Luteal phase HCG support for unexplained recurrent pregnancy loss – a low hanging fruit?. Issue 3 (March 2017)

• Record Type: Journal Article
• Authors: Fox, Chelsea; Azores-Gococo, Denise; Swart, Linda; Holoch, Kristin; Savaris, Ricardo F.; Likes, Creighton E.; Miller, Paul B.; Forstein, David A.; Lessey, Bruce A.
• Is Part Of: Reproductive biomedicine online. Volume 34:Issue 3(2017)
• Page Start: 319
• Page End: 324
• Publication Date: 2017-03
• Subjects: HCG -- Miscarriage -- Pregnancy -- Recurrent pregnancy loss -- Window of implantation; Human reproductive technology -- Periodicals; Human embryo -- Periodicals; Reproduction -- Periodicals; 616.692
• DOI: 10.1016/j.rbmo.2016.11.016
• Languages: English
• ISSNs: 1472-6483

Abstract

Abstract: 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.