[The frequency and causes of spontaneous abortion following artifitial insemination (author's transl)]

Abstract

This paper is concerned with the causes of spontaneous abortion in a sample of 200 pregnancies induced by artificial insemination. In particular it examines the importance of the following factors: existing disorders in the woman's menstrual cycle, the influence of hormone treatment during the conception cycle, the age of the woman treated, and the type of semen used. Of the 200 pregnancies in our treatment sample 27 terminated in abortions (13.5%). Clinical examination before treatment established the presence of menstrual disorders in 69 of 180 women to be treated: 23.9% exhibited corpus luteum deficiency, 12% anovular cycles, and 2% oligomenorrhea. On the basis of this preliminary examination the principal cause of abortion proved to be an existing corpus luteum deficiency, since 15 of the 27 abortions occurred in women with this type of menstrual disorder. Our observations show that it is important when performing artificial insemination to correct the patient's existing menstrual disorders by means of hormone treatment. This emerges from the following figures: In 26 cases without hormone treatment the incidence of abortion was 35%. In 174 cases that received hormone treatment during the successful cycle only 18 abortions occurred (an incidence of 10.3%). Breaking down hormone treatment into 6 basic types, we get incidences of abortion ranging from 0 to 25% in the different groups. Dividing the treatment sample into age groups reveals an 11 to 14% incidence of abortion in the 30 to 34 age group; in the 35 to 40 group age group the incidence doubles to 26%. Whereas existing menstrual disorders and adequate hormone treatment significantly influence the incidence of abortion, there is no close relationship between incidence of abortion and the type of semen used. The innocuousness of using deep-frozen semen with an admixture of glycerine has been shown by various authors reporting on laboratory and clinical investigations. For 117 pregnancies induced purely with deep-frozen semen we had an incidence of abortion of 13.7%. This figure is of the same order as the incidence of abortion in pregnancies induced by insemination with fresh semen. The results obtained permit one to conclude that incidence of abortion is not significantly dependent on the type of semen used. Our work demonstrates the importance of assessing the patient's genital constitution from both the functional and the organic points of view, not merely in order to achieve conception but also for the purposes of preventing abortion by means of the appropriate hormone treatment. If satisfactory therapeutic results are to be achieved candidates for artificial insemination must therefore be given a thorough diagnostic examination beforehand and, if necessary, adequate hormone treatment during the insemination cycle.

PIP: In a sample of 200 pregnancies induced by artificial insemination, 1970-1975, 27 (13.5%) ended in abortion. These 27 abortions occurred among 23 women, 12 of whom had previously been diagnosed as having corpus luteum deficiency. Repetitions brought the number of abortions attributed to corpus luteum deficiency to 15, or 56% of total abortions. Among women with corpus luteum deficiency in the whole sample, the abortion rate was 29%, vs. an abortion rate of 9.1% among women with normal cycles. Data were also tabulated according to hormone treatment, which was administered to 77% of the women to time ovulation or correct cycle anomalies. The abortion rate was highest (35%) among those not receiving hormones; it was lowest (3%) among women receiving human menopausal gonadotropin (HMG) plus an ovulation-inducing hormone, and those receiving HCG or luteinizing hormone-releasing hormone (LH-RH) and retroprogesterone. For those given ovulation-timers (HCG or LH-RH) alone, the abortion rate was 13%. The rate for all pregnancies among women receiving hormone therapy was 10.3%. Study results indicate that corpus luteum deficiency is the major cause of abortion in pregnancies by artificial insemination and confirm the importance of thorough examination and, where appropriate, hormone treatment of artificial insemination candidates. Breakdown of the data by age showed that among the 3 youngest patient grousp (to age 34), abortion rates ranged from 11 to 14%, whereas for women ages 35-40, the rate was 26%. No close relationship between abortion rate and quality of semen (fresh or frozen) was found.