Novel Approaches to the Management of Recurrent Pregnancy Loss: The OPTIMUM (OPtimization of Thyroid Function, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy

Overview

Journal Reprod Med Biol

Specialty Biology

Date 2021 Oct 14

PMID 34646081

Citations 8

Authors

Keiji Kuroda

Yuko Ikemoto

Takashi Horikawa

Azusa Moriyama

Yuko Ojiro

Satoru Takamizawa

Toyoyoshi Uchida

Shuko Nojiri

Koji Nakagawa

Rikikazu Sugiyama

Affiliations

Soon will be listed here.

Abstract

Purpose: Does the OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu (OPTIMUM) treatment strategy, developed for treating repeated implantation failure (RIF), contribute to improving pregnancy outcomes in patients with a history of recurrent pregnancy loss (RPL)?

Methods: Between 2018 and 2019, women with RPL after two or more clinical pregnancy losses underwent RPL testing. We treated chronic endometritis with antibiotics, high Th1/Th2 cell ratios with vitamin D and/or tacrolimus, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. Of 168 consecutive women aged ≤43 years, 115 underwent RPL testing. We compared 100 pregnancies (90 women) and 46 pregnancies (41 women) with and without the OPTIMUM treatment strategy, respectively.

Results: RPL testing identified intrauterine abnormalities in 66 (57.4%), elevated Th1/Th2 cell ratios in 50 (43.5%), thyroid dysfunction in 33 (28.7%), and thrombophilia in 33 (28.7%). The live birth rate in the OPTIMUM group was significantly higher than that in the control group among women aged <40 years (78.1% and 42.3%, respectively; = 0.002), but no significant difference was observed in women aged ≥40 years (55.6% and 30.0%, respectively; = 0.09).

Conclusions: The OPTIMUM treatment strategy improved pregnancy outcomes in patients with not only RIF but also RPL.

Citing Articles

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