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

ObjectiveTo report a case of a habitual aborter that had a pregnancy reach near term and successfully delivered a viable female infant.DesignReport 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.SettingA private advanced reproductive center.Patient39-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.InterventionsExamination, 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 measureDelivery of viable infant.ResultsThis advanced reproductive age woman had three subsequent pregnancies. While compliant with our prescribed protocol, the patient successfully carried two pregnancies to viability.ConclusionClinicians should be alert to the possibility of a luteal phase defect when a patient presents with recurrent fertility problems and multiple spontaneous abortions.