To investigate the efficacy of hCG in the management of recurrent early pregnancy loss.
Design
A prospective, randomized, controlled trial.
Setting
Miscarriage Clinic, Women's Hospital, Liverpool, United Kingdom.
Subjects
Eighty-one women attending the miscarriage clinic with idiopathic recurrent pregnancy loss were randomized to receive hCG supplementation or placebo in early pregnancy.
Main Outcome Measure
The success rate or live birth rate.
Results
In women with regular menstrual cycles it was found that hCG had no beneficial effect, the pregnancy success rate being 86% in both groups. However, women with oligomenorrhea had a pregnancy success rate of 40% in the placebo group but a statistically significant improvement to 86% if hCG was given.
Conclusions
Human chorionic gonadotropin can be recommended for idiopathic recurrent pregnancy loss in women with oligomenorrhea.
hCG supplementation recurrent pregnancy loss randomized controlled trial, human chorionic gonadotropin recurrent miscarriage treatment, oligomenorrhea recurrent pregnancy loss hCG efficacy, Quenby Farquharson hCG recurrent miscarriage, idiopathic recurrent pregnancy loss hormonal support, hCG early pregnancy support live birth rate, progesterone support alternatives recurrent miscarriage, oligomenorrhea irregular cycles miscarriage treatment, placebo controlled trial hCG pregnancy loss, luteal phase support recurrent early pregnancy loss
PMID 7646609 7646609 DOI 10.1016/s0015-0282(16)56992-1 10.1016/s0015-0282(16)56992-1 Quenby et al. 1994, Quenby 1994
Cite this article
Quenby, S., & Farquharson, R. G. (1994). Human chorionic gonadotropin supplementation in recurring pregnancy loss: a controlled trial. Fertility and sterility, 62(4), 708-710. https://doi.org/10.1016/s0015-0282(16)56992-1
Quenby S, Farquharson RG. Human chorionic gonadotropin supplementation in recurring pregnancy loss: a controlled trial. Fertil Steril. 1994;62(4):708-710. doi:10.1016/s0015-0282(16)56992-1
Quenby, S., and R. G. Farquharson. "Human chorionic gonadotropin supplementation in recurring pregnancy loss: a controlled trial." Fertility and sterility, vol. 62, no. 4, 1994, pp. 708-710.
To determine if repetitive administration of hCG causes decreased pregnancy wastage rates in patients who are at a high risk of luteal inadequacy. 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). 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). 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.
To compare the effect of hCG therapy with placebo or bed rest in women with threatened abortion. Random assignment, double-blind. Community hospitals. Sixty-one women with viable pregnancies under 8 weeks' gestation on admission to hospital were randomly allocated to receive injections of hCG or placebo, or were advised to rest in bed. Abortion vs. continuation of pregnancy at 16 weeks' gestation. Thirty-one aborted: 6/20 on hCG, 10/21 on placebo, 15/20 on bed rest. hCG vs. bed rest, P < .01; placebo vs. bed rest, hCG vs. placebo--not significant. Plasma progesterone: continuing pregnancy > abortion, P < .01; continued with hCG vs. aborted on placebo, P < .001; continued with hCG vs. aborted with bed rest, P < .001. No significant differences in pregnancy/birth complications or infants' birth weight. Female/male ratio was 2:1. hCG is significantly better than bed rest.
Hammarbäck S et al., 1988·Acta Obstet Gynecol Scand
A treatment with the GnRH-agonist, buserelin, was given intranasally in a dosage of 400 micrograms once daily, to induce anovulation in 26 women with premenstrual tension syndrome; 23 patients completed the study course. The design was double-blind and cross-over. Daily symptom ratings were made for two pretreatment, diagnostic cycles and continued for up to six cycles or 6 months. The rating scale used was an earlier described visual analogue scale. Blood samples for estradiol and progesterone radio-immunoassay were taken once weekly throughout the study. Results show beneficial effects of both placebo and GnRH-agonist, compared with the pretreatment situation. The GnRH-agonist was, however, significantly better than placebo. At the end of the treatment periods the patients while still taking placebo, still showed cyclical symptom changes, whereas during the GnRH-agonist treatment the cyclical changes had disappeared. The results indicate that a factor from the corpus luteum must be involved in the etiology of cyclical mood changes. The results also show that inhibition of ovulation by mean of GnRH-agonists is one possible way to treat premenstrual tension syndrome.
Harrison RF, 1985·Eur J Obstet Gynecol Reprod Biol
Human chorionic gonadotropin was administered intramuscularly in an open study of 32 women whose last three pregnancies had ended in spontaneous abortion. An initial dosage of 10 000 iu on earliest diagnosis of pregnancy was followed up by 5000 IU twice weekly up to wk 12, then once weekly up to wk 16. Only 2 of the 32 patients aborted (6.2%). Using the same regime a further 20 habitual aborters were randomly allocated double-blind to either hCG or placebo. All 10 women on active therapy continued (100%) compared with only 3 on placebo (30%) (P less than 0.01). These results suggest that hCG should be considered as treatment in women with habitual abortion where other specific causes have been ruled out and a potentially treatable hormonal imbalance surmised.