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Roy G. Farquharson - One of the best experts on this subject based on the ideXlab platform.
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Recurrent Miscarriage and thrombophilia: an update.
Current opinion in obstetrics & gynecology, 2012Co-Authors: Kelly M. Mcnamee, Feroza Dawood, Roy G. FarquharsonAbstract:Purpose of reviewAcquired and inherited thrombophilia is an important research avenue in the Recurrent Miscarriage field. The optimum treatment for patients with Recurrent Miscarriage and a confirmed thrombophilia remains a contentious issue. We aim to appraise and explore the latest research in the
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Recurrent Miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy.
Journal of thrombosis and haemostasis : JTH, 2010Co-Authors: Danny M. Cohn, Mariette Goddijn, Saskia Middeldorp, Feroza Dawood, Johanna C. Korevaar, Roy G. FarquharsonAbstract:Background: Although women with antiphospholipid antibodies (APLAs) are at increased risk of Recurrent Miscarriage, the outcome of a subsequent pregnancy is not clearly elucidated. Objectives: To assess the pregnancy outcome of a subsequent pregnancy in women with APLAs and compare this outcome with women with unexplained Recurrent Miscarriage. Methods: We performed a cohort study among all women who attended the Miscarriage Clinic at Liverpool Women’s Hospital between 1987 and 2006 after being referred due to Recurrent Miscarriage (= 2 consecutive pregnancy losses). All women underwent a standardized investigation sequence. Women with other reasons for Recurrent Miscarriage were excluded. Results: A total of 693 women fulfilled the selection criteria, of whom 176 (25%) had APLAs. One hundred and twenty-two (69%) women with APLAs had a subsequent live birth compared with 324 (63%) women with unexplained Recurrent Miscarriage (OR 1.3, 95% CI 0.9–1.9). No differences were found for birth weight, gestational age, and intra-uterine growth restriction. When treatment was analyzed, 53/67 (79%) of women with APLAs who had received aspirin and heparin during their pregnancy had a live birth, compared with 64/104 (62%) of women with APLAs who received aspirin only (adjusted OR 2.7, 95% CI 1.3–5.8). In unexplained Recurrent Miscarriage, stratification for treatment showed no differences in outcome. Conclusion: The prognosis of a subsequent pregnancy in women with APLAs is good. Although this was not a randomized clinical trial, combined treatment of aspirin and heparin seemed associated with a better outcome in women with APLAs, but not in women with unexplained Recurrent Miscarriage. (aut. ref.)
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evidence based guidelines for the investigation and medical treatment of Recurrent Miscarriage
Human Reproduction, 2007Co-Authors: Eric Jauniaux, Roy G. Farquharson, Ole Bjarne Christiansen, Niek ExaltoAbstract:Recurrent Miscarriage (RM; > or =3 consecutive early pregnancy losses) affects around 1% of fertile couples. Parental chromosomal anomalies, maternal thrombophilic disorders and structural uterine anomalies have been directly associated with Recurrent Miscarriage; however, in the vast majority of cases the pathophysiology remains unknown. We have updated the ESHRE Special Interest Group for Early Pregnancy (SIGEP) protocol for the investigation and medical management of RM. Based on the data of recently published large randomized controlled trials (RCTs) and meta-analyses, we recommend that basic investigations of a couple presenting with Recurrent Miscarriage should include obstetric and family history, age, BMI and exposure to toxins, full blood count, antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies), parental karyotype, pelvic ultrasound and/or hysterosalpingogram. Other investigations should be limited to particular cases and/or used within research programmes. Tender loving care and health advice are the only interventions that do not require more RCTs. All other proposed therapies, which require more investigations, are of no proven benefit or are associated with more harm than good.
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Recurrent Miscarriage and long term thrombosis risk a case control study
Human Reproduction, 2005Co-Authors: Siobhan Quenby, Feroza Dawood, Roy G. Farquharson, A.m. Hughes, J. ToppingAbstract:BACKGROUND: Recurrent Miscarriage has been associated with antiphospholipid syndrome (APS) and other prothombotic conditions. We tested the hypothesis that women diagnosed as having APS as an aetiological factor for their Miscarriages were at higher risk of thrombosis than those with idiopathic Recurrent Miscarriage. METHODS: A retrospective case–control study was performed using validated questionnaires. A total of 141 women with Recurrent Miscarriage and APS alone were matched with 141 women with idiopathic Recurrent Miscarriage for age, number and type of pregnancy loss and number of years of follow-up. A subgroup of eight women included those who initially presented with Recurrent Miscarriage, thrombosis and APS. RESULTS: The mean length of follow-up was 7.3 years and response rate 74%. The incidence of thrombosis was similar in the Recurrent Miscarriage and APS women (6/1000 women-years) and in the idiopathic Recurrent Miscarriage women (2/1000 women-years) (P 5 0.18). All eight women who presented with Recurrent Miscarriage, APS and thrombosis reported further thrombotic events. CONCLUSIONS: Both idiopathic and APS-associated Recurrent Miscarriage were associated with a similar long-term risk of thrombosis.
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Recurrent Miscarriage and long-term thrombosis risk: a case–control study
Human reproduction (Oxford England), 2005Co-Authors: Siobhan Quenby, Feroza Dawood, Roy G. Farquharson, A.m. Hughes, J. ToppingAbstract:BACKGROUND: Recurrent Miscarriage has been associated with antiphospholipid syndrome (APS) and other prothombotic conditions. We tested the hypothesis that women diagnosed as having APS as an aetiological factor for their Miscarriages were at higher risk of thrombosis than those with idiopathic Recurrent Miscarriage. METHODS: A retrospective case–control study was performed using validated questionnaires. A total of 141 women with Recurrent Miscarriage and APS alone were matched with 141 women with idiopathic Recurrent Miscarriage for age, number and type of pregnancy loss and number of years of follow-up. A subgroup of eight women included those who initially presented with Recurrent Miscarriage, thrombosis and APS. RESULTS: The mean length of follow-up was 7.3 years and response rate 74%. The incidence of thrombosis was similar in the Recurrent Miscarriage and APS women (6/1000 women-years) and in the idiopathic Recurrent Miscarriage women (2/1000 women-years) (P 5 0.18). All eight women who presented with Recurrent Miscarriage, APS and thrombosis reported further thrombotic events. CONCLUSIONS: Both idiopathic and APS-associated Recurrent Miscarriage were associated with a similar long-term risk of thrombosis.
D. Ware Branch - One of the best experts on this subject based on the ideXlab platform.
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Recurrent fetal aneuploidy and Recurrent Miscarriage
Obstetrics & Gynecology, 2004Co-Authors: Amy E. Sullivan, Robert M Silver, T. Flint Porter, D. Yvette Lacoursiere, D. Ware BranchAbstract:OBJECTIVE: Some investigators have found a high frequency of abortus aneuploidy in women with Recurrent Miscarriage, suggesting the possibility of Recurrent aneuploidy as a cause of Recurrent Miscarriage. Others contend that aneuploidy is not a cause of Recurrent Miscarriage. The purpose of this study was to investigate the relationship between fetal aneuploidy and Recurrent Miscarriage by estimating whether fetal aneuploidy is more common in patients with Recurrent Miscarriage than in patients with sporadic Miscarriage METHODS: Recurrent Miscarriage cases (n = 135) included women who had a subsequent Miscarriage in which an abortus karyotype was obtained. Controls (n = 150) were patients experiencing a sporadic Miscarriage who had fetal karyotypes performed as part of a study to assess the utility of abortus tissue for transplantation. Karyotype analysis was performed using standard G-banding techniques. RESULTS: Abortuses from 122 cases and 133 controls were successfully karyotyped. Thirty-one (25.4%) abortuses from cases and 56 (42.1%) from controls were aneuploid (odds ratio 0.47, 95% confidence interval 0.27-0.80). Aneuploid abortuses occurred in 20% of cases and 25% of controls, aged 20-29 years, 19% of cases and 24% of controls, aged 30-34 years, 35% of cases and 47% of controls, aged 35-39 years, and 50% of both cases and controls, aged 40 years or older (not significant). Of 30 cases in whom 2 or more Miscarriages were karyotyped, 3 (10%) had aneuploidy in each abortus. CONCLUSION: In our population of Recurrent Miscarriage patients, abortus aneuploidy occurred significantly less often than in sporadic Miscarriages. The rate of aneuploidy in this study was considerably lower than reported in other studies. If Recurrent aneuploidy contributes to Recurrent Miscarriage, it does so in only a small number of patients.
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Recurrent fetal aneuploidy and Recurrent Miscarriage.
Obstetrics and gynecology, 2004Co-Authors: Amy E. Sullivan, Robert M Silver, T. Flint Porter, D. Yvette Lacoursiere, D. Ware BranchAbstract:OBJECTIVE Some investigators have found a high frequency of abortus aneuploidy in women with Recurrent Miscarriage, suggesting the possibility of Recurrent aneuploidy as a cause of Recurrent Miscarriage. Others contend that aneuploidy is not a cause of Recurrent Miscarriage. The purpose of this study was to investigate the relationship between fetal aneuploidy and Recurrent Miscarriage by estimating whether fetal aneuploidy is more common in patients with Recurrent Miscarriage than in patients with sporadic Miscarriage METHODS Recurrent Miscarriage cases (n = 135) included women who had a subsequent Miscarriage in which an abortus karyotype was obtained. Controls (n = 150) were patients experiencing a sporadic Miscarriage who had fetal karyotypes performed as part of a study to assess the utility of abortus tissue for transplantation. Karyotype analysis was performed using standard G-banding techniques. RESULTS Abortuses from 122 cases and 133 controls were successfully karyotyped. Thirty-one (25.4%) abortuses from cases and 56 (42.1%) from controls were aneuploid (odds ratio 0.47, 95% confidence interval 0.27-0.80). Aneuploid abortuses occurred in 20% of cases and 25% of controls, aged 20-29 years, 19% of cases and 24% of controls, aged 30-34 years, 35% of cases and 47% of controls, aged 35-39 years, and 50% of both cases and controls, aged 40 years or older (not significant). Of 30 cases in whom 2 or more Miscarriages were karyotyped, 3 (10%) had aneuploidy in each abortus. CONCLUSION In our population of Recurrent Miscarriage patients, abortus aneuploidy occurred significantly less often than in sporadic Miscarriages. The rate of aneuploidy in this study was considerably lower than reported in other studies. If Recurrent aneuploidy contributes to Recurrent Miscarriage, it does so in only a small number of patients. LEVEL OF EVIDENCE II-2
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The factor V Leiden mutation is not a common cause of Recurrent Miscarriage
Journal of reproductive immunology, 1997Co-Authors: Donna Dizon-townson, D. Ware Branch, Sonja Kinney, Kenneth WardAbstract:Abstract Some investigators suggest that placental thrombosis and infarction can cause Recurrent Miscarriage. We have shown that the common missense mutation in the factor V gene, the Leiden mutation, which renders factor Va resistant to cleavage inactivation by activated protein C, predisposes to placental thrombosis and spontaneous Miscarriage. Our objective was to determine the frequency of the Leiden mutation in a population with well-characterized idiopathic Recurrent Miscarriage. DNA was extracted from whole blood of 40 couples with a history of idiopathic Recurrent Miscarriage and 25 couples with a history of proven fertility (seven or more live births). The polymerase chain reaction was used to amplify exon 10 of the factor V gene followed by allele-specific restriction with Mnl 1 for mutation detection. Results were analyzed with a χ 2 contingency table. None of the 40 women with idiopathic Recurrent Miscarriage carried the mutation and only one of their reproductive partners was heterozygous for the mutation. Similarly, none of the control women carried the mutation, and only one of the 25 control male partners was heterozygous for the mutation. In our referral population, the factor V Leiden mutation which predisposes to thrombosis is not a common cause of Recurrent Miscarriage.
Siobhan Quenby - One of the best experts on this subject based on the ideXlab platform.
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Obesity and Recurrent Miscarriage
Obesity, 2013Co-Authors: Harish Malappa Bhandari, Siobhan QuenbyAbstract:Recurrent Miscarriage is a heterogenous condition that affects 1% of women trying to conceive. There is a great concern at the increasing global trend of obesity. Obesity has adverse effects on endometrial development, ovarian function and developing embryo thus increasing the risk of Miscarriage and Recurrent Miscarriage. The management of obese women with Recurrent Miscarriage is challenging in the absence of good-quality evidence.
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Recurrent Miscarriage and long term thrombosis risk a case control study
Human Reproduction, 2005Co-Authors: Siobhan Quenby, Feroza Dawood, Roy G. Farquharson, A.m. Hughes, J. ToppingAbstract:BACKGROUND: Recurrent Miscarriage has been associated with antiphospholipid syndrome (APS) and other prothombotic conditions. We tested the hypothesis that women diagnosed as having APS as an aetiological factor for their Miscarriages were at higher risk of thrombosis than those with idiopathic Recurrent Miscarriage. METHODS: A retrospective case–control study was performed using validated questionnaires. A total of 141 women with Recurrent Miscarriage and APS alone were matched with 141 women with idiopathic Recurrent Miscarriage for age, number and type of pregnancy loss and number of years of follow-up. A subgroup of eight women included those who initially presented with Recurrent Miscarriage, thrombosis and APS. RESULTS: The mean length of follow-up was 7.3 years and response rate 74%. The incidence of thrombosis was similar in the Recurrent Miscarriage and APS women (6/1000 women-years) and in the idiopathic Recurrent Miscarriage women (2/1000 women-years) (P 5 0.18). All eight women who presented with Recurrent Miscarriage, APS and thrombosis reported further thrombotic events. CONCLUSIONS: Both idiopathic and APS-associated Recurrent Miscarriage were associated with a similar long-term risk of thrombosis.
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Recurrent Miscarriage and long-term thrombosis risk: a case–control study
Human reproduction (Oxford England), 2005Co-Authors: Siobhan Quenby, Feroza Dawood, Roy G. Farquharson, A.m. Hughes, J. ToppingAbstract:BACKGROUND: Recurrent Miscarriage has been associated with antiphospholipid syndrome (APS) and other prothombotic conditions. We tested the hypothesis that women diagnosed as having APS as an aetiological factor for their Miscarriages were at higher risk of thrombosis than those with idiopathic Recurrent Miscarriage. METHODS: A retrospective case–control study was performed using validated questionnaires. A total of 141 women with Recurrent Miscarriage and APS alone were matched with 141 women with idiopathic Recurrent Miscarriage for age, number and type of pregnancy loss and number of years of follow-up. A subgroup of eight women included those who initially presented with Recurrent Miscarriage, thrombosis and APS. RESULTS: The mean length of follow-up was 7.3 years and response rate 74%. The incidence of thrombosis was similar in the Recurrent Miscarriage and APS women (6/1000 women-years) and in the idiopathic Recurrent Miscarriage women (2/1000 women-years) (P 5 0.18). All eight women who presented with Recurrent Miscarriage, APS and thrombosis reported further thrombotic events. CONCLUSIONS: Both idiopathic and APS-associated Recurrent Miscarriage were associated with a similar long-term risk of thrombosis.
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Recurrent Miscarriage: a defect in nature’s quality control?
Human reproduction (Oxford England), 2002Co-Authors: Siobhan Quenby, Roy G. Farquharson, Gill Vince, John D. AplinAbstract:Recent data on Recurrent Miscarriage (RM) is discussed in the framework of the selection failure hypothesis which states, 'Recurrent Miscarriage is the result of failure of the prevention of 'poor quality' embryos implanting, allowing embryos that are destined to fail to implant and present clinically as Recurrent Miscarriage. Thus, Recurrent Miscarriage is a failure of nature's quality control.' The assumption that RM results from the maternal rejection of normal fetuses is challenged and evidence reviewed regarding the contribution of abnormal embryos and endometrial receptivity. Further research is needed to understand the mechanisms of maternal tract-embryo interaction and move towards improved management of Recurrent pregnancy loss.
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Recurrent Miscarriage a defect in nature s quality control
Human Reproduction, 2002Co-Authors: Siobhan Quenby, Roy G. Farquharson, Gill Vince, John D. AplinAbstract:Recent data on Recurrent Miscarriage (RM) is discussed in the framework of the selection failure hypothesis which states, 'Recurrent Miscarriage is the result of failure of the prevention of 'poor quality' embryos implanting, allowing embryos that are destined to fail to implant and present clinically as Recurrent Miscarriage. Thus, Recurrent Miscarriage is a failure of nature's quality control.' The assumption that RM results from the maternal rejection of normal fetuses is challenged and evidence reviewed regarding the contribution of abnormal embryos and endometrial receptivity. Further research is needed to understand the mechanisms of maternal tract-embryo interaction and move towards improved management of Recurrent pregnancy loss.
Frans H.j. Claas - One of the best experts on this subject based on the ideXlab platform.
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Oral sex is associated with reduced incidence of Recurrent Miscarriage.
Journal of reproductive immunology, 2019Co-Authors: Tess Meuleman, Geert W. Haasnoot, Jan M. M. Van Lith, Frans H.j. Claas, N. Baden, M.m. Wagner, Olaf M. Dekkers, S. Le Cessie, C. Picavet, Kitty W.m. BloemenkampAbstract:Abstract A possible way of immunomodulation of the maternal immune system before pregnancy would be exposure to paternal antigens via seminal fluid to oral mucosa. We hypothesized that women with Recurrent Miscarriage have had less oral sex compared to women with uneventful pregnancy. In a matched case control study, 97 women with at least three unexplained consecutive Miscarriages prior to the 20th week of gestation with the same partner were included. Cases were younger than 36 years at time of the third Miscarriage. The control group included 137 matched women with an uneventful pregnancy. The association between oral sex and Recurrent Miscarriage was assessed with conditional logistic regression, odds ratios (ORs) were estimated. Missing data were imputed using Imputation by Chained Equations. In the matched analysis, 41 out of 72 women with Recurrent Miscarriage had have oral sex, whereas 70 out of 96 matched controls answered positive to this question (56.9% vs. 72.9%, OR 0.50 95%CI 0.25−0.97, p = 0.04). After imputation of missing exposure data (51.7%), the association became weaker (OR 0.67, 95%CI 0.36–1.24, p = 0.21). In conclusion, this study suggests a possible protective role of oral sex in the occurrence of Recurrent Miscarriage in a proportion of the cases. Future studies in women with Recurrent Miscarriage explained by immune abnormalities should reveal whether oral exposure to seminal plasma indeed modifies the maternal immune system, resulting in more live births.
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Paternal HLA-C is a risk factor in unexplained Recurrent Miscarriage.
American Journal of Reproductive Immunology, 2017Co-Authors: Tess Meuleman, Geert W. Haasnoot, Jan M. M. Van Lith, Willem Verduijn, Kitty W.m. Bloemenkamp, Frans H.j. ClaasAbstract:Problem HLA-C is the only classical HLA-I antigen expressed on trophoblast. We hypothesized that the alloimmune response to paternal HLA-C plays a role in unexplained Recurrent Miscarriage. Method of study In a case-control design, we included 100 women with at least three unexplained consecutive Miscarriages along with their partners and children. For the first control group, we included 90 women with an uneventful singleton pregnancy without pregnancy complications in their history along with their children. The second control group consisted of 425 families. HLA-C*07 and HLA-C*17 frequencies, which are the most immunogenic HLA-C antigens, along with HLA-C mismatches, and the presence of specific HLA antibodies in the mother were determined. Results HLA-C and HLA-C*07 mismatches were significantly increased in couples with Recurrent Miscarriage compared to control subjects (P = .016, P = .008, respectively). The incidence of child-specific HLA-C*07/HLA-C*17 antibodies was increased in women with Recurrent Miscarriage (P = .007). Conclusion The results show that HLA-C incompatibility between couples is significantly associated with unexplained Recurrent Miscarriage.
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HLA-C antibodies in women with Recurrent Miscarriage suggests that antibody mediated rejection is one of the mechanisms leading to Recurrent Miscarriage.
Journal of reproductive immunology, 2016Co-Authors: Tess Meuleman, Jan M. M. Van Lith, Frans H.j. Claas, E. Van Beelen, Risto Kaaja, Kitty W.m. BloemenkampAbstract:HLA-C is the only polymorphic classical HLA I antigen expressed on trophoblast cells. It is known that higher incidence of C4d deposition on trophoblast cells is present in women with Recurrent Miscarriage. C4d is a footprint of antibody-mediated classical complement activation. Therefore, this study hypothesize that antibodies against HLA-C may play a role in the occurrence of unexplained consecutive Recurrent Miscarriage. Present case control study compared the incidence of HLA-C specific antibodies in 95 women with at least three consecutive Miscarriages and 105 women with uneventful pregnancy. In the first trimester of the next pregnancy, presence and specificity of HLA antibodies were determined and their complement fixing ability. The incidence of HLA antibodies was compared with uni- and multivariate logistic regression models adjusting for possible confounders. Although in general a higher incidence of HLA antibodies was found in women with Recurrent Miscarriage 31.6% vs. in control subjects 9.5% (adjusted OR 4.3, 95% CI 2.0-9.5), the contribution of antibodies against HLA-C was significantly higher in women with Recurrent Miscarriage (9.5%) compared to women with uneventful pregnancy (1%) (adjusted OR 11.0, 95% CI 1.3-89.0). In contrast to the control group, HLA-C antibodies in the Recurrent Miscarriage group were more often able to bind complement. The higher incidence of antibodies specific for HLA-C in women with Recurrent Miscarriage suggests that HLA-C antibodies may be involved in the aetiology of unexplained consecutive Recurrent Miscarriage.
Juan Balasch - One of the best experts on this subject based on the ideXlab platform.
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The effect of maternal age on chromosomal anomaly rate and spectrum in Recurrent Miscarriage
Human reproduction (Oxford England), 2012Co-Authors: Maribel Grande, Antoni Borrell, Raul Garcia-posada, Virginia Borobio, Miriam Muñoz, Montserrat Creus, Anna Soler, Aurora Sánchez, Juan BalaschAbstract:Study question Is there any effect of maternal age on chromosomal anomaly rate and spectrum in Recurrent Miscarriage? Summary answer There was no significant difference in the chromosome abnormality rate between sporadic and Recurrent Miscarriage but the chromosome abnormality rate increased significantly with maternal age. What is known already About 50-70% of non-Recurrent Miscarriages occur because of a chromosomal anomaly, but no agreement about the effect of either maternal age or the number of previous Miscarriages on the chromosomal anomaly rate has been reached. Study design, size, duration A retrospective cohort of 353 Miscarriages successfully karyotyped in the same center between 2002 and 2011, grouped according to the number of Miscarriages and maternal age. Participants/materials, setting, methods Among the 353 women, 153 were below 35 years (73 with sporadic, 48 with two and 32 with Recurrent Miscarriage) and 200 were 35 years or more (81 with sporadic, 55 with two and 64 with Recurrent Miscarriage). The chromosomal anomaly rate and the anomaly spectrum were compared between sporadic and Recurrent Miscarriage, within the two maternal age groups, using the chi-square test and the Bonferroni correction for all the P-values. Risk of chromosomal anomaly was estimated for maternal age, number of Miscarriages and previous live births by multivariate binary logistic regression analysis. Main results and the role of chance Sporadic and Recurrent Miscarriage did not show significantly different chromosomal anomaly rates (68 versus 60%) and maternal age was the only statistically significant predictor of the chromosomal anomaly risk we identified. Some trends were observed in the chromosomal anomaly spectrum when sporadic was compared with Recurrent Miscarriage: Recurrent Miscarriage exhibited a decrease in viable trisomies (37 versus 11%) and an increase in non-viable trisomies (38 versus 57%) in women >35 years, together with an increase in unbalanced structural anomalies (4.9 versus 29%) in younger women. Limitation, reasons for caution The mixed origin of our study population, and the limited number of Recurrent Miscarriages, particularly in the younger group, limits statistical power to detect differences. Wider implications of the findings The most commonly observed chromosomal anomaly type in Recurrent Miscarriage depends on maternal age: non-viable autosomal trisomies in older women and unbalanced structural anomalies in younger women. When a chromosomal anomaly is identified as the cause of Miscarriage, additional maternal evaluation may be avoided. Study funding/competing interests No competing interests declared.
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progestagen therapy for Recurrent Miscarriage
Human Reproduction Update, 2007Co-Authors: Julia Szekeresbartho, Juan BalaschAbstract:BACKGROUND: Recurrent pregnancy loss (RM) affects 0.5-1% of couples. The pathophysiology of RM is complex. The suggested causes include anatomical, genetic and molecular abnormalities, endocrine disorders, thrombophilias and anti-phospholipid syndrome. In approximately 50% of the cases neither of the above can be identified. We aimed at examining the evidence on the role of progesterone in the pathophysiology of RM, and the clinical evidence on effectiveness of progestogen treatment. METHODS: We searched PubMed and the Cochrane database covering the period of 1968-2007. The search terms progestogens and Recurrent Miscarriage, NK cells and Recurrent Miscarriage as well as cytokines and Recurrent Miscarriage were used. RESULTS: Progesterone is indispensable for creating a suitable endometrial environment for implantation. RM may be due to subnormal progesterone secretion and retarded endometrial development in the peri-implantation period. Progesterone also acts on the immune system, mainly by affecting cytokine synthesis and the function of NK cells. A recent meta-analysis showed that though progesterone treatment did not affect pregnancy outcome in women with Miscarriages in general, separate analysis of three small and dated studies including altogether 91 patients with RM revealed a small but significant effect. It is noteworthy that the design of these 40 years old studies does not meet modern requirements. CONCLUSION: Standardized laboratory protocols for identifying potential targets of progestogen treatment as well as implementation of well-designed randomized studies are needed to establish the usefulness of progesterone supplementation in the treatment of RM.
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Progestagen therapy for Recurrent Miscarriage
Human reproduction update, 2007Co-Authors: Julia Szekeres-bartho, Juan BalaschAbstract:BACKGROUND: Recurrent pregnancy loss (RM) affects 0.5–1% of couples. The pathophysiology of RM is complex. The suggested causes include anatomical, genetic and molecular abnormalities, endocrine disorders, thrombophilias and anti-phospholipid syndrome. In 50% of the cases neither of the above can be identified. We aimed at examining the evidence on the role of progesterone in the pathophysiology of RM, and the clinical evidence on effectiveness of progestogen treatment. METHODS: We searched PubMed and the Cochrane database covering the period of 1968–2007. The search terms progestogens and Recurrent Miscarriage, NK cells and Recurrent Miscarriage as well as cytokines and Recurrent Miscarriage were used. RESULTS: Progesterone is indispensable for creating a suitable endometrial environment for implantation. RM may be due to subnormal progesterone secretion and retarded endometrial development in the peri-implantation period. Progesterone also acts on the immune system, mainly by affecting cytokine synthesis and the function of NK cells. A recent meta-analysis showed that though progesterone treatment did not affect pregnancy outcome in women with Miscarriages in general, separate analysis of three small and dated studies including altogether 91 patients with RM revealed a small but significant effect. It is noteworthy that the design of these 40 years old studies does not meet modern requirements. CONCLUSION: Standardized laboratory protocols for identifying potential targets of progestogen treatment as well as implementation of well-designed randomized studies are needed to establish the usefulness of progesterone supplementation in the treatment of RM.