The effect of low-dose ovarian stimulation with HMG plus progesterone on pregnancy outcome in women with history of recurrent pregnancy loss and secondary infertility: a retrospective cohort study

Abstract

We assessed the outcome of pregnancy in women with a history of recurrent pregnancy loss (RPL) following treatment with low-dose human menopausal gonadotropin (HMG)+progesterone or progesterone alone. This single-center retrospective cohort study included data from women diagnosed with RPL and treated between February 2005 and December 2012 with one cycle of HMG + progesterone or progesterone alone. Primary endpoint was the rate of ongoing pregnancies and losses by treatment, age (<38 vs. ≥38 years) and in the subgroup with unexplained RPL. Of 169 RPL patients, 35.5% (n = 60) received HMG + progesterone and 64.5% (n = 109) progesterone alone. Compared to progesterone alone, HMG + progesterone led to a lower, although not significant, frequency of losses (3.3% vs. 11.9%, p = .09) and a twofold higher rate of ongoing pregnancies (41.7% vs. 19.3%, p = .002). Similar results were obtained in the subgroup of patients with unexplained RPL (ongoing pregnancies: 48.1% upon HMG + progesterone vs. 21.3% upon progesterone, p = .03; losses: 0% vs. 8.5%, respectively, p = .29) and in those <38 years (ongoing pregnancies: 47.4% vs. 18.8%, respectively, p = .003; losses: 5.3% vs. 10.9% respectively, p = .47). These findings suggest that HMG in women with RPL may reduce the rate of miscarriages and increase that of live births regardless of RPL cause and in women aged <38 years.

Chinese abstract

我们评估了具有复发性流产（RPL）史的女性应用低剂量人绝经期促性腺激素（HMG）联合黄体酮或者单独黄体酮治疗后的妊娠结局。该单中心回顾性队列研究包含的数据来源于在2005年2月至2012年12月期间被诊断为RPL后接受一个周期HMG 联合黄体酮或者单独黄体酮治疗的女性。该研究的主要终点是治疗后的临床妊娠率和流产率, 年龄（<38岁vs.≥38岁）和不明原因的RPL亚组。在169名RPL患者中, 35.5％（n = 60）接受HMG 联合黄体酮治疗, 64.5％（n = 109）接受单独黄体酮治疗。与单独黄体酮治疗相比, HMG 加黄体酮治疗出现较低的流产率, 尽管无明显统计学差异（3.3％ vs. 11.9％, p = .09）, 临床妊娠率增加2倍（41.7％ vs. 19.3％, p = .002）。在不明原因的RPL患者亚组中获得类似的结果（临床妊娠率： HMG 联合黄体酮组48.1％ vs. 单独黄体酮组21.3％, p = .03; 流产率分别为0％和8.5％, p = .29）。在<38岁组中（临床妊娠率：分别为47.4％和18.8％, p = .003; 流产率分别为5.3％和10.9％, p = .47）。这些研究结果表明, 不管是RPL还是年龄<38岁女性的原因, RPL女性应用HMG治疗可能会降低流产率, 并增加活产率。

Keywords:

• Gonadotropins
• progesterone
• pregnancy outcome
• recurrent pregnancy loss
• unexplained recurrent pregnancy loss

Disclosure statement

No potential conflict of interest was reported by the authors.