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Recurrent spontaneous abortion and polycystic ovarian disease: comparison of two regimens to induce ovulation
1Department of Obstetrics and Gynaecology, St George's Hospital, London.
Objective:
To determine whether pituitary suppression before induction of ovulation reduces the rate of spontaneous abortion in women with polycystic ovarian disease and primary recurrent spontaneous abortions.
Design:
Closed, randomised, sequential trial. Pairs of women were allocated to each treatment by the toss of a coin.
Setting:
Supraregional clinic for women who had had recurrent spontaneous abortions.
Subjects:
Forty two women with polycystic ovarian disease and primary recurrent spontaneous abortions.
Interventions:
Ovulation was induced by clomiphene or pituitary suppression with buserelin followed by pure follicle stimulating hormone.
Main Outcome Measures:
Preference for a particular treatment was noted. A preference occurred when one woman in a pair had a successful pregnancy (defined as one of over 12 weeks' gestation) and one had a spontaneous abortion; the preference was for the treatment resulting in the successful pregnancy.
Results:
Spontaneous abortions occurred in 11 of 20 women given clomiphene compared with two of 20 who had pituitary suppression. Eleven preferences were found for buserelin and two for clomiphene. In seven pairs both women had successful pregnancies. One pair was discarded because one of the women did not become pregnant. The ratio of luteinising hormone concentration to follicular diameter was found to be a possible diagnostic indicator of spontaneous abortion.
Conclusion:
Pituitary suppression before induction of ovulation significantly reduces the risk of spontaneous abortion in women with polycystic ovarian disease and primary recurrent spontaneous abortions.