Hormonal disorders

There are a number of hormonal disorders that are commonly associated with recurrent pregnancy loss.

The four most common hormonal disorders are:

1. Progesterone

Low levels of progesterone hormone are frequently found in women whose pregnancies are miscarrying.

However, low progesterone levels in early pregnancy reflect the fact that the pregnancy has not implanted successfully in the womb lining, rather than because the developing placenta is not producing enough progesterone to maintain the pregnancy. This is an important point - low progesterone is the effect not the cause of the miscarriage. This explains why giving women progesterone and/or hCG hormone injections in early pregnancy does not improve pregnancy outcome.

The exception to this is when we take advantage of the immunosuppressant effects of progesterone in women who are found to have immune problems.

2. Follicle Stimulating Hormone

Follicle stimulating hormone (FSH) drives the ovary to start growing follicles. Unfortunately, some women with a history of pregnancy loss are also found to have high FSH levels because their ovaries have become prematurely menopausal. Although rare, this is obviously a very important problem to identify. If FSH levels are high, the appropriate next step is referral to a fertility specialist.

3. The uterine lining (the endometrium)

At the present time the only way of determining the response of the endometrium at the time of implantation is to sample it and look at the histological (microscopic) evidence of the state of the tissues. An endometrial biopsy can be performed towards the end of your cycle (approximately day 26). This biopsy is no more uncomfortable than undergoing a cervical smear test. However, in order to be able to obtain the most useful information from the biopsy, it is important to know exactly the time of ovulation.

4. Polycystic ovarian syndrome

A pelvic ultrasound scan shows that many women with recurrent miscarriage have polycystic ovaries (PCO). This is a common condition, found in 25% of all women, in which there are multiple small cysts within the ovary. These cysts are not dangerous and cannot be removed as they are within the ovary.

Polycystic ovaries can sometimes be associated with a number of hormonal imbalances such as increased production of LH and testosterone. A number of carefully designed studies have shown that neither PCO nor high LH levels are a cause for recurrent miscarriages.