Relation of Endocrine Diseases with Recurrent Pregnancy Loss

Luteal Phase Defect and Progesterone Deficiency

Luteal phase defect is an entity in which the corpus luteum is defective, with insufficient progesterone production resulting in retarded endometrial development. Because progesterone is necessary for successful implantation and the maintenance of early pregnancy, progesterone deficiency during the luteal phase is associated with recurrent miscarriage. However, standard diagnostic criteria required to assess the true incidence and effect of luteal phase defect as a cause of recurrent miscarriage are lacking. No convincing studies show that treatment of luteal phase defect improves pregnancy outcome in women with recurrent miscarriage. Still progesterone is widely used in patients with recurrent miscarriages but mostly empirically


Polycystic Ovary Syndrome, Hypersecretion of Luteinizing Hormone, and Hyperandrogenemia

Polycystic ovaries, a high luteinizing hormone (LH) level, and hyperandrogenemia are classic features of PCOS and have been reported as risk factors for recurrent miscarriage. But this is not convincingly proved yet. More recently, the association between PCOS and insulin resistance leading to compensatory hyperinsulinemia has come under scrutiny as a risk factor for recurrent miscarriage. Insulin resistance is associated with a higher rate of miscarriage among women with PCOS undergoing ovulation induction compared with those who are not insulin resistant. Prospective controlled trials are needed to establish this fact

Systemic Endocrine Factors

Diabetes mellitus and thyroid disease are associated with miscarriage, but there is no direct evidence that they contribute to recurrent miscarriage. Women with diabetes who have high hemoglobin A1c levels in the first trimester are at risk for miscarriage and fetal malformation.

In contrast, well-controlled diabetes mellitus is not a risk factor for recurrent miscarriage, nor is treated thyroid dysfunction. The prevalence of diabetes mellitus and thyroid dysfunction in women with recurrent miscarriage is similar to that expected in the general population.