Does suppressing luteinising hormone secretion reduce the miscarriage rate? Results of a randomised controlled trial.
OBJECTIVE
To determine whether prepregnancy pituitary suppression of luteinising hormone secretion with a luteinising hormone releasing hormone analogue improves the outcome of pregnancy in ovulatory women with a history of recurrent miscarriage, polycystic ovaries, and hypersecretion of luteinising hormone.


METHODS
Randomised controlled trial.


METHODS
Specialist recurrent miscarriage clinic.


METHODS
106 women with a history of three or more consecutive first trimester miscarriages, polycystic ovaries, and hypersecretion of luteinising hormone.


METHODS
Women were randomised before conception to receive pituitary suppression with a luteinising hormone releasing hormone analogue followed by low dose ovulation induction and luteal phase progesterone (group 1) or were allowed to ovulate spontaneously and then given luteal phase progesterone alone or luteal phase placebo alone (group 2). No drugs were prescribed in pregnancy.


METHODS
Conception and live birth rates over six cycles.


RESULTS
Conception rates in the pituitary suppression and luteal phase support groups were 80% (40/50 women) and 82% (46/56) respectively (NS). Live birth rates were 65% (26/40) and 76% (35/46) respectively (NS). In the luteal phase support group there was no difference in the outcome of pregnancy between women given progesterone and those given placebo pessaries. Live birth rates from an intention to treat analysis were 52% (26/50 pregnancies) in the group given pituitary suppression and 63% (35/56) in the controls (NS).


CONCLUSIONS
Prepregnancy suppression of high luteinising hormone concentrations in ovulatory women with recurrent miscarriage and hypersecretion of luteinising hormone does not improve the outcome of pregnancy. The outcome of pregnancy without pituitary suppression is excellent.
Clifford
K
K
Department of Obstetrics and Gynaecology, St. Mary's Hospital Medical School, London.
Rai
R
R
Watson
H
H
Franks
S
S
Regan
L
L
D000026:Abortion, Habitual / Q000517:prevention & control*; D000328:Adult; D005260:Female; D005498:Follicular Phase; D006801:Humans; D007231:Infant, Newborn; D008183:Luteal Phase; D007986:Luteinizing Hormone / Q000037:antagonists & inhibitors*; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011374:Progesterone / Q000627:therapeutic use*
D011374:Progesterone; D007986:Luteinizing Hormone