Neopterin and the anti-Mullerian hormone's role in Unexplained Recurrent Pregnancy Loss

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Background: Recurrent pregnancy loss were prevalent complications in pregnancy. Immunological biomarkers as Neopterin used as a marker in recurrent pregnancy loss. Anti-Mullerian hormone is a reliable marker of the ovarian reserve. Therefore, was also considered as a marker to evaluate its role in the recurrent pregnancy losses. This study was conducted to assess whether neopterin and Anti- Mullerian hormone can be used as a marker in the condition of unexplained recurrent pregnancy loss. Material’s and Methods: A case control study was done in the Department of Obstetrics and Gynecology Salahdeen general hospital in Tikrit city from first January to thirty of August 2020. One hundred patient enrolled in the study. Study contains two groups:1- Group A as cases. 2- Group B as control group. The data collection done through:1-Designed closed and open-ended questionnaire, 2- Laboratory investigations of : Serum Neopterin and Anti-Mullerian hormone levels using enzyme-linked immunosorbent assay. Results: Mean Neopterin level was significantly higher among cases (24.3±10.7)nml/l than control group (2.9±1.1) nml/l. Mean Neopterin level increased with increasing abortion number. It was significantly higher among those with ≥5 abortions (30.02±10.04) nml/l than those with (3-4) and 2 abortions (28.7±15.29) nml/l and (20.1±0.03) nml/l. The mean Neopterin level increased with increasing age among cases and controls. Among cases was (28.7±12.03) nmol/L among those aged (31- 35) year, which was higher than those aged (18-25), and those aged (26-35) years Mean Anti-Mullerian hormone level was significantly lower among cases (0.8±0.6) ng/ml than control group (5.01±2.7) ng/ml. Mean Anti-Mullerian hormone level was significantly higher among those with 2 abortions (1.06±0.7) ng/ml than those with (3-4) and 5 abortions (0.6±0.56) ng/ml and (0.97±0.4) ng/ml respectively. Among case the mean AMH level was lower among those aged (31-35) years (0.5±0.31) ng/ml than those aged (26-30), and (18-25) years (0.8±0.7) ng/ml, (0.97±0.7) ng/ml, respectively Conclusions: A statistically significant high Mean Neopterin level among cases and its increased mean Neopterin level with increasing abortion number. A statistically significant low levels of mean Anti-Mullerian hormone level among cases, more reduction in its level with increasing abortion. This pioneer study in Iraq, determined the significant association between the unexplained recurrent pregnancy loss with the increased levels of Neopterin and its effect on Anti-Mullerian hormone that lead to recurrent pregnancy loss.