Miscarriage Following Assisted Conception

In: Spontaneous Abortion · 1992 · pp. 133–148 · doi:10.1007/978-1-4471-1918-0_9 · W81576845
book-chapter OA: closed CC0
Full text JSON View on OpenAlex View at publisher
⚙ AI-generated summary by gemini-2.5-flash-lite+body, 2026-06-13 ⓘ

This paper questions whether assisted conception therapies increase miscarriage or fetal malformations, and if so, whether it's due to treatment or the underlying infertility.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

The paper reviews the background rates and determinants of miscarriage in spontaneous pregnancies and infertile couples, then frames an assisted-conception question: whether infertility therapies increase miscarriage or fetal malformations, or whether any changes reflect the underlying fertility disorder. It synthesizes evidence from trials and observational studies of ovulation induction and assisted reproduction methods, considering hormonal regimens and associated risks. A key limitation is that the included literature is heterogeneous and often difficult to disentangle treatment effects from baseline patient risk factors. Relevance to endometriosis: endometriosis is explicitly mentioned as one of several conditions that may affect implantation and pregnancy outcome, though the paper is not a study focused specifically on endometriosis.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Full text 19,909 characters · extracted from oa-doi-fallback · 3 sections · click to expand

Abstract

Miscarriage occurs in between 10% and 30% of all spontaneous pregnancies (Shoham et al. 1991). Infertility is also common, affecting about 30% of couples (Hull et al. 1985). The causes of infertility are multiple and diverse, yet some, for example endometriosis and the polycystic ovary syndrome, may also affect successful implantation and pregnancy outcome. With the development of the techniques of assisted conception it is now possible either to overcome or to circumvent the majority of problems presented by the subfertile couple. One of the main questions to have arisen from the various therapies available is: Do they increase the rate of miscarriage or fetal malformations? And if they are found to do so, is this secondary to the treatment or a reflection of the underlying fertility disorder? Preview Unable to display preview. Download preview PDF. Similar content being viewed by others

References

Abdalla HI, Ahuja KK, Leonard T, Morris NN, Honour JW, Jacobs HS (1990) Comparative trial of luteinising hormone releasing hormone analogue/HMG and clomiphene citrate/HMG in an assisted conception programme. Fertil Steril 53:473–478 Abdulwahid NA, Adams J, Van der Spuy ZM, Jacobs HS (1985) Gonadotrophin control of follicular development. Clin Endocrinol 23:613–626 Adashi EY, Rock JA, Sapp KC, Martin EJ, Wentz AC, Jones GS (1979) Gestational outcome of clomiphene-related conceptions. Fertil Steril 31:620–626 Ahlgren M, Kallen B, Rannevik G (1976) Outcome of pregnancy after clomiphene therapy. Acta Obstet Gynecol Scand 55:371–375 Andrews MC, Muasher SJ, Levy D, Jones HW, Garcia JE, Rosenwaks Z, Jones GS, Acosta AA (1986) An analysis of the obstetric outcome of 125 consecutive pregnancies conceived in vitro and resulting in 100 deliveries. Am J Obstet Gynecol 154:848–854 Australian IVF Collaborative Group (1985) High incidence of preterm births and early losses in pregnancy after IVF. Br Med J 291:1160–1163 Baird PA, Sadovnick AD, Yee IML (1991) Maternal age and birth defects: a population study. Lancet 337:527–530 Ben-Rafael Z, Dor J, Mashiach S, Blankstein J, Lunenfeld B, Serr DM (1983) Abortion rate in pregnancies following ovulation induced by human menopausal gonadotropin/human chorionic gonadotropin. Fertil Steril 39:157 Berman P (1975) Congenital abnormalities associated with maternal clomiphene ingestion. Lancet i:878 Bishop PMF (1970) Clomiphene. Br Med Bull 26:22–25 Bohrer M, Kemmann E (1987) Risk factors for spontaneous abortion in menotropin-treated women. Fertil Steril 48:571 Boue JG, Boue A (1973) Increased frequency of chromosomal anomalies in abortions after induced ovulation. Lancet i:679 Boue A, Boue J (1977) Le role des anomalies chromosomiques dans les echecs de la reproduction. J Gynecol Obstet Biol Reprod 6:5–21 Brambati B (1990) Fate of human pregnancies. In: Edwards RG (ed): Establishing a successful human pregnancy, Serono Symposia, vol. 66. Raven Press, NY, pp 269–281 Brown GB (1986) Gonadotropins. In: Insler V, Lunenfeld B (eds) Infertility: male and female. Churchill Livingstone, New York, pp 359–373 Buvat J, Marcolin G, Guittard C, Herbaut JC, Louvet AL, Dehaone JL (1990) Luteal support after LHRH agonist for IVF: superiority of human chorioinic gonadotropin over oral progesterone. Fertil Steril 53:490–494 Caspi E, Ronen J, Schreyer P, Goldberg MD (1976) The outcome of pregnancy after gonadotropin therapy. Br J Obstet Gynaecol 83:967–971 Cohen J, Mayaux MJ, Guihard-Moscato ML (1988) Pregnancy outcomes after in vitro fertilization: A collaborative study on 2342 pregnancies. Ann NY Acad Sci 541:1–6 Conway GS, Honour JW, Jacobs HS (1989) Heterogeneity of the polycystic ovary syndrome: clinical, endocrine and ultrasound features in 556 patients. Clin Endocrinol 30:459–470 Cornel MC, Kate LPT, Dukes MN, de Jong VD, Berg LTW, Meyboom RHB, Garbis H, Peters PW (1989) Ovulation induction and neural tube defects. Lancet i:1386 Corsan GH, Kemmann E (1990) Risk of a second consecutive first-trimester spontaneous abortion in women who conceive with menotropins. Fertil Steril 53:817–821 Corson SL, Dickey RP, Gocial B, Batzer FR, Eisenberg E, Huppert L, Maislin G (1989) Outcome in 242 in vitro fertilization-embryo replacement or gamete intrafallopian transfer-induced pregnancies. Fertil Steril 51:644–650 Czeizel A (1989) Ovulation induction and neural tube defects. Lancet i:167 Dekel N, Galiani D, Aberdam E (1990) Regulation of rat oocyte maturation: involvement of protein kinases. In: Bavister BD, Cummins J, Roldan ERS (eds) Fertilisation in mammals. Serono Symposia, Norwell, USA, pp 17–24 Downs SM (1990) Maintenance of meiotic arrest in mammalian oocytes. In: Bavister BD, Cummins & Roldan ERS (eds) Fertilisation in mammals, pp 5–16. Serono Symposia, Norwell, USA Dyson JL, Kohler HG (1973) Anencephaly and ovulation stimulation. Lancet i: 1256–1257 Edmonds DK, Lindsay KS, Miller JF, Williamson E, Wood PJ (1982) Early embryonic mortality in women. Fertil Steril 38:447–453 Erickson GF, Magoffin DA, Dyer CA, Hofeditz C (1985) The ovarian androgen producing cells: a review of structure/function relationships. Endo Rev 6:371–399 Field B, Kerr C (1974) Ovulation stimulation and defects of neural-tube closure. Lancet ii:1511 Fleming R, Haxton MJ, Hamilton MPR, McCune GS, Black WP, Macnaughton MC, Coutts JRT (1985) Successful treatment of infertile women with oligomenorrhoea using a combination of a luteinising hormone releasing hormone agonist and exogenous gonadotrophin. Br J Obstet Gynaecol 92:369–374 Fleming R, Jamieson ME, Hamilton MPR, Black WP, Macnaughton MC, Coutts JRT (1988) The use of gonadotrophin releasing hormone analogues in combination with exogenous gonadotropins in infertile women. Acta Endocrinol, suppl 288, 119:77–84 Fleming R, Coutts JRT (1988) luteinising hormone releasing hormone analogues for ovulation induction, with particular reference to polycystic ovary syndrome. In: Healy D (ed) Anti- Hormones in Clinical Gynaecology, Bailliere’s Clin Obstet Gynaecol 2:677–688 Fowler PA, Messinis IE, Templeton AA (1989) Gonadotrophin surge-attenuating factor activity in human follicular fluid is different from inhibin. J Repro Fert, Abs series 4 no. 17 Frydman R, Belaisch-Allart JC, Fries N, Hazout A, Glissant A, Testart J (1986) An obstetric assessment of the first 100 births from the in vitro fertilization program at Clamont, France. Am J Obstet Gynecol 154:550–555 Frydman R, Fries N, Testart J et al. (1988) Luteinising hormone releasing hormone agonists in in- vitro fertilisation: different methods of utilization and comparison with previous ovulation stimulation treatments. Hum Reprod 3:559–561 Furuhjelm M, Jonson B, Lagergren CC (1962) The quality of human semen in spontaneous abortion. Int J Fertil 7:17–21 Garcia J, Jones GS, Wentz AC (1977) The use of clomiphene citrate. Fertil Steril 28:707–717 Gemzell CA (1967) Clomiphene induction of ovulation. In: Westlin B, Wiqvist N (eds). Fertility and sterility. Excerpta Medica Foundation, Amsterdam, p 43 Goldfarb AF, Morales A, Rakoff AE, Protos P (1968) Critical review of 160 clomiphene related pregnancies. Obstet Gynecol 31:342–345 Greenblatt RB, Barfield WE, Jungck EC, Ray AW (1961) Induction of ovulation with MRL-41. JAMA 178:101 Greenblatt RB, Roy S, Mahesh VB, Barfield W, Jungck EC (1962) Induction of ovulation. Am J Obstet Gynecol 84:900–907 Hack M, Brish M, Serr DM, Insler V, Lunenfeld B (1970) Outcome of pregnancy after induced ovulation. Follow-up of pregnancies and children born after gonadotropin therapy. JAMA 211:791–976 Hack M, Brish M, Serr DM, Insler V, Salomy M, Lunenfeld B (1972) Outcome of pregnancy after induced ovulation. JAMA 220:1329–1333 Harlap S (1976) Ovulation induction and congenital malformations. Lancet ii:961 Hassold T, Jacobs P, Kline J, Stein Z, Warburton D (1980) Effect of maternal age on autosomal trisomies. Ann Hum Genet 44:29–36 Hertig AT (1967) The overall problem in man. In Benirschke K (ed) Comparative aspects of reproductive failure. Springer-Verlag, NY, pp 11–41 Homburg R, Armar NA, Eshel A, Adams J, Jacobs HS (1988) Influence of serum luteinising hormone concentrations on ovulation, conception and early pregnancy loss in polycystic ovary syndrome. Br Med J 297:1024–1026 Homburg R, Eshel A, Armar NA, Tucker M, Mason PW, Adams J, Kilborn J, Sutherland IA, Jacobs HS (1989) One hundred pregnancies after treatment with pulsatile luteinising hormone releasing hormone to induce ovulation. Br Med J 298:809–812 Homburg R, Eshel A, Kilborn J, Adams J, Jacobs HS (1990) Combined luteinising hormone releasing hormone analogue and exogenous gonadotrophins for the treatment of infertility associated with polycystic ovaries. Hum Repro 5:32–35 Hook EB, Woodbury DF, Albright SG (1979) Rates of trisomy 18 in livebirths, stillbirths and at amniocentesis. Birth defects: original article series. New York: A. R. Liss, 15(5c):81–89 Howies CM, Macnamee MC, Edwards RG, Goswamy R, Steptoe PC (1986) Effect of high tonic levels of luteinising hormone on outcome of in-vitro fertilisation. Lancet i:521—522 Hull MGR (1990) Indications for assisted conception. In: Edwards RG (ed) Assisted Human Conception. Br Med Bull 46:580–595 Hull MGR, Glazener CM A, Kelly NJ et al. (1985) Population study of causes, treatment and outcome of infertility. Br Med J 291:1693–1697 Jacobs HS, Porter R, Eshel A, Craft I (1987) Profertility uses of luteinising hormone releasing hormone agonist analogues. In: Vickery BH, Nestor J J (eds) LHRH and its Analogs. MTP Press Ltd, Lancaster, pp 303–322 James WH (1974) Anencephaly, ovulation stimulation and subfertility. Lancet ii: 1353 Joel CA (1966) New etiologic aspects of habitual abortion and infertility with special reference to the male factor. Fertil Steril 17:374–379 Johnson P, Pearch JM (1990) Recurrent spontaneous abortion and polycystic ovarian disease: comparison of two regimens to induce ovulation. Br Med J 301:154–156 Jones GS, Acosta AA, Garcia JE, Bernadus RE, Rosenwaks Z (1985) The effect of follicle stimulating hormone without additional luteinising hormone on follicular stimulation and oocyte development in normal ovulatory women. Fertil Steril 43:696–702 Karow WG, Payne SA (1968) Pregnancy after clomiphene citrate treatment. Fertil Steril 19:351–362 Knight PG, Lacey M, Peter JLT, Whitehead SA (1990) Demonstration of a non-steroidal factor in human follicular fluid that attenuates the self-priming action of gonadotrophin-releasing hormone on pituitary gonadotropes. Biol Repro 42:613–618 Kurachi K, Aono T, Minagawa J, Miyake A (1983) Congenital malformations of newborn infants after clomiphene-induced ovulation. Fertil Steril 40:187–189 Lam S-Y, Baker HWG, Evans JH, Pepperell RJ (1989) Factors affecting fetal loss in induction of ovulation with gonadotrophins: increased abortion rates related to hormonal patterns in conceptual cycles. Am J Obstet Gynecol 160:621–629 Leeton J, Trounson A, Jessup D (1985) Support of the luteal phase in in vitro fertilization programs: result of a controlled trial with intramuscular Proluton. J In Vitro Fert Embryo Transfer 2:166–171 Lev-Gur M, Rodriguez LJ, Smith KD, Steinberger E (1990) Risk factors for pregnancy loss apparent at conception in infertile couples. Int J Fert 35:51–57 Lunenfeld B, Serr DM, Mashiach S et al. (1981) Therapy with gonadotropins: Where are we today? Analysis of 2890 menotropin treatment cycles in 914 patients. In: Insler V, Bettendorf G (eds) Advances in diagnosis and treatment of infertility. Elsevier Inc, Amsterdam, pp 27–31 Lunenfeld B, Blankstein J, Kotev-Emet S, Kokia E, Geier A (1986) Drugs used in ovulation induction: safety of patients and offspring. Hum Reprod 1:435–439 MacDougall J, Tan SL, Jacobs HS (1992) Ovarian Hyperstimulation Syndrome after in-vitro fertilisation. Fertil Steril (in press) MacGregor AH, Johnson JE, Bunde CA (1968) Further clinical experience with clomiphene citrate. Fertil Steril 19:616–622 Mahadevan MM, Leader A, Taylor PJ (1985) Effects of low dose human chorionic gonadotrophin on corpus luteum function after embryo transfer. J In Vitro Fert Embryo Transfer 2:190–194 Mason P, Adams J, Morris DV, Tucker M, Price J, Voulgaris Z, Van der Spuy ZM, Sutherland I, Chambers GR, White S, Wheeler MJ, Jacobs HS (1984) Induction of ovulation with pulsatile luteinising hormone releasing hormone. Br Med J 288:181–185 Medical Research International (1989) In vitro fertilization/embryo transfer in the United States: 1987 results from the National IVF-ET Registry. Fertil Steril 51:13–15 Mills JL, Simpson JL, Rhoads GG et al. (1990) Risk of neural tube defects in relation to maternal fertility and fertility drug use. Lancet 336:103–104 Miyake A, Kurachi H, Wakimoto H, Hirota K, Terakawa N, Aono T, Tanizawa O (1988) Second pregnancy with spontaneous ovulation following clomiphene- or gonadotropin-induced pregnancy. Eur J Obstet Gynecol Reprod Biol 27:1–5 National Perinatal Statistics Unit (NPSU) and the Fertility Society of Australia and New Zealand (1988) I VF and GIFT Pregnancies Australia and New Zealand, 1987. NPSU, 1988 Olson JL, Rebar RW, Schreiber JR, Vaitukaitis JL (1983) Shortened luteal phase after ovulation induction with human menopausal gonadotropin and human chorionic gonadotropin. Fertil Steril 39:284–289 Penrose LS (1933) The relative effects of maternal and paternal age in mongolism. J Genet 27:219- 224 Poland BJ, Miller JR, Jones DC, Trimble BK (1977) Reproductive counselling in patients who have had a spontaneous abortion. Am J Obstet Gynecol 127:685–691 Poison DW, Mason HD, Saldahna MB, Franks S (1987) Ovulation of a single dominant follicle during treatment with low-dose pulsatile follicle stimulating hormone in women with polycystic ovary syndrome. Clin Endocrinol 26:205–212 Porter RN, Smith W, Craft IL, Abdulwahid NA, Jacobs HS (1984) Induction of ovulation for in-vitro fertilisation using buserelin and gonadotrophins. Lancet ii: 1284–1285 Regan L, Braude PR, Trembath PL (1989) Influence of past reproductive performance on risk of spontaneous abortion. Br Med J 299:541–545 Regan L, Owen EJ, Jacobs HS (1990) Hypersecretion of luteinising hormone, infertility and miscarriage. Lancet ii: 1141–1144 Romeu A, Muasher SJ, Acosta AA, Veeck LL, Diaz J, Jones GS, Jones HW, Rosenwaks Z (1987) Results of in vitro fertilization attempts in women 40 years of age and older: the Norfolk experience. Fertil Steril 47:130–136 Rutherford AJ, Subak-Sharpe RJ, Dawson MJ, Margara RA, Franks S, Winston RML (1988) Improvement of in-vitro fertilisation after treatment with buserelin, an agonist of luteinising hormone releasing hormone. Br Med J 296:1765–1768 Sagle M, Bishop K, Alexander FM, Michel M, Bonney RC, Beard RW, Franks S (1988) Recurrent early miscarriage and polycystic ovaries. Br Med J 297:1027–1028 Sandler B (1973) Anencephaly and ovulation stimulation. Lancet ii:379 Schwartz M, Jewelewicz R, Dyrenfurth I, Tropper P, Vande Wile RL (1980) The use of human menopausal and chorionic gonadotropins for ovulation induction. Am J Obstet Gynecol 138:801- 806 Seppala M (1985) The World Collaborative Report on in vitro fertilization and embryo replacement: current state of the art in January 1984. Ann N Y Acad Sci 442:558–563 Sharma V, Riddle A, Mason BA, Pampiglione J, Campbell S (1988) An analysis of factors influencing the establishment of a clinical pregnancy in an ultrasound-based ambulatory in-vitro fertilisation program. Fertil Steril 49:468–478 Shoham Z, Borenstein R, Lunenfeld B, Pariente C (1990) Hormonal profiles following clomiphene citrate therapy in conception and nonconception cycles. Clin Endocrinol 33:271–278 Shoham Z, Zosmer A, Insler V (1991) Early miscarriage and fetal malformations after induction of ovulation (by clomiphene citrate and/or human menotropins), in vitro fertilization, and gamete intrafallopian transfer. Fertil Steril 55:1–11 Singh M (1978) Possible relationship between clomiphene and neural tube defects. J Ped 93:152 Smith KD, Rodriguez-Rigau LJ, Steinberger E (1981) The influence of ovulatory dysfunction and timing of insemination on the success of AID with fresh or cryopreserved semen. Fertil Steril 36:496–499 Spadoni LR, Cox DW, Smith DC (1974) Use of human menopausal gonadotropin for the induction of ovulation. Am J Obstet Gynecol 120:988–992 Stanger JD, Yovich JL (1985) Reduced in-vitro fertilisation of human oocyte from patients with raised basal luteinising hormone levels during the follicular phase. Br J Obstet Gynaecol 92:385–393 Steer C, Campbell S, Davies M, Mason B, Collins W (1989) Spontaneous abortion rates after natural and assisted conception. BMJ 299: 1317–1318 Steinberger E, Rodriguez-Rigau LJ, Smith KD (1982) Interaction of the two partners in the couple. In Menchini Fabris GF, Pasini W, Martini L (eds) Therapy in Andrology. Int Cong Ser 596: 21–29 Tan SL, Riddle A, Sharma V, Mason B, Campbell S (1989) The relation between the number of gestation sacs seen after IVF-ET and outcome of pregnancy. Proceedings of the Xllth Asian and Oceanic Congress of Obstetrics and Gynaecology Thomas A, Okamoto S, O’Shea F, Maclachlan V, Besanko M, Healy D (1989) Do raised serum luteinising hormone levels during stimulation for in-vitro fertilisation predict outcome? Br J Obstet Gynaecol 96:1328–1332 Toshinobu T, Seiichiro F, Noriaki S, Kihyoe I (1979) Correlation between dosage or duration of clomid therapy and abortion rate. Int J Fert 24:193–197 Trimble BK, Baird PA (1978) Maternal age and Down syndrome. Age specific incidence rates by single year maternal age intervals. Am J Med Genet 1:1–5 Trounson A, Wood C (1984) In vitro fertilisation results, 1972–1982, at Monash University, Queen Victoria, and Epworth Medical Centres. J IVF-ET 1:42–47 Trounson A, Howlett D, Rogers P, Hoppen HO (1986) The effect of progesterone supplementation around the time of oocyte recovery in patients superovulated for in vitro fertilization. Fertil Steril 45:532–537 Wall JA, Franklin RR, Kaufman RH (1964) Reversal of benign and malignant endometrial changes with clomiphene. Am J Obstet Gynecol 88:1–7 Wang CF, Gemzell C (1980) The use of human gonadotrophins for the induction of ovulation in women with polycystic ovary syndrome. Clin Endocrinol 12: 479–486 Watson H, Hamilton-Fairly D, Kiddy D, Bray C, Armstrong P, Beard R, Bonrey R, Franks S (1989) Abnormalities of follicular phase luteinising hormone secretion in women with recurrent early miscarriage. J Endocrinol 123 suppl, Abstract 25 Weir WC, Hendricks CH (1969) The reproductive capacity of an infertile population. Fertil Steril 20:289–298 Yovich JL, Stanger JD, Yovich JM, Tuvik A (1984) Assessment and hormonal treatment of the luteal phase of IVF cycles. Aus N Z J Obstet Gynaecol 24:125 Yovich JL, McColm SC, Yovich JM, Matson PL (1985) Early luteal serum progesterone concentrations are higher in conception cycles. Fertil steril 44:185–191 Yovich JL, Matson PL (1988) Early pregnancy wastage after gamete manipulation. Br J Obstet Gynaecol 95:1120–1127 Yovich JL, Edirisinghe WR, Cummins JM (1991) Evaluation of luteal support therapy in a randomized controlled study within a gamete intrafallopian transfer program. Fertil Steril 55:131- 139 Editor information Editors and Affiliations Rights and permissions Copyright information © 1992 Springer-Verlag London Limited About this chapter Cite this chapter Balen, A.H., Yovich, J.L. (1992). Miscarriage Following Assisted Conception. In: Stabile, I., Grudzinskas, J.G., Chard, T. (eds) Spontaneous Abortion. Springer, London. https://doi.org/10.1007/978-1-4471-1918-0_9 Download citation DOI: https://doi.org/10.1007/978-1-4471-1918-0_9 Publisher Name: Springer, London Print ISBN: 978-1-4471-1920-3 Online ISBN: 978-1-4471-1918-0 eBook Packages: Springer Book Archive

Keywords

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Citation neighborhood (sparse)

Too few in-corpus citations on either side for a chart; here are the lists.

Cites (3)

References (100)

Source provenance

openalex
last seen: 2026-06-04T00:00:01.174412+00:00
unpaywall
last seen: 2026-10-01T06:38:16.588661+00:00
License: CC0 · commercial use OK