Links between PCOS, hyperandrogenism, hyperinsulinemia, and recurrent pregnancy loss make use of insulin-sensitizing agents in the treatment of recurrent pregnancy loss associated with PCOS attractive (89–92). Although further study is needed, there are an increasing number of reports that support its use for this application (365,366). Prepregnancy glycemic control may be particularly important for women with overt diabetes mellitus (93,95). Thyroid hormone replacement with Synthroid may be helpful in cases of hypothyroidism. There are data indicating that thyroid hormone therapy may be of some benefit in euthyroid recurrent loss patients with antithyroid antibodies and possibly even in all pregnant women with “euthyroid” TSH levels between 2.5 and 5.0 mIU/L (98–100,272). There does not appear to be a place in the medical management of recurrent pregnancy loss for adding bromocriptine in women who do not have a prolactin disorder.
Infections Empiric antibiotic treatment has been used for couples with recurrent abortion. Its efficacy is unproven. Elaborate testing for infectious factors among recurrent pregnancy loss patients and use of therapeutic interventions is not justified unless a patient is immunocompromised or a specific infection has been documented (113). For cases in which an infectious organism has been identified, appropriate antibiotics should be administered to both partners, followed by posttreatment culture to verify eradication of the infectious agent before attempting conception.
Immunologic Factors Immune-mediated recurrent pregnancy loss has received more attention than any other single etiologic classification of recurrent pregnancy loss. Nevertheless, the diagnosis and subsequent treatment of the majority of cases remains unclear (102,367–370). Most therapies for proposed immune-related recurrent pregnancy loss must be considered experimental. As stated earlier, it is known that the developing conceptus contains paternally inherited gene products and
Immunostimulating Therapies: Leukocyte Immunization tissue-specific differentiation antigens, and that there is maternal recognition of these antigens (216–218). Historically, it has been speculated that either inappropriately weak immune responses to these antigens or unusually strong responses could result in early pregnancy loss. As a consequence, both immunostimulating and immunosuppressive therapies have been proposed, but no conclusions about efficacy can be drawn.