Prevention of miscarriage following ovulation induction in women with endocrine infertility in anamnesis
DOI:
https://doi.org/10.14739/2310-1210.2019.4.173345Keywords:
induction of ovulation, hyperandrogenism, hyperprolactinemia, hypothalamic-pituitary insufficiency, miscarriageAbstract
Prescription of adjusted maintenance hormonal therapy during early stages of induced pregnancy is one of the most effective means of reducing reproductive losses.
Aim. To improve the maintenance hormonal therapy during early stages of induced pregnancy in patients with endocrine infertility of various genesis in anamnesis.
Materials and methods. In total, 44 women with induced singleton pregnancy and anovulatory infertility in anamnesis and 20 healthy pregnant women underwent ultrasound and hormonal monitoring during the first trimester of pregnancy. Depending on the dynamics of hormonal changes, corrective hormonal therapy was prescribed for patients with induced pregnancy. Prolongation of pregnancy up to 12 weeks was considered to be the main criterion for the evaluation of the therapeutic measures effectiveness. Statistical processing of data was performed using the programs StatSoft Statistica v.6.0, Microsoft Excel XP.
Results. Despite the exogenous administration of progestins in the group of women with anovulatory infertility in anamnesis, there were detected high risks of miscarriage (47.7 %), chorionic pathology (29.5 %), abortions (27.3 %). Hormonal monitoring in patients with termination of pregnancy and hypothalamic-pituitary insufficiency revealed an initially low level of β-hCG, normal level of progesterone but an inadequate their rise in dynamics; in patients with hyperprolactinemia – a very high concentration of progesterone, normal β-hCG level in early gestation and its gradual decrease during the first trimester; in patients with hyperandrogenemia – a very high concentration of progesterone at the beginning and progressive its decrease during the first trimester, inadequate rise of β-hCG from the beginning of the study combined with increased levels of androgens – dehydroepiandrostenediol sulfate and/or free testosterone.
Conclusions. In order to select an appropriate maintenance hormonal therapy, the concentration of progesterone and β-hCG should be determined at the beginning of the first trimester in patients with induced pregnancy and endocrine infertility in anamnesis. The first weeks of gestation (hyperconcentration of hormones) and the middle of the first trimester (corpus luteum regression) are the critical periods for such pregnant women. An adequate rise of β-hCG with normal or increased level of progesterone in women with hyperandrogenism and hyperprolactinemia during the first weeks of pregnancy serves as a reason for withdrawal of exogenous progesterone administration with a possible prolonged therapy after 6–7 weeks of gestation under the dynamic control of progesterone and β-hCG levels. Patients with hypothalamic-pituitary insufficiency should receive constant maintenance hormonal therapy with progestins in high therapeutic doses at the beginning of pregnancy.
References
Vol'f, M., & Shtute, P. (2018) Ginekologicheskaya e'ndokrinologiya i reproduktivnaya medicina. [Gynecological endocrinology and reproductive medicine]. Moscow. [in Russian].
Voskresenskiy, S. L., & Trishina, V. L. (2017) Soderzhanie progesterona v krovi beremennykh v I i vo II trimestrakh gestacii pri neblagopriyatnom zavershenii beremennosti [The contents of progesterone in the blood of pregnant in I and II trimesters of gestation with an unfavorable outcome of the pregnancy]. Zhurnal akusherstva i zhenskikh boleznej, 66(4), 32–39. doi: 10.17816/JOWD66432-39 [in Russian].
Gardner, D., & Shobek, D. (2010) Bazisnaya i klinicheskaya e'ndokrinologiya. [Basic and clinical endocrinology]. (Book 1). Moscow: BINOM. [in Russian].
Kulakov, V. I. (2010) Besplodnyj brak. Sovremennye podkhody k diagnostike i lecheniyu [Infertile marriage. Modern approaches to diagnostics and treatment]. Moscow: GE'OTAR-Media. [in Russian].
Likhachev, V. K. (2012) Gormonal'naya diagnostika v praktike akushera-ginekologa: Rukovodstvo dlya vrachej [Hormonal diagnostics in the practice of obstetrician-gynecologist: A guide for doctors]. Kyiv. [in Russian].
Nagornaya, V. F. (2015) Giperandrogeniya kak prichina nevynashivaniya beremennosti [Hyperandrogenism as the cause of miscarriage]. Akusherstvo. Ginekologiya. Genetika, 2, 12–17. [in Russian].
(2008) Klinichnyi protokol «Nevynoshuvannia vahitnosti» [The clinical protocol «Noncarrying of pregnancy»]. [in Ukrainian].
(2013) Nakaz MOZU «Pro zatverdzhennia Poriadku zastosuvannia dopomizhnykh reproduktyvnykh tekhnolohii v Ukraini» №787 [The order of the Ministry of Health of Ukraine «On approval of the procedure for the use of assisted reproductive technologies in Ukraine» №787]. [in Ukrainian].
Tronko, M. D., Komisarenko, V. P., Antypkin, Y. G., Kaminskyi, V. V., Shupyk, P. L., & Tatarchuk, T. F. (2016) Natsionalnyi konsensus shchodo vedennia patsiientiv iz hiperprolaktynemiieiu (2016) [National consensus on the management of patients with hyperprolactinemia (2016)]. Reproduktyvna endokrynolohiia, 4(30), 8–18. [in Ukrainian].
Rykova, O. V. (2015) Sindrom polikistoznykh yaichnikov: sovremennye vozmozhnosti laboratornoj diagnostiki. Obzor rukovodstva po diagnostike i lecheniyu sindroma polikistoznykh yaichnikov [Polycystic ovary syndrome: current laboratory diagnostic capabilities. Review of guidelines for the diagnostics and treatment]. Mezhdunarodnyj e'ndokrinologicheskij zhurnal, 7(71), 69–75. [in Russian].
Sidel'nikova, V. M. (2005) Privychnaya poterya beremennosti [Recurrent pregnancy loss]. Moscow: Triad-X. [in Russian].
Kaur, R., & Gupta, K. (2016) Endocrine dysfunction and recurrent spontaneous abortion: An overview. Int J Appl Basic Med Res., 6(2), 79–83. doi: 10.4103/2229-516X.179024
Ke, R. W. (2014) Endocrine basis for recurrent pregnancy loss. Obstet. Gyn. Clin., 41(1), 103–112. doi: 10.1016/j.ogc.2013.10.003
Saccone, G., Schoen, C., Franasiak, J. M., Scott, R. T., & Berghella, V. (2017) Supplementation with progestogens in the first trimester of pregnancy to prevent miscarriage in women with unexplained recurrent miscarriage: a systematic review and meta-analysis of randomized, controlled trials. Fertil. Steril., 107(2), 430–438.e3. doi: 10.1016/j.fertnstert.2016.10.031
Jeve, Y. B., & Davies, W. (2014) Evidence-based management of recurrent miscarriages. J. Hum. Reprod. Sci., 7(3), 159–169. doi: 10.4103/0974-1208.142475.
Zhu, X. X., Ye, H., & Fu, Y. L. (2017) Use of Utrogestan during controlled ovarian hyperstimulation in normally ovulating women undergoing in vitro fertilization or intracytoplasmic sperm injection treatments in combination with a “freeze all” strategy: a randomized controlled dose-finding study of 100 mg versus 200 mg. Fertility and Sterility, 107(2), 379–386.e4. doi: 10.1016/j.fertnstert.2016.10.030
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