Many factors have been identified as causes of the recurrent pregnancy loss (RPL) experienced by 2-4% of reproductive-age couples.
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Many factors have been identified as causes of the recurrent pregnancy loss (RPL) experienced by 2-4% of reproductive-age couples. But for the 30-40% whose miscarriages are unexplained, the heartache of losing their hoped-for babies is compounded by not knowing the reason why it happened or what they can do to try to carry the next pregnancy to term. Much work is being done to identify correctible causes that contribute to RPL and certain conditions have been associated with it. Women with polycystic ovarian syndrome, who experience a complex of symptoms, including anovulation, androgen excess, and insulin resistance, also have an increased frequency of RPL. Researchers at the University of Tennessee Health Science Center decided to investigate the connection between insulin resistance and RPL beyond the population of patients with polycystic ovarian syndrome.
Patients referred to the Center between the ages of 22 and 46, who had had two or more consecutive pregnancy losses with the same partner were evaluated; they were given a hysterosalpingogram or hysteroscopy, chromosomal evaluation, and hormone, antibody, and infectious disease testing. Diabetic and pregnant women were excluded from the study, as were women who had had viable, ectopic, or molar pregnancies interspersed with their pregnancy losses. Seventy-four patients qualified for the study and were matched for age, race, and body mass index with 74 controls- fertile, non-pregnant, non-diabetic women without RPL who had at least one child. Both groups were tested for fasting insulin and glucose levels. Twenty of the 74 women with RPL (27%) were insulin resistant contrasted with only 7 of the 74 controls (9.5%). While the physiologic mechanisms associating insulin resistance have not been identified, one hypothesis suggests that insulin resistance causes a diabetic-like state in the fetal environment that results in increased first trimester loss.
HIGHLIGHTS IN FERTILITY AND STERILITY
Vol. 78, No. 3, September 2002
The American Society for Reproductive Medicine, founded in 1944, is an organization of more than 8,500 physicians, researchers, nursed, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology. Affiliated societies include the Society for Assisted Reproductive Technology, the Society for Male Reproduction and Urology, the Society for Reproductive Endocrinology and Infertility, and the Society of Reproductive Surgeons.
(Craig, et al, Increased prevalence of insulin resistance on women with a history of recurrent pregnancy loss, Fertility and Sterility, Vol.78, No. 3, September 2002)
For more information go to www.asrm.org