J M Pearce1, R I Hamid. 1. Department of Obstetrics and Gynaecology, St George's Hospital, London.
Abstract
OBJECTIVE: To determine whether the use of human chorionic gonadotrophin (hCG) would reduce the recurrent miscarriage rate in women with polycystic ovarian disease. DESIGN: Double-blind, prospective, randomised controlled trial. SETTING:A pregnancy loss clinic in a London teaching hospital. SUBJECTS:One hundred and ninety-one women with a history of three consecutive spontaneous first trimester miscarriages and polycystic ovary syndrome. INTERVENTION: 10,000 i.u. of hCG or a placebo were given when the leading follicle was > or = 21 mm, then 5000 i.u. of hCG or a placebo were given twice weekly until miscarriage or the tenth week of pregnancy. MAIN OUTCOME MEASURE: Miscarriage rate. RESULTS:Women with polycystic ovaries who receivedhCG treatment had a lower miscarriage rate (14%) compared with women who received placebo (43%). In women with follicular phase luteinising hormone > 10 iu/l, those who received hCG therapy had a miscarriage rate of 10% compared with a rate of 44% in women who received the placebo. When clomiphene was used for ovulation induction, women treated with hCG had a miscarriage rate of 14% compared with a rate 47% in women who received the placebo. There was no significant benefit from hCG therapy in natural cycles. CONCLUSION: The use of hCG in women with recurrent miscarriage and polycystic ovary syndrome improves the pregnancy outcome.
RCT Entities:
OBJECTIVE: To determine whether the use of human chorionic gonadotrophin (hCG) would reduce the recurrent miscarriage rate in women with polycystic ovarian disease. DESIGN: Double-blind, prospective, randomised controlled trial. SETTING: A pregnancy loss clinic in a London teaching hospital. SUBJECTS: One hundred and ninety-one women with a history of three consecutive spontaneous first trimester miscarriages and polycystic ovary syndrome. INTERVENTION: 10,000 i.u. of hCG or a placebo were given when the leading follicle was > or = 21 mm, then 5000 i.u. of hCG or a placebo were given twice weekly until miscarriage or the tenth week of pregnancy. MAIN OUTCOME MEASURE: Miscarriage rate. RESULTS:Women with polycystic ovaries who received hCG treatment had a lower miscarriage rate (14%) compared with women who received placebo (43%). In women with follicular phase luteinising hormone > 10 iu/l, those who received hCG therapy had a miscarriage rate of 10% compared with a rate of 44% in women who received the placebo. When clomiphene was used for ovulation induction, women treated with hCG had a miscarriage rate of 14% compared with a rate 47% in women who received the placebo. There was no significant benefit from hCG therapy in natural cycles. CONCLUSION: The use of hCG in women with recurrent miscarriage and polycystic ovary syndrome improves the pregnancy outcome.