Pregnancy failure after spontaneous conception or ovulation induction: endocrine causes and treatment

The spontaneous abortion rate in the general population is about 10%. In some women treated with drug regimens for ovulation induction with or without modern assisted reproductive technology (IVF/ICSI etc.) the rate of pregnancy failure is high. Special attention should be directed towards women with recurrent abortion after spontaneous or stimulated cycles without or combined with methods of ART. Besides the known organic defects of the reproductive system the endocrine abnormalities need to be considered (i.e. corpus luteum insufficiency, disturbances of the luteoplacental shift, trophoblast disturbance). In case of abnormal progesterone and estradiol at the beginning of pregnancy, at the time of the luteo-placental shift or delayed placental endocrine function later in time treatment with progesterone or progestins or estrogen/progestin combinations should be done and the therapeutic effect controlled by repeated progesterone and estradiol measurements.