title: Luteal phase HCG support for unexplained recurrent pregnancy loss - a low hanging fruit?
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.
authors.affiliation: Department of Obstetrics and Gynecology, Greenville Hospital System, Greenville, SC 29605.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Fox
authors.affiliation: University of South Carolina School of Medicine Greenville, Greenville, SC 29605.
authors.forename: Denise
authors.initials: D
authors.lastname: Azores-Gococo
authors.affiliation: University of South Carolina School of Medicine Greenville, Greenville, SC 29605; University of South Carolina School of Medicine, Columbia, SC 29208.
authors.forename: Linda
authors.initials: L
authors.lastname: Swart
authors.affiliation: University of Kansas Medical Center, Kansas City, KS 66160.
authors.forename: Kristin
authors.initials: K
authors.lastname: Holoch
authors.affiliation: Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, 90035-903 RS, Brazil.
authors.forename: Ricardo F
authors.initials: RF
authors.lastname: Savaris
authors.affiliation: Department of Obstetrics and Gynecology, Greenville Hospital System, Greenville, SC 29605.
authors.forename: Creighton E
authors.initials: CE
authors.lastname: Likes
authors.affiliation: Department of Obstetrics and Gynecology, Greenville Hospital System, Greenville, SC 29605.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Miller
authors.affiliation: Department of Obstetrics and Gynecology, Greenville Hospital System, Greenville, SC 29605.
authors.forename: David A
authors.initials: DA
authors.lastname: Forstein
authors.affiliation: Department of Obstetrics and Gynecology, Greenville Hospital System, Greenville, SC 29605. Electronic address: blessey@ghs.org.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Lessey
mesh_terms: D000026:Abortion, Habitual / Q000188:drug therapy*; D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008183:Luteal Phase; D011247:Pregnancy; D011256:Pregnancy Outcome; D012102:Reproductive Control Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D061685:Time-to-Pregnancy
chemical_list: D006063:Chorionic Gonadotropin; D012102:Reproductive Control Agents
keywords: HCG; Miscarriage; Pregnancy; Recurrent pregnancy loss; Window of implantation