Inadequate Luteal Phase Research Articles

Agreement Between the 2- and 3-Step Methods for Identifying Subtle Menstrual Disturbances.

To investigate the agreement between the 2- and 3-step methods for the detection of SMDs. Menstrual cycles (MCs, 98) of 59 athletes were assessed using the 2- and 3-step methods. Regular-length MCs (ie,≥21 and ≤35d) were classified as either having no SMD (luteal phase length ≥10d, midluteal progesterone concentration ≥16nmol·L-1, and being ovulatory) or having an SMD (eg,short luteal phase [<10d], inadequate luteal phase [midluteal progesterone concentration <16nmol·L-1], or being anovulatory). Method agreement was assessed using theMcNemar test and Cohen kappa (κ). Substantial agreement was observed between methods (κ = .72; 95% CI, .53-.91), but the 2-step method did not detect all MCs with an SMD, resulting in evidence of systematic bias (χ2 = 5.14; P = .023). The 2-step method detected 61.1% of MCs that had an SMD ([51.4, 70.8]), as verified using the 3-step method, and correctly identified 100% of MCs without an SMD. MCs classified as being disturbed using the 2-step method could be considered valid evidence of SMDs. However, MCs classified without SMDs do not definitively confirm their absence, due to the proven underdetection via the 2-step method.

Female sex steroids and epilepsy: Part 1. A review of reciprocal changes in reproductive systems, cycles, and seizures.

Seizures, antiseizure medications, and the reproductive systems are reciprocally entwined. In Section2 of this review, we outline how seizures may affect the hypothalamic-pituitary-gonadal axis, thereby altering sex steroids, and changes in sex steroids across the menstrual cycle and changes in pharmacokinetics during pregnancy may alter seizure susceptibility. The literature indicates that females with epilepsy experience increased rates of menstrual disturbances and reproductive endocrine disorders. The latter include polycystic ovary syndrome, especially for females on valproate. Studies of fertility have yielded mixed results. We aim to summarize and attempt to detangle the existing knowledge on these reciprocal interactions. The menstrual cycle causes changes in seizure intensity and frequency for many females. When this occurs perimenstrually, during ovulation, or in association with an inadequate luteal phase, it is termed catamenial epilepsy. There is a clear biophysiological rationale for how the key female reproductive neurosteroids interact with the brain to alter the seizure threshold, and Section3 outlines this important relationship. Critically, what remains unknown is the specific pathophysiology of catamenial epilepsy that describes why not all females are affected. There is a need for mechanism-focused investigations in humans to uncover the complexity of the relationship between reproductive hormones, menstrual cycles, and the brain.

Hyperprolactinemia among the patients of menstrual disorders in a tertiary care hospital

Background: Menstrual disorders are a common clinical problem due to multiple causes. Hyperprolactinemia, is disorders of hypothalamic-pituitary axis in young women, is usually associated with amenorrhea, oligomenorrhea, anovulation, and ovulatory cycles with short or inadequate luteal phase, and galactorrhoea. Menstrual disorder affects physical and mental health of every woman. Aims and Objectives: The aim of the study was to know hyperprolactinemia among the patients of menstrual disorders in a tertiary care hospital. Materials and Methods: Women with menstrual irregularities attending Gynae outpatient department and admitted initially checked clinically and their serum prolactin level were measured. Women in reproductive age group (15–45 years) with complain of abnormal uterine bleeding were included in the study. Menopausal women, women with organic diseases in uterus and cervix, and pregnant women were excluded from the study. Results: Prolactin level is statistically significant with age (P = 0.011). The patients from age group of 20 to 35 years had high proportion (14.4%) of hyperprolactinemia followed by age group &lt;20 years. (12.9%) and &gt;35 years (12.9%). The women presenting with menstrual disorders enlisted in the study were evaluated on the basis of their sociodemographic parameters. About (15.5%) were below 20 years. About (27%) were above 35 years and majority of the women (57.5%) enrolled in the study were from age group of 2035 years of age. Serum prolactin level was observed in 15.4% in patients with frequent menses, 9.1% in patients with metrorrhagia and 7.7% in patients with heavy menstrual bleeding. That result was statistically significant with P = 0.039. Conclusion: Serum prolactin level should be evaluated in every patient of menstrual disorders.

Dydrogesterone supplementation in addition to routine micronized progesterone administration for luteal support in cycles triggered with lone GnRH agonist results in an acceptable pregnancy rate and avoids the need to freeze embryos.

Ovarian hyperstimulation syndrome (OHSS) is reduced when using antagonist cycle with gonadotrophin releasing hormone (GnRH) agonist trigger before ovum pick up. This trigger induces short luteinizing hormone (LH) and follicle stimulating hormone (FSH) peaks, resulting in an inadequate luteal phase and a reduced implantation rate. We assessed whether the luteal phase can be rescued by supplementing with oral dydrogesterone (duphaston) in antagonist cycles after a lone GnRH agonist trigger. A retrospective cohort study. The study group (N.=123) included women who underwent IVF. Patients received a GnRH-antagonist with a lone GnRH-agonist trigger due to imminent OHSS. The control group (N.=374) included patients who underwent a standard antagonist protocol with a dual trigger of a GnRH-agonist and human chorionic gonadotrophin (hCG). All the patients were treated with micronized progesterone (utrogestan) for luteal phase support. Study patients were given duphaston in addition. The fertilization rate was comparable between the two groups. The mean number of embryos transferred, the clinical pregnancy rate and the take-home baby rate were comparable between groups (1.5±0.6 vs. 1.5±0.5 and 46.3% vs. 41.2%, and 66.7% vs. 87.7%, respectively). No OHSS event was reported in either group. This study was the first to evaluate outcomes of duphaston supplementation for luteal support in an antagonist cycle with lone GnRH agonist trigger. The functionality of the luteal phase of those cycles could be restored by adding duphaston. This approach was found to be safe and prevented the need to postpone embryo transfer in case of pending OHSS.

P–667 Dydrogesterone supplementation in cycles triggered with lone GnRH agonist for final oocyte maturation resulted in an acceptable pregnancy rate

Abstract Study question Can luteal oral Dydrogesterone (Duphaston) supplementation in an antagonist cycle after a lone GnRH agonist trigger rescue the luteal phase, allowing the possibility to peruse with fresh embryo transfer? Summary answer Functionality of the luteal phase in an antagonist cycle after a lone GnRH agonist trigger can be restored by adding Duphaston to conventional luteal support. What is known already Ovarian hyperstimulation syndrome (OHSS) is dramatically reduced when using antagonist cycle with lone GnRH agonist trigger before ovum pick up. This trigger induces short luteinizing hormone (LH) and follicle-stimulating hormone (FSH) peaks, associated with reduced progesterone and estrogen levels during the luteal phase. They cause an inadequate luteal phase and a significantly reduced implantation rate leading to a freeze all practice in those cycles. Study design, size, duration A retrospective cohort study. The study group (n = 123) included women that underwent in vitro fertilization cycles from January 2017 to May 2020. Patients received a GnRH-antagonist with a lone GnRH-agonist trigger due to imminent OSHH. The control group (n = 374) included patients under 35 years old that, during the same time period, underwent a standard antagonist protocol with a dual trigger of a GnRH-agonist and hCG. Participants/materials, setting, methods Study patients were given Dydrogesterone (Duphaston) in addition to micronized progesterone vaginal pills (Utrogestan) for luteal support (Duphaston group). Controls were treated conventionally with Utrogestan for luteal phase support (hCG group). The outcomes measured were pregnancy rate and OHSS events. Main results and the role of chance Our study was the first to evaluate the addition of Duphaston to standard luteal phase support in an antagonist cycle triggered by a lone GnRH agonist before a fresh embryo transfer. The mean number of oocytes retrieved and estradiol plasma levels were significantly higher in the Duphaston group than in the hCG group (16.9 ±7.7 vs. 10.8 ± 5.3 and 11658 ± 5280 pmol/L vs. 6048 ± 3059 pmol/L, respectively). The fertilization rate was comparable between the two groups. The mean number of embryos transferred and the clinical pregnancy rate were also comparable between groups (1.5 ± 0.6 vs 1.5 ± 0.5 and 46.3% vs 40.9%, respectively). No OHSS event was reported in either group. Limitations, reasons for caution This retrospective study may carry an inherent selection and information bias, derived from medical record coding. An additional limitation was the choice of physician for the lone GnRH trigger, which may have introduced a selection bias and another potential caveat was the relatively small sample size of our study groups. Wider implications of the findings: The addition of Duphaston to conventional luteal support could effectively salvage the luteal phase without increasing the risk for OHSS. This enables, to peruse in those cycle, with fresh embryo transfer, avoiding the need to freeze all the embryos and postponed embryo transfer. Leading to lower psychological burden and costs. Trial registration number 0632–20-HMO

Low dose hCG supplementation in a Gn-RH-agonist trigger protocol is associated with worse pregnancy outcomes: a retrospective cohort study

BackgroundA number of studies have looked at dual triggers with hCG and GnRH agonist (GnRHa) in varying doses, but the question remains: what is the optimal dose of hCG to minimize ovarian hyperstimulation syndrome (OHSS) and still offer adequate pregnancy rates? The purpose of this study was to compare pregnancy and OHSS rates following dual trigger for oocyte maturation with GnRHa and a low-dose hCG versus hCG alone. A secondary objective was the assess pregnancy outcomes in subsequent frozen cycles for the same population.MethodsA total of 963 women < 41 years old, with a BMI 18–40 kg/m2 and an AMH > 2 ng/mL who underwent fresh autologous in vitro fertilization (IVF) with GnRH antagonist protocol at a University-based fertility center were included in this retrospective cohort study. Those who received a low dose dual trigger with hCG (1000u) and GnRHa (2 mg) were compared to those who received hCG alone (10,000u hCG/250-500 μg Ovidrel). Differences in implantation rates, pregnancy, live birth, and OHSS were investigated.ResultsThe dual trigger group was younger (mean 33.6 vs 34.1 years), had a higher AMH (6.3 vs 4.9 ng/mL,) more oocytes retrieved (18.1 vs 14.9) and a higher fertilized oocyte rate (80% vs 77%) compared with the hCG only group. Yet, the dual trigger group had a lower probability of clinical pregnancy (gestational sac, 43.4% vs 52.8%) and live birth (33.4% vs 45.8%), all of which were statistically significant. There were 3 cases of OHSS, all in the hCG-only trigger group. In subsequent frozen cycles, pregnancy rates were comparable between the two groups.ConclusionsThe dual trigger group had a better prognosis based on age and AMH levels and had better stimulation outcomes, but significantly worse pregnancy outcomes, suggesting the low dose hCG (1000u) in the dual trigger may not have provided adequate luteal support, compared to an hCG-only trigger (10,000u hCG/250-500 μg Ovidrel). Interestingly, the pregnancy rates were comparable in subsequent frozen cycles, further supporting the hypothesis that the issue lies in inadequate luteal phase support, rather than embryo quality. Based on these findings, our program has changed the protocol to 1500u of hCG in a dual trigger.

Serum progesterone level and ongoing pregnancy rate following frozen-thawed embryo transfer after artificial endometrial preparation: a monocentric retrospective study

IntroductionIn some studies, early pregnancy loss (EPL) rate is higher with artificial cycle (AC) endometrial preparation for frozen-thawed embryo (FET) transfer than with other protocols, even though pregnancy rates are similar. An inadequate luteal phase support could explain these findings. The aim of this study was to compare, among the patients who had a pregnancy after FET with AC endometrial preparation, serum progesterone (PG) levels between those who experienced an EPL or an ongoing pregnancy. Material and methodsA monocentric retrospective cohort study, conducted at a University affiliated fertility center, studied 130 FET cycles with AC endometrial preparation between June 2016 and July 2017. Serum PG rates were compared according to reproductive outcomes and to endometrial preparation protocol on day 10 or 12 after FET (PG0) according to the embryo stage, and every 48h in case of pregnancy (i.e. PG1; PG2). ResultsAmong patients who had a pregnancy after FET with AC (n=33), serum PG levels were higher in case of an ongoing pregnancy than EPL, only significantly at PG1 (PG0 12.4ng/mL [7.5−14.6] vs 8.2ng/mL [6.0−13.0], p= 0.320; PG1 15.0 ng/mL [14.0−15.9] vs 8.5ng/mL [5.9−13.8], p= 0.048). DiscussionWe found that serum PG level was lower in women experiencing early pregnancy loss after FET with AC endometrial preparation, potentially reflecting a lack of appropriate luteal phase support with PG. A cycle AC test, monitoring serum PG levels after its steady state, could detect this lack of PG, allowing physicians to adapt PG supplementation.

Characteristics and causes of the inadequate corpus luteum

An inadequate luteal phase occurs in domestic ruminants in several physiological situations (e.g. puberty, post partum), and also following the induction of ovulation in anoestrous ewes with GnRH treatment. The induced corpora lutea (CL) initially developed, but then regressed rapidly after Day 4, unless the animals had been primed with progesterone before GnRH therapy or hysterectomized. Significant increases in prostaglandin F-2 alpha metabolite (PGFM) secretion and coincident peaks of oxytocin and PGFM occurred around the time of premature regression. Endometrial oxytocin receptors were also detectable at this time in ewes which had abnormal luteal phases, but not in ewes which had been progesterone primed and thus had normal luteal phases. This suggests that the presence or otherwise of the oxytocin receptor during the early luteal phase may be crucial in determining whether the CL has a short or normal lifespan. These results show that an inadequate luteal phase is often caused by the premature induction of luteolysis and the presence of the endometrial oxytocin receptor in necessary for this occurrence. This receptor in turn is controlled by the steroid environment to which the uterus has previously been exposed.

Genetic control of reproduction in dairy cows under grazing conditions.

Fertility performance is a key driver of the efficiency and profitability of seasonal-calving pasture- based systems of milk production. Since the 1990’s and early 2000’s, most countries have placed varying levels of emphasis on fertility and survivability traits, and phenotypic performance has started to improve. In recent years, the underlying physiological mechanisms responsible for good or poor phenotypic fertility have started to be unravelled. It is apparent that poor genetic merit for fertility traits is associated with multiple defects across a range of organs and tissues that are antagonistic to achieving satisfactory fertility performance. The principal defects include excessive mobilisation of body condition score (BCS), unfavourable metabolic status, delayed resumption of cyclicity, increased incidence of endometritis, dysfunctional estrous expression, and inadequate luteal phase progesterone concentrations. At a tissue level, coordinated changes in gene expression in different tissues have been observed to orchestrate more favourable BCS, uterine environment and corpus luteum function. Interestingly, cows with poor genetic merit for fertility traits have up-regulated inflammation and immune response pathways in multiple tissues. Sire genetic merit for daughter fertility traits is improving rapidly in the dairy breeds, especially in the predominant Holstein and Friesian breeds. With advances in animal breeding, especially genomic technologies to identify superior sires, genetic merit for fertility traits can be improved much more quickly than they initially declined.

Hiperprolactinemia en mujeres infértiles

OBJETIVOS: Identificar las características de pacientes con infertilidad e hiperprolactinemia (HPRL). MÉTODO: Se revisó 464 historias clínicas de 39 mujeres del Servicio de Infertilidad del Hospital Arzobispo Loayza (HAL); seleccionándose las que tenían por lo menos 2 dosajes de prolactina (PRL) sérica mayores de 25 ng/ml, edades entre 15 y 42 años, tiempo de infertilidad &gt; 1 año y vida sexual activa. RESULTADOS: Las pacientes con HPRL representan el 8,4% de mujeres infértiles del HAL. Del ellos, 56,4% tenía PRL entre 26 y 50 ng/mL; edad promedio de 33,1 años y tiempo de enfermedad de 5,4 años. Los antecedentes más relevantes fueron: aborto (48,7%), galactorrea (35,9%), trastornos menstruales (25,6%), relaciones sexuales insatisfactorias (23,1%) y ejercicio físico (23,1%). Los hallazgos clínicos más importantes fueron: galactorrea (46,2%), índice de masa corporal &gt; 25 (44,8%) y fase lútea inadecuada (43,6%). Los diagnósticos etiológicos más frecuentes fueron: HPRL idiopática (53,8%) y fisiológica (20,5%). Las pacientes con microadenoma de hipófisis tuvieron niveles de PRL significativamente mayores que mujeres con otras etiologías de HPRL (p&lt;0,05). CONCLUSIONES: La prevalencia de HPRL en pacientes infértiles fue menor de lo esperado. Las pacientes con HPRL acudieron tarde por ayuda médica.

Genetic control of reproduction in dairy cows

The advent of AI has markedly improved the production potential of dairy cows in all systems of production and transformed the dairy industry in many countries. Unfortunately, for many years breeding objectives focused solely on milk production. This resulted in a major decline in genetic merit for fertility traits. In recent years, the underlying physiological mechanisms responsible for this decline have started to be unravelled. It is apparent that poor genetic merit for fertility traits is associated with multiple defects across a range of organs and tissues that are antagonistic to achieving satisfactory fertility performance. The principal defects include excessive mobilisation of body condition score, unfavourable metabolic status, delayed resumption of cyclicity, increased incidence of endometritis, dysfunctional oestrus expression and inadequate luteal phase progesterone concentrations. On a positive note, it is possible to identify sires that combine good milk production traits with good fertility traits. Sire genetic merit for daughter fertility traits is improving rapidly in the dairy breeds, including the Holstein. With advances in animal breeding, especially genomic technologies, to identify superior sires, genetic merit for fertility traits can be improved much more quickly than they initially declined.

Evaluation of brain-derived neurotrophic factor in menstrual blood and its identification in human endometrium

The presence of high-affinity brain-derived neurotrophic factor receptor Trk B in mouse and in human fetal oocytes, together with the presence of neurotrophins in human follicular fluid suggests a paracrine role for brain-derived neurotrophic factor (BDNF) in female biology. This study aims to evaluate if BDNF is present and quantitatively determined in human menstrual blood and endometrium. Twenty-one women were studied and subdivided in two groups: A, 11 fertile women (27 ± 2 days cycle length) and B, 10 anovulatory women and/or women with inadequate luteal phase (36 ± 2 days cycle length). In fertile women menstrual BDNF levels was higher than plasma (679.3 ± 92.2 vs 301.9 ± 46.7 pg/ml p <0.001). Similarly, in Group B, BDNF in menstrual blood was higher than plasma (386.1 ± 85.2 vs 166.8 ± 24.1 pg/ml p < 0.001). Moreover, both menstrual and plasma BDNF concentrations in Group A were significantly higher respect to Group B (679.3 ± 92.2 vs 386.1 ± 85.2 pg/ml p < 0.001; 301.9 ± 46.7 vs 166.8 ± 24.1 pg/ml p < 0.001). Immunohistochemistry evidence of BDNF in endometrium, during follicular and luteal phase, was also shown. The detection of BDNF in the human menstrual blood and endometrium further supports the role of this neurotrophin in female reproductive function.

Low-dose human chorionic gonadotropin versus estradiol/progesterone luteal phase support in gonadotropin-releasing hormone agonist–triggered assisted reproductive technique cycles: understanding a new approach

It remains unclear how GnRH agonist (GnRHa) triggering affects the luteal phase, so we investigated the luteal phase after GnRHa triggering, supported with conventional E(2)/P with or without low-dose hCG. E(2)/P support, compared with low-dose hCG, induced a shorter luteal phase (11.2 ± 1.1 vs. 15.0 ± 1.6 days) and fewer subjective complaints (0 vs. 42%), whereas hCG caused more free fluid accumulation and enlarged ovaries than E(2)/P alone. Steroids and low-dose hCG differentially affected corpus luteum function, ovarian size, free fluid accumulation, and patient comfort.

Gonadotropin-releasing hormone agonist to induce final oocyte maturation prevents the development of ovarian hyperstimulation syndrome in high-risk patients and leads to improved clinical outcomes compared with coasting

Ninety-four women undergoing IVF with peak E2 level>4000 pg/mL received leuprolide acetate (LA) trigger (LA trigger group) or had gonadotropins withheld for one or more days (coasting group) followed by hCG trigger, unless cycle cancellation occurred. There were no cases of ovarian hyperstimulation syndrome in either group, and the LA trigger group had significantly more oocytes retrieved (26.9+/-9.5 vs. 17.7+/-9.3) P<0.001, more normally fertilized oocytes (15.0+/-7.8 vs. 10.3+/-6.3) P=0.01, and higher clinical and ongoing pregnancy rates than the coasting group (52.5% vs. 27.2%; 49.2% vs. 24.2%, P=0.02 for both comparisons, respectively).

Reproductive hormonal changes and catamenial pattern in adolescent females with epilepsy

We aimed to evaluate the effect of epilepsy on the reproductive hormones levels among female patients, and to investigate the frequency of catamenial pattern of seizures. A total of 42 female patients with epilepsy and 21 healthy females (control group) were included. Subjects were at least 2 years postmenarche with regular cycles. Symptoms of premenstrual syndrome (PMS) were assessed using calendar of premenstrual experience scoring. Patients were evaluated for catamenial pattern of seizures. Levels of FSH, LH, estradiol (E), and progesterone (P) were assessed for all subjects in the three phases of the cycles. Pelvi-abdominal ultrasound was performed near time of ovulation, to follow up size of mature follicle. Symptoms of PMS were not different in patients and controls, or in patients with and those without catamenial tendency. In both perimenstrual (M) and midluteal phases, FSH and P levels were lower and E/P ratio higher in patients group. There was a catamenial pattern of seizures in 31% of patients (53.8% M C(1); 46.15% inadequate luteal phase C(3)pattern). Patients with C(3)pattern showed lower P levels in the midluteal phase compared to patients with noncatamenial pattern, to those with C(1)pattern or to controls. Patients with C(1)pattern had lower P levels than controls in the M phase. There was evident disruption in the reproductive hormones in female patients with epilepsy with lower FSH and P levels and higher E/P ratio. A total of 31% of patients showed catamenial pattern of seizures (C(1)and C(3)patterns) that was significantly related to P withdrawal.

Effects of a single Silastic® contraceptive implant containing nomegestrol acetate (Uniplant) on endometrial morphology and ovarian function for 1 year

Purpose This study was undertaken to evaluate the effects of a subdermal implant containing nomegestrol acetate (Uniplant) on endometrial histology and ovarian function. Methods Twenty healthy female volunteers of reproductive age were included and completed a menstrual diary throughout the study. Hysteroscopy, transvaginal sonography and blood sampling were performed prior to implant insertion (control cycle) and following 6 and 12 months of Uniplant use. Transvaginal sonography was performed every other day from Day 8 of the cycle up to the obtainment of sonographic evidence of a 12-mm follicle, then every day until the obtainment of sonographic evidence of follicular rupture and thereafter every other day until the next menstrual bleeding. Blood samples were taken for the measurement of estradiol, follicle-stimulating hormone, luteinizing hormone and progesterone on the same days on which transvaginal sonography was performed. The implants were removed after 1 year. Results Twenty percent of cycles were ovulatory, and 80% were anovulatory. The development of persistent nonluteinized follicle occurred in 40% of all cycles studied, inadequate luteal phase occurred in 20% of cycles and no follicular development occurred in 40%. Endometrial thickness remained below 8 mm in all cycles studied. Alterations in endometrial vascularization were observed in all treated cycles. Conclusion Our results suggest that this long-acting contraceptive method affects follicular growth and endometrial vascularization, disrupts endometrial architecture and leads to inadequate luteal phase.

P-798: Induction of oocyte maturation with GnRH agonist in high-risk patients undergoing IVF treatment does not adversely affect implantation rate

Previous studies have suggested that GnRH agonist trigger during IVF treatment may adversely affect implantation rates. This may be due to inadequate luteal phase and early pregnancy steroidal concentrations induced by early luteolysis. We evaluated the effect of GnRH agonist trigger on implantation and pregnancy rates in high-risk patients who used a different luteal phase steroidal supplementation protocol than that used in previous studies.

Susceptibility to Energy-Related Menstrual Disturbances is Reduced with Increased Age

PURPOSE: Although energy deficiency is known to disrupt reproductive function in exercising women, no studies have examined whether the susceptibility to menstrual disturbances is altered with increased age. Therefore, the purpose of this study was to determine whether increased age is associated with reduced susceptibility to menstrual disturbances caused by chronic energy deficiency. METHODS: A subset of twenty-four premenopausal women (12 young and 12 middle aged) from a larger study were matched according to the amount weight lost during a three month diet and exercise intervention. Menstrual status was assessed with daily urine samples and measurement of estrogen (E1 G) and progesterone (PdG) conjugates using ELISA. The occurrence of menstrual disturbances, i.e., short luteal phases, inadequate luteal phases, oligomenorrheic cycles, and anovulatory cycles was quantified according to the number of defects/number of cycles observed. Independent samples t-tests were conducted to determine if there was a significant difference between younger and older women in the occurrence of menstrual disturbances. RESULTS: The results are shown below:TableCONCLUSIONS: Older age was associated with significantly fewer disturbances in response to weight loss resulting from a diet and exercise intervention. These results suggest that factor(s) associated with increased age confer protection against menstrual disturbances caused by energy deficiency.

Effects of Vaginal Progesterone on Pain and Uterine Contractility in Patients with Threatened Abortion before Twelve Weeks of Pregnancy

Fifty women with previous diagnosis of inadequate luteal phase and threatened abortion underwent a prospective, randomized, double-blind study in one medical center carried out with a parallel trial. The primary objective was to establish the effects of vaginal progesterone (Crinone 8%) in reducing both pain and uterine contractions (UCs). The gel with or without (placebo) vaginal progesterone was administered once a day since the diagnosis of threatened abortion and for 5 days. The efficacy on pain symptom amelioration was evaluated by a 5-score intensity gradation, while the UCs were evaluated by ultrasound. The secondary objective of the study was to evaluate the outcome of the pregnancies. The use of progesterone was effective both on pain relief and on the frequency of the UCs that decreased after 5 days of vaginal progesterone administration (P < 0.005). The evaluation of the ongoing pregnancy and spontaneous abortion in both study groups after 60 days showed that 4 patients of group A and 8 patients of group B miscarried (P < 0.05). In conclusion, patients with threatened abortion benefit from vaginal progesterone by a reduction of UCs and pain. The use of vaginal progesterone improved the outcome of pregnancies complicated by threatened abortion and previous diagnosis of inadequate luteal phase.

A study of pregnancy loss in 352 women with recurrent miscarriages.

The aim of the study was to investigate the type of pregnancy loss (PL) in women with recurrent miscarriages. The study population included 411 women with a history of recurrent pregnancy loss (RPL) attending the Recurrent Miscarriage Clinic of the 2nd Department of Obstetrics and Gynecology, University of Athens (tertiary referral center). Subjects were divided in groups according to their underlying pathology and in some of them appropriate treatment was applied. The study of the 323 pregnancies achieved after referral, revealed that the PL after ultrasonographic detection of fetal heart (FH) is overall increased, is more common in women with anatomical uterine anomalies and unexplained RPL, and treatment reduces its rate in women with anatomical uterine anomalies and an inadequate luteal phase. The PL before the detection of FH is reduced after treatment in women with thrombotic tendency and an inadequate luteal phase.