Endocrinological and endometrial factors in recurrent miscarriage.

OBJECTIVE: To investigate the endocrinological and endometrial factors in women with unexplained recurrent miscarriage
DESIGN: Prospective, case study
SETTING: Recurrent miscarriage clinic, Jessop Hospital for Women, Sheffield PARTICIPANTS: One hundred and forty-four women with unexplained recurrent (> or =3) miscarriages
METHODS: A blood sample was obtained in early follicular phase (day 3-5) to measure follicle stimulating hormone, luteinising hormone, prolactin, androgens and thyroid function; daily blood/urine samples were obtained from mid-follicular phase to measure luteinising hormone until the luteinising hormone surge was identified; endometrial biopsy and a further blood sample for progesterone measurement were obtained in the mid-luteal phase. A transvaginal ultrasonography was performed to evaluate ovarian morphology.
RESULTS: Hypersecretion of luteinising hormone or ultrasonographic features of polycystic ovarian disease was present in 8% and 7.8% of women, respectively. The free androgen index was elevated in 14.6% of subjects. In the mid-luteal phase, low progesterone level was found in 17.4% and delayed endometrial development was noted in 27.1% of women. Although women with recurrent miscarriage women and delayed endometrium had significantly lower progesterone levels than those with normal endometrial development, only 8/24 had mid-luteal progesterone levels below 30 nmol/L. Recurrent miscarriage was not associated with hyperprolactinaemia or abnormal thyroid function test.
CONCLUSIONS: Endocrinological and endometrial abnormalities are present in about a quarter of women with unexplained recurrent miscarriage.