The only treatment for couples with balanced translocations is gamete donation, either sperm or ooctyes, depending on which partner has the translocation. Because the chance of having a normal child, as many of these couples has had previously, they most often opt for neither of these.
The current treatment of the septate uterus is hysteroscopic metroplasty. The division of the septum is equally successful with hysteroscopic scissors, electrocautery, or laser, depending upon the preference and experience of the surgeon. The need for postoperative adjunctive therapy with an intrauterine stent and estrogen therapy is unclear but generally felt to be unnecessary. The chance of successful pregnancy after hysterscopic metroplasty has varied widely in many studies, depending upon the nature of the group studied and the size of the septum. The majority of studies, however, report a 70 to 90% chance of live birth after surgery.
If a luteal phase defect is suspected, treatment is generally initiated with clomiphene ovulation induction (which increases luteal phase progesterone production), or addition of progesterone in the early luteal phase. Progesterone may be administered orally, vaginally, or intramuscularly. Many practitioners treat empirically with progesterone because of the difficulty of making a firm diagnosis, low treatment cost, and lack of risk.
A combination of low dose aspirin and heparin has been shown to enhance the chance of successful pregnancy in women with antiphospholipid antibodies. Treatment is usually begun when fetal cardiac activity is detected. The addition of intravenous immunoglobulin to this regimen was shown in a multicenter, randomized pilot study to have no beneficial effect.
In women of advanced reproductive age and in those with poor ooctye quality indicated by elevated early follicular phase FSH and estradiol levels, consideration should be given to oocyte donation.
It should be recognized that in most studies of couples with unexplained RPL, control groups have a 60 to 70% chance of successful live birth. With this in mind, the practitioner should resist the temptation to treat these couples with unproven, expensive, or potentially deleterious modalities. The lessons learned from the diethylstilbestrol experience should not be forgotten.
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