Early pregnancy wastage: the role of repetitive human chorionic gonadotropin supplementation during the first 8 weeks of gestation.
OBJECTIVE
To determine if repetitive administration of hCG causes decreased pregnancy wastage rates in patients who are at a high risk of luteal inadequacy.


METHODS
Ovulation induction using human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) or clomiphene citrate (CC) is associated with luteal phase defects that may cause increased pregnancy wastage. An increased risk of abortion exists also in pregnancies in patients with previous repeated miscarriage, women older than 37 years, and various causes of infertility such as hyperprolactinemia. Because the presumed common denominator to the increased rate of pregnancy wastage in all these cases is luteal dysfunction, repetitive hCG administration, 2,500 U two times weekly, was carried out between the 4th and 8th week of gestation in 249 cases of ovulation induction and/or previous abortions, whereas 198 gestations served as controls (no hCG administration).


RESULTS
In the hCG treatment group, 43 ended in miscarriage (17.3%) versus 97 abortions in the control group (49%, P less than 0.01). In 160 cases of hMG/hCG generated gestations, 94 received hCG and 66 did not. The pregnancy wastage rates were 21.3% and 42.4%, respectively (P less than 0.05). In 144 cases of CC/hCG-induced pregnancies, 95 received hCG and 49 served as controls. The respective abortion rates were 15.8% and 44.8% (P less than 0.01). The remaining 143 spontaneous conceptions occurred in infertile patients with previous repeated abortions. In 60 of these conceptions, hCG was administered during the first 4 weeks of gestation and 83 cases served as control. The pregnancy wastage rates were 13.3% versus 56.6%, respectively (P less than 0.001).


CONCLUSIONS
Repetitive administration of hCG during the early gestation in cases that are at high risk of luteal inadequacy may significantly decrease the pregnancy wastage rate.
Blumenfeld
Z
Z
Department of Obstetrics and Gynecology, Rambam Medical Center, Technion-Israel Institute of Technology, Haifa.
Ruach
M
M
D006063:Chorionic Gonadotropin / Q000494:pharmacology*; D002996:Clomiphene / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D010064:Embryo Implantation; D005260:Female; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects / Q000502:physiology; D010062:Ovulation Induction; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000187:drug effects* / Q000502:physiology; D013997:Time Factors
D006063:Chorionic Gonadotropin; D002996:Clomiphene