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

• Published in: Reproductive biomedicine online Vol. 34; no. 3; pp. 319 - 324
• Main 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.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2017
• Subjects: Abortion, Habitual - drug therapy; Adult; Chorionic Gonadotropin - therapeutic use; Female; HCG; Humans; Luteal Phase; Miscarriage; Obstetrics and Gynecology; Pregnancy; Pregnancy Outcome; Recurrent pregnancy loss; Reproductive Control Agents - therapeutic use; Retrospective Studies; Time-to-Pregnancy; Window of implantation; Pregnancy; Miscarriage; Recurrent pregnancy loss; HCG; Window of implantation; miscarriage; pregnancy; recurrent pregnancy loss; window of implantation
• ISSN: 1472-6483; 1472-6491; 1472-6491
• DOI: 10.1016/j.rbmo.2016.11.016

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.