Luteal phase HCG support for unexplained recurrent pregnancy loss - a low hanging fruit?

REPRODUCTIVE BIOMEDICINE ONLINE

卷:34

Article

Fox, Chelsea¹  Azores-Gococo, Denise²  Swart, Linda^2,3  Holoch, Kristin⁴  Savaris, Ricardo F.⁵  Likes, Creighton E.¹  Miller, Paul B.¹  Forstein, David A.¹  Lessey, Bruce A.¹ 

[1] Greenville Hosp Syst, Dept Obstet & Gynecol, Greenville, SC 29605 USA

[2] Univ South Carolina, Sch Med Greenville, Greenville, SC 29605 USA

[3] Univ South Carolina, Sch Med, Columbia, SC 29208 USA

[4] Univ Kansas, Med Ctr, Kansas City, KS 66160 USA

[5] Univ Fed Rio Grande do Sul, Dept Ginecol Obstet, BR-90035903 Porto Alegre, RS, Brazil

关键词: HCG;    Miscarriage;    Pregnancy;    Recurrent pregnancy loss;    Window of implantation;   

DOI  :  10.1016/j.rbmo.2016.11.016

来源: Elsevier

【 摘 要 】

Recurrent pregnancy loss (RPL) is defined by two or more failed pregnancies and accounts for only 1-5% of pregnancy failures. Treatment options for unexplained RPL (uRPL) are limited. Previous studies suggest a link between delayed implantation and pregnancy loss. Based on this, a timely signal for rescue of the corpus luteum (CL) using human chorionic gonadotrophin (HCG) could improve outcomes in women with uRPL. This retrospective cohort study included 98 subjects with uRPL: 45 underwent 135 monitored cycles without HCG support; and 53 underwent 142 cycles with a single mid-luteal HCG injection. Based on Log-rank Mantel-Cox survival curves, miscarriage rate and time to pregnancy decreased in the HCG group (P = 0.0005). Women receiving luteal HCG support had an increased chance of an ongoing pregnancy compared with those not receiving it (RR = 2.4; 95% CI 1.4-3.6; number need to treat (NNT) = 7; 95% CI 4-18). Subjects receiving HCG support had a significant absolute risk reduction (ARR) of miscarriage (P < 0.001; ARR = 11.5%; 95% CI 3.6-19.5; NNT = 9(5-27). These data suggest restoration of synchrony and CL support improves outcomes in women with RPL. Further randomized controlled trials of luteal-phase HCG in women with RPL appears warranted. (C) 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

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