High basal estradiol level and FSH/LH ratio in unexplained recurrent pregnancy loss

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The potential role of diminished ovarian reserve in unexplained recurrent pregnancy loss (RPL) in a retrospective comparative analysis.


Eighty women with RPL underwent routine work-up to exclude known associations of RPL. Serum FSH, LH and E2 levels were assessed on the 3rd day of the menstrual cycle. Following investigation, 58 women failed to reveal an identifiable cause and are therefore classified as unexplained RPL. Control group consisted of women in whom the cause of abortions was known such as uterine septum and parental chromosomal abnormalities. Mean age, gravidity, parity, presence of infertility, previous number of miscarriages, duration of marriage were similar in both groups. Day 3 serum levels of FSH, E2 and FSH: LH ratios were compared in the two groups.


Elevated FSH concentrations were equally distributed in the unexplained RPL and control groups. Both day 3 E2 and FSH:LH ratio were elevated in the unexplained RPL group compared with the control group (p=0.0066 and p=0.0187 respectively). The percentage of women with elevated FSH and/or E2 levels on day 3 were significantly higher in the unexplained RPL group than in controls (p=0.0045).


Unexplained RPL may be associated with diminished ovarian reserve and should be considered in the workup of RPL.

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