Abstract
Recurrent pregnancy loss (RPL) or recurrent miscarriage is a common but devastating occurance in pregnancy and affects at least 2% of all couples (using the definition of 2 or more losses)1 ⚫ RPL needs to be investigated and underlying causes treated due to the high physical, psychological and economic burden of future obstetrical complications ⚫ Thorough investigation generally identifies contributing factors in about 50% of cases ⚫ Likely that a significant number of causative factors remain unexplained and further study is needed ⚫ Restorative reproductive medicine (RRM) seeks to manage infertility and RPL from a systematic multifactorial approach by finding and treating all potential underlying factors contributing to reproductive dysfunction2 ⚫ RRM has been shown to be at least as successful in achieving live births as compared to assisted reproductive technologies (ART)3,4 ⚫ DHEA supplementation has been shown to improve follicular function, spontaneous pregnancy, and live birth rates while hypoandrogenemia (low DHEA) has been associated with increased risk of miscarriage5 ⚫ Low estradiol levels during pregnancy are associated with a higher risk of miscarriage and likewise using DHEA orally during pregnancy has been shown to improve estradiol levels and decrease risk of PL6 39-year-old female with nine previous pregnancies including 4 live births and 5 pregnancy losses ⚫ low progesterone in the luteal phase was found after the 4th pregnancy loss (PL) th PL occurred at 8 weeks despite progesterone ⚫ 5 supplementation and ASA th ⚫ Estradiol levels were found to be low during this 9 pregnancy ⚫ In our care, hypoandrogenemia was also discovered ⚫ RRM multifactorial approach to treatment included follicle stimulation with letrozole and DHEA ⚫ Estradiol levels were followed and DHEA titrated through the 10th pregnancy ⚫ Healthy baby girl delivered at 38+3 weeks ⚫ Low estradiol levels as a cause for RPL should be considered and treated with DHEA supplementation By treating all the potential underlying causative factors, we were able to help this couple successfully conceive and deliver a healthy baby after her 5 pregnancy losses one of which was a late loss. Of particular note is the use of DHEA during pregnancy to titrate and maintain estradiol levels sufficiently high to reduce the risk of miscarriage. Further studies need to be done to establish estradiol thresholds for gestational age and treatment guidelines as low estradiol levels can be a significant factor in RPL.
