Open AccessNovel approaches to the management of recurrent pregnancy loss: The OPTIMUM (OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu) treatment strategy
Author(s) -
Kuroda Keiji,
Ikemoto Yuko,
Horikawa Takashi,
Moriyama Azusa,
Ojiro Yuko,
Takamizawa Satoru,
Uchida Toyoyoshi,
Nojiri Shuko,
Nakagawa Koji,
Sugiyama Rikikazu
Publication year - 2021
Publication title -
reproductive medicine and biology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.005
H-Index - 22
eISSN - 1447-0578
pISSN - 1445-5781
DOI - 10.1002/rmb2.12412
Subject(s) - medicine , levothyroxine , pregnancy , thrombophilia , subclinical infection , obstetrics , gynecology , recurrent miscarriage , thyroid function , aspirin , thyroid , thrombosis , miscarriage , biology , genetics
Purpose Does the OP timization of T hyroid function, T hrombophilia, Im munity, and U terine M ilieu (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; p = 0.002), but no significant difference was observed in women aged ≥40 years (55.6% and 30.0%, respectively; p = 0.09). Conclusions The OPTIMUM treatment strategy improved pregnancy outcomes in patients with not only RIF but also RPL.