Luteal phase support for documented failure of placental steroidogenesis: A case report

OBJECTIVE: To report a case of a habitual aborter that had a pregnancy reach near term and successfully delivered a viable female infant. DESIGN: Report of a unique case of a G10P1 that was successfully able to maintain a pregnancy by maintaining serum levels of estradiol and progesterone at or above 200 pg/dL and 25 ng/dL respectively. This case provides a benchmark for exogenous support of estradiol and progesterone throughout pregnancy. SETTING: A private advanced reproductive center. PATIENT: 39-year-old G10P1091 diagnosed to have antiphospholipid syndrome but continued to have continuous miscarriages despite accepted treatment. In addition, 8 products of conception were sent for cytogenetic testing and all were found to be normal. INTERVENTIONS: Examination, laboratory studies, imaging, clinical judgment, and knowledge of previous treatment failures were used to guide the treatment of this patient. Fertility was achieved with continuous supplementation of progesterone, estrogen, LMW-heparin, and prednisone. MAIN OUTCOME MEASURE: Delivery of viable infant. RESULTS: This advanced reproductive age woman had three subsequent pregnancies. While compliant with our prescribed protocol, the patient successfully carried two pregnancies to viability. CONCLUSION: Clinicians should be alert to the possibility of a luteal phase defect when a patient presents with recurrent fertility problems and multiple spontaneous abortions.