Changes in Testosterone, SHBG, DHEA and Cervical Length During Pregnancy in Egyptian Women With History of Recurrent Miscarriage

Introduction

Recurrent miscarriage (RM )is defined as the loss of three of more consecutive pregnancies before 20 weeks gestation (Royal College of Obstetricians & Gynaecologists 2011, Practice Committee of American Society for Reproductive Medicine 2013). The prevalence of RM varies from country to country and within communities within the country. It tends to be higher in developing countries. However it effects 1% to 2%of women (Jeve et al., 2014, Green-top Guideline No. 17).Other studies have reported incidences of RM between 0.5% and 2.3 % (Christiansen et al.,2007, Stirrat et al., 1990, Alberman et al., 1988).

Currently the established risk factors of RM include hormonal associated conditions (Stephenson et al.,1996, Fox-Lee et al., 2007) , uterine abnormalities (including adhesions post-surgery) (Rimbizis et al.,2001, Salim et al.,2003) anti-phospholipid syndrome Thrombotic (Greer et al., 2003) , chromosomal and genetic (Braekeleer et al., 1990 , Clifford et al.,1994, Stephenson et al., 2006, Franssen et al., 2006) conditions .Indeed some researchers consider PCOS as a risk factor, However some don't.

Approximately 8% to 12% of RM is due to endocrine causes mainly due to hyperandrogenism and hyperinsulinemia in PCOS (Smith et al., 2011, Witchel et al., 2019, Rai et al., 2000) . Little research focuses directly on the effect of PCOS during gestation and how that can be linked to poor pregnancy outcomes. However, there is a positive correlation between increased risk of miscarriage and hyperhomocysteinemia in insulin resistant patients, a common component of PCOS (Chakraborty et al.,2013).

The current literature providing conflicting views on androgen levels effecting pregnancy in PCOS patients some clarity is required as to whether its elevation impacts pregnancy. Not only that, but the is limited published data which compared the androgen and cervical length at different gestational periods of women with history of miscarriage either due to PCOS or for unknown reasons.