Corpus luteum deficiency as a cause of early recurrent abortion: a case history.

ABSTRACT

PIP This paper presents a case history that suggests recurrent abortions in early pregnancy may be due to an inability to maintain an efficient corpus luteum. Pregnancy tests and the estimation of urinary human chorionic gonadotropin (HCG) titers were carried out for 62 days following the onset of the menstrual period preceding the study period. The patient was judged to have ovulated on the 19th or 20th day of the cycle and to have become pregnant at that point. The corpus luteum began to secrete progesterone in response to fertilization. Pregnanediol excretion rose from an average of 0.3 mg/day before ovulation to a high of 8.7 mg on day 31, but then fell sharply to only 1.0-3.0 mg/day, jeopardizing the chance of successful maintenance of the fetoplacental unit. HCG excretion was undetectable before day 43, then fluctuated between 1500-3500 IU/L, and became undetectable again on day 62. A heavy "menstrual" loss occurred on day 63. Progesterone replacement therapy in a subsequent pregnancy produced a successful outcome. This treatment should be administered as soon as the 1st period is missed. It is unclear whether corpus luteum dificiency is a direct cause of early recurrent abortion, or whether it is due to some others cause such as failure of the anterior pituitary to secrete sufficient luteinizing or luteotropic hormone.^ieng