Fox Chelsea, Azores-Gococo Denise, Swart Linda, Holoch Kristin, Savaris Ricardo F, Likes Creighton E, Miller Paul B, Forstein David A, Lessey Bruce A
Department of Obstetrics and Gynecology, Greenville Hospital System, Greenville, SC 29605.
University of South Carolina School of Medicine Greenville, Greenville, SC 29605.
Reprod Biomed Online. 2017 Mar;34(3):319-324. doi: 10.1016/j.rbmo.2016.11.016. Epub 2016 Dec 21.
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.
复发性流产（RPL）定义为两次或更多次妊娠失败，仅占妊娠失败的1%-5%。不明原因复发性流产（uRPL）的治疗选择有限。既往研究提示着床延迟与流产之间存在关联。基于此，使用人绒毛膜促性腺激素（HCG）及时挽救黄体（CL）的信号可能改善uRPL女性的结局。这项回顾性队列研究纳入了98例uRPL患者：45例在无HCG支持的情况下接受了135个监测周期；53例在黄体中期单次注射HCG的情况下接受了142个周期。根据对数秩Mantel-Cox生存曲线，HCG组的流产率和妊娠时间降低（P = 0.0005）。接受黄体期HCG支持的女性与未接受支持的女性相比，持续妊娠的机会增加（风险比（RR）= 2.4；95%置信区间（CI）1.4-3.6；需治疗人数（NNT）= 7；95%CI 4-18）。接受HCG支持的受试者流产的绝对风险显著降低（P < 0.001；绝对风险降低（ARR）= 11.5%；95%CI 3.6-19.5；NNT = 9(5-27)）。这些数据表明恢复同步性和黄体支持可改善RPL女性的结局。对RPL女性进行黄体期HCG的进一步随机对照试验似乎是必要的。
