated a strong and significant correlation (r = 0.93, p < 0.001) between the average luteal P and E2 levels and the length of pregnancy (weeks) and between luteal P and E2 values and the parameters of the newborns (r = 0.84 − 0.71, p < 0.001): newborn weight, length, weight percentile and BPD.

In the 24 patients (4.8 %) whose pregnancies ended in abortion despite physiological FLF, we repeated treatment 16 times in 12 patients, and to our surprise, every pregnancy with physiological FLF resulted in birth.

Although in 12 patients we could not repeat the treatment, we achieved successful birth in 97.6 % of patients by the normalisation of FLF. This suggests that the cause or causes other than FLI is marginal or questionable in the occurrence of RM.

Keywords

Preterm Birth Pregnancy Outcome Clomiphene Citrate Recurrent Miscarriage Weight Percentile 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • György Siklósi
    • 1
  1. 1.Semmelweis University Second Department of Obstetrics and GynecologyBudapestHungary

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