The Relationship of Recurrent Spontaneous Miscarriage with Reproductive Failure

Abstract

Objective: To investigate the reproductive performance of non-pregnant women with recurrent spontaneous miscarriage (RSM) and the association between RSM and polycystic ovary syndrome (PCOS) in reproductive failure. Subjects and Methods: Fifty non-pregnant women with 3 or more consecutive RSM attending our RSM clinic were evaluated prospectively. Detailed history and physical examination were completed. Extensive laboratory investigations, ultrasonographic, radiological and specialized procedures/tests were performed. Those patients who did not achieve pregnancy within the first 6 months of follow-up had appropriate treatment options implemented. The outcome of any subsequent pregnancies was analyzed. Results: The mean age of the patients was 33.8 ± 4.6 years (range 22–43 years). The aetiological factors associated with RSM were chromosome anomaly, uterine abnormality, antiphospholipid syndrome, PCOS and infections; 40% were ‘unexplained’. Thirty patients (60%) were able to achieve viable pregnancies which progressed to term, resulting in live births. Fourteen of the other 20 patients had high body mass index (BMI) >30 and evidence of PCOS. Of these 20 patients, 13 eventually achieved pregnancies which ended again in first-second-trimester abortions (cause undetermined). The remaining 7 patients (4 with high BMI) who had a combination of male factor/protracted PCOS/ovarian failure did not achieve pregnancies. Conclusion: The association of RSM with PCOS resulted in poor reproductive performance, which may progress to reproductive failure.

Recurrent Spontaneous Miscarriage Is Still a Challenging Diagnostic and Therapeutic Quagmire

“…Polycystic ovary syndrome (PCOS) has been associated with an increased risk of miscarriage and RSM, although the exact mechanism for this association remains uncertain [5,47] and the incidence reported is quite varied: PCOS has been associated with RSM in 56% of the population [62,63], whereas a rate of 21.1-40% was reported from Kuwait [64,65] and a lower rate of 8.3-10% in the study of Cocksedge et al [66]. Hyperinsulinaemia, increased insulin resistance and hyperandrogenaemia, which have all been reported in PCOS, have been linked with an increased risk of miscarriage and RSM.…”

“…In 50-60% of patients, the aetiology of RSM remains elusive, unidentified or unexplained [65,70]. An immunological reason has been proposed as the underlying basis of these unexplained RSM [71] although the exact mechanism has not been elucidated.…”

“…A failure to adhere to this strict guideline in diagnosis by some colleagues contributed to the high incidence of 33% reported for APS in our earlier report on RSM (fig. 1) [64]; this rate was reduced in later studies to 15-20% [15,65.] Practitioners in this field should avoid short cuts in the care of their patients so that they do not fall prey to such diagnostic pitfalls.…”

“…Practitioners in this field should avoid short cuts in the care of their patients so that they do not fall prey to such diagnostic pitfalls. Lupus anticoagulant has been detected in Kuwait and in other countries [3,5,64,65] by the dilute Russell viper venom time test and other coagulation tests, and ACL (IgG/IgM) are determined by ELISA. The β 2 -glycoproteins (β 2 IgG/β 2 IgM) for the main ACL antibodies are estimated in all patients being investigated for RSM in Kuwait [64,65]; these investigations are recommended by professional organizations.…”

Vascular Dysfunction in Women with Recurrent Pregnancy Loss

“…Using a combination of clinical, ultrasonographic, and biochemical criteria, the diagnosis of PCOS is usually reserved for those women who display one or more clinical symptoms including chronic anovulation, an ultrasonographical morphology of polycystic ovaries, inappropriate gonadotropin secretion, and hyperandrogenism (Franks, 1995;Dunaif, 1997). It is reported that women with PCOS have adverse pregnancy outcome including miscarriage (Abbott et al, 2002;Doldi et al, 1998;Glueck et al, 1999;Wang et al, 2001;Diejomaoh et al, 2003).…”