The endocrinological basis of recurrent miscarriages.
OBJECTIVE
This review discusses the endocrinological aspects of recurrent miscarriage based on the literature from January 2004 to January 2005, elaborating on the advances in the field and their impact on diagnosis and management.


RESULTS
Endometrial luteal phase defect is associated with recurrent miscarriage. Fifty years have passed since the diagnostic criteria for dating the endometrial biopsy was established by Noyes et al. This has been the gold standard and last year its accuracy and clinical utility were critically analysed. A Cochrane review has shown a small but statistically significant difference in the live birth rate in the subgroup of women in which progestogen was used to prevent recurrent miscarriage. Endocannabinoids and fatty acid amide hydrolase have been found to have a potential role in signalling for implantation and maintenance of pregnancy.


CONCLUSIONS
Abnormal secretory endometrial changes may adversely affect the early pregnancy outcome. Other dating techniques using biochemical and molecular markers of endometrial function may prove useful in predicting outcome. Use of progestogens with or without estrogens for prevention of recurrent miscarriage needs to be investigated further in larger randomized controlled trials. The role of endocannabinoids and agents modulating their receptors are potentially very exciting areas to be explored further.
Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
Neelam
N
Potdar
Justin C
JC
Konje
D000026:Abortion, Habitual / Q000097:blood / Q000209:etiology / Q000378:metabolism*; D020533:Angiogenesis Inhibitors / Q000502:physiology; D063385:Cannabinoid Receptor Modulators / Q000502:physiology; D010064:Embryo Implantation / Q000502:physiology; D004717:Endometrium / Q000502:physiology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D007694:Killer Cells, Natural / Q000502:physiology; D008183:Luteal Phase; D011085:Polycystic Ovary Syndrome / Q000378:metabolism; D011247:Pregnancy; D011374:Progesterone / Q000097:blood*; D011962:Receptors, FSH / Q000502:physiology
D020533:Angiogenesis Inhibitors; D063385:Cannabinoid Receptor Modulators; D011962:Receptors, FSH; D011374:Progesterone