RANDOMIZED CONTROLLED TRIAL OF THE USE OF HUMAN CHORIONIC-GONADOTROPIN IN RECURRENT MISCARRIAGE ASSOCIATED WITH POLYCYSTIC OVARIES

Objective To determine whether the use of human chorionic gonadotrophi n (hCG) would reduce the recurrent miscarriage rate in women with poly cystic ovarian disease. Design Double-blind, prospective, randomised c ontrolled 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 polycys tic ovary syndrome. Intervention 10000 i.u. of hCG or a placebo were g iven when the leading follicle was greater than or equal to 21 mm, the n 5000 i.u. of hCG or a placebo were given twice weekly until miscarri age or the tenth week of pregnancy. Main outcome measure Miscarriage r ate. Results Women with polycystic ovaries who received hCG treatment had a lower miscarriage rate (14 %) compared with women who received p lacebo (43 %). In women with follicular phase luteinising hormone > 10 iu/1, those who received hCG therapy had a miscarriage rate of 10 % c ompared with a rate of 44 % in women who received the placebo. When cl omiphene was used for ovulation induction, women treated with hCG had a miscarriage rate of 14 % compared with a rate 47 % in women who rece ived the placebo. There was no significant benefit from hCG therapy in natural cycles. Conclusion The use of hCG in women with recurrent mis carriage and polycystic ovary syndrome improves the pregnancy outcome.