Prevention of miscarriage following ovulation induction in women with endocrine infertility in anamnesis
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 va...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Zaporozhye State Medical University
2019-07-01
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| Series: | Zaporožskij Medicinskij Žurnal |
| Subjects: | |
| Online Access: | http://zmj.zsmu.edu.ua/article/view/173345/173877 |
| Summary: | 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. |
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| ISSN: | 2306-4145 2310-1210 |