Human Reproduction, Vol. 17, No. 12, 3072-3078,
December 2002
© 2002 European Society of Human Reproduction and Embryology
Circulating levels of inhibin A, activin A and follistatin in missed and recurrent miscarriages
1 Department of Obstetrics and Gynaecology, Royal Free-UCL Medical School, 86–96 Chenies Mews, London WC1E 6HX, 2 Academic Department of Obstetrics and Gynaecology, St. Mary’s Hospital, Imperial College Medical School, London and 3 School of Biological and Molecular Sciences, Oxford Brookes University, Gipsy Lane, Headington, Oxford, UK
BACKGROUND: The aim of this study was to investigate the changes in circulating levels and the clinical use of inhibin A, activin A and follistatin as endocrine markers of early pregnancy loss. METHODS: Blood samples were collected from women presenting with a sporadic missed miscarriage (n = 10), and controls having pregnancy termination at 8–12 weeks (n = 15) and from women with a history of unexplained recurrent miscarriages (n = 12) at 6–12 weeks gestation. All samples were assayed for inhibin A, inhibin B, activin A, follistatin, hCG, estradiol and progesterone. RESULTS: Serum inhibin A, hCG, estradiol and progesterone levels were significantly (
2–3 fold) decreased in sporadic miscarriages compared with controls. In the recurrent miscarriage group, time dependent changes in plasma inhibin A and hCG levels were significantly (P < 0.05) altered in the group that had a subsequent miscarriage compared with those who had a live birth. At 6–7 weeks gestation, plasma inhibin A (4 fold, P < 0.01), hCG (4 fold, P < 0.01) and estradiol (2 fold, P < 0.001) levels were significantly lower in women who went on to have another miscarriage than those with a live birth. Inhibin B levels were near the detection limit of the assay. CONCLUSIONS: Our findings suggest that inhibin A is a specific marker of early pregnancy loss before the onset of the clinical symptoms of recurrent miscarriage. There is a high degree of association between levels of inhibin A and hCG in cases of miscarriage, indicating that these two proteins could be used in combination to predict future pregnancy outcome.
Key words: activin A/early pregnancy/follistatin/inhibin A/miscarriage
4 To whom correspondence should be addressed. E-mail: s.muttukrishna{at}ucl.ac.uk
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