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Hum. Reprod. Advance Access originally published online on February 8, 2008
Human Reproduction 2008 23(4):797-802; doi:10.1093/humrep/den022
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Does free androgen index predict subsequent pregnancy outcome in women with recurrent miscarriage?

K.A. Cocksedge1,5, S.H. Saravelos1, Q. Wang1,2, E. Tuckerman3, S.M. Laird4 and T.C. Li1,3

1 Reproductive Medicine and Surgery Unit, Sheffield Teaching Hospitals, University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK 2 Reproductive Medicine Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China 3 Biomedical Research Unit, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK 4 BMRC, Sheffield Hallam University, City Campus, Sheffield S1 1WB, UK

5 Correspondence address. E-mail: mdc06kc{at}sheffield.ac.uk

BACKGROUND: Several studies have investigated plasma androgen levels in women with recurrent miscarriage (RM) with conflicting results on whether an association between hyperandrogenaemia and RM exists. However, none of these studies included sensitive androgen measurements using a large data set. We therefore investigated the free androgen index (FAI) in a large number of women with RM in order to ascertain whether hyperandrogenaemia is a predictor of subsequent pregnancy outcome.

METHODS: We studied 571 women who attended the Recurrent Miscarriage Clinic in Sheffield and presented with ≥3 consecutive miscarriages. Serum levels of total testosterone and sex hormone-binding globulin were measured in the early follicular phase and FAI was then deduced.

RESULTS: The prevalence of hyperandrogenaemia in RM was 11% and in a subsequent pregnancy, the miscarriage rate was significantly higher in the raised FAI group (miscarriage rates of 68% and 40% for FAI > 5 and FAI ≤ 5 respectively, P = 0.002).

CONCLUSIONS: An elevated FAI appears to be a prognostic factor for a subsequent miscarriage in women with RM and is a more significant predictor of subsequent miscarriage than an advanced maternal age (≥40 years) or a high number (≥6) of previous miscarriages in this study.

Key words: recurrent miscarriage/hyperandrogenaemia/polycystic ovary syndrome

Submitted on October 16, 2007; resubmitted on December 10, 2007; accepted on January 14, 2008.


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