DOES SUPPRESSING LUTEINIZING-HORMONE SECRETION REDUCE THE MISCARRIAGERATE - RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Objective-To determine whether prepregnancy pituitary suppression of l uteinising hormone secretion with a luteinising hormone releasing horm one analogue improves the outcome of pregnancy in ovulatory women with a history of recurrent miscarriage, polycystic ovaries, and hypersecr etion of luteinising hormone. Design-Randomised controlled trial, Sett ing-Specialist recurrent miscarriage clinic. Subjects-106 women with a history of three or more consecutive first trimester miscarriages, po lycystic ovaries, and hypersecretion of luteinising hormone. Intervent ions-Women were randomised before conception to receive pituitary supp ression 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 phas e progesterone alone or luteal phase placebo alone (group 2). No drugs were prescribed in pregnancy. Main outcome measures-Conception and li ve birth rates over six: cycles, Results-Conception rates in the pitui tary 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 give n progesterone and those given placebo pessaries. Live birth rates fro m an intention to treat analysis were 52% (26/50 pregnancies) in the g roup given and 63% (35/56) in the pituitary suppression controls (NS). Conclusions-Prepregnancy suppression of high luteinising hormone conc entrations in ovulatory women with recurrent miscarriage and hypersecr etion of luteinising hormone does not improve the outcome of pregnancy , The outcome of pregnancy without pituitary suppression is excellent.