Sign of early miscarriage

I think I am miscarrying, what to do about it?

How long to wait after a miscarriage?

Transfer interrupted!

MFS says:
My doctor told me to wait one cycle before trying again, but his only reason was so that they could date the pregnancy. I didn't really care about that, since I would know when I ovulated due to temps, and tried that month anyway.

How long temps stay elevated after miscarriage?

MFS says:
I miscarried early, at 4 1/2 weeks in May, and, like sara, my temps only stayed high for a short time. I usually have 27-28 day cycles, and the one after the miscarriage was just 31 days - so my temps only stayed high for a few extra days. We also tried right away, but have not yet been successful.

Miscarriage[Causes and Treatments]

I found this new research-study article (see below) which might interest you. And ask your doctor about this new drug "bromocriptine" for treatment.

Wednesday August 12 1:07 PM EDT

HIGH PROLACTIN LINKED TO RECURRENT MISCARRIAGE

NEW YORK, Aug 12 (Reuters) -- High levels of the hormone prolactin -- a disorder called hyperprolactinemia -- may be linked to recurrent miscarriage, say researchers in Japan. Bromocriptine, a drug that reduces blood levels of the hormone, may help prevent miscarriage in these women, they conclude.

Prolactin levels are important in maintaining early pregnancy, note the researchers. Hyperprolactinemia is relatively common in women who miscarry, but its role in recurrent miscarriages is not clear, according to lead author Dr. Fumiki Hirahara, and colleagues from Yokohama City University School of Medicine in Yokohama, Japan.

``There have not been extensive reports on the role of hyperprolactinemia in recurrent spontaneous abortion,'' they report in the August issue of the journal Fertility and Sterility.

Yet, in a study of 352 women who had had two to four miscarriages, hyperprolactinemia was found to be a common problem. A total of 106 of the women (30%) had elevated levels of the hormone in their blood.

Out of this group of 106 women, 48 between the ages of 24 and 40 agreed to participate in a study in which half of them would be treated with the prolactin-suppressing drug called bromocriptine, and the other half given no medication. The group of women given the drug began therapy before conception, and continued taking the drug up to the 10th week of pregnancy.

Most of the 48 women subsequently became pregnant, and the researchers found that those who were treated with bromocriptine were less likely to have miscarriages. Overall, 85.7% of the bromocriptine-treated group gave birth compared with only 52.4% of those not treated with the drug.

Though larger studies need to be done, the researchers believe their small study ``has demonstrated that maintaining an appropriate level of serum prolactin during early pregnancy is an important therapeutic strategy for patients with recurrent spontaneous abortion and prolactin disorders.''

SOURCE: Fertility and Sterility 1998;70:246-252.

I read also in the medical news that low estrogen is linked to miscarriage. I cut an pasted the article in the section below

--begin article
Wednesday March 18 12:45 PM EST

Low Estrogen Linked To Miscarriage

NEW YORK (Reuters) -- Low levels of estrogen during pregnancy lead to fetal death, which in turn leads to miscarriage, according to a study in monkeys presented at the Society for Gynecological Investigation in Atlanta, Georgia.

Dr. Eugene D. Albrecht of the University of Maryland and Dr. Gerald J. Pepe of Eastern Virginia Medical School blocked estrogen secretion in 22 pregnant baboons, causing 55% to miscarry. The result is similar to that seen in clinical studies of women who have estrogen receptor defects. Those women have an estimated 50% rate of miscarriage.

In the animal study, adding an estrogen supplement to the estrogen-suppressing drug "reversed the (adverse) effects in 100%" of the pregnant animals.

The next step is to "try to find out why these fetuses are dying," Albrecht told Reuters. He suspects that the estrogen deficiency may reduce production of cortisol, a hormone that is critical to the maturation of fetal lungs and liver, as well as other organs and tissues.
--end article

In another medical research/study Links Tap Water Chemical to Miscarriages.
Women who drink five or more glasses a day of ordinary tap water have a higher rate of miscarriage, and a byproduct of the chlorine used to purify water supplies may be to blame researchers say. They said that women who had a high exposure to trihalomethanes (water chemicals) had a miscarriage rate of 15.7 percent compared to 9.5 percent among women with a low exposure to the chemicals. Worried women can refrigerate water in an open container for several hours, they can boil it and then cool it before drinking, or use a carbon water filter to try to remove some of the chemicals in it.

Chris (aka tscat) found the following information and thought she would pass it on to all of us. She says it's very educational and enlightening -- good for all TTC'ers:

Alternative names: miscarriage

      currently pregnant 
      vaginal bleeding 
           with or without abdominal cramps 
           between periods 
      low back pain or abdominal pain 
           dull or sharp or cramping 
           persistent/constant or intermittent 
      tissue or clot-like material that passes from the vagina 

Jill collected a substentiel amount of information too about this topic from the Trying To Conceive After Loss board. Here are her findings:

I was curious about what the medical literature had to say about the risks of repeat miscarriage and the recommended time to wait after miscarriage. I found these articles that I thought were of some interest (there are many, many more that are relevant to the topic). Some of the findings:

• 1. No one seems to know what really causes miscarriages.
• 2. The time interval after a miscarriage doesnt seem to have an affect on future pregnancy success.
• 3. Women who have had repeat miscarriages (up to 6!) have virtually the same chance as women who have had no miscarriages to carry a pregnancy to term.
• 4. Some studies find that a woman who has never carried a child to term is more likely to suffer from a repeat miscarriage than a woman who has delivered at least one child. Other studies do not find a difference related to prior births.
• 5. There is little evidence of the success of the medical treatment of repeat miscarriages (although treatment of aspirin with heparin - but not aspirin alone - is helpful for some women with a certain diagnosis of repeat miscarriage).
• 6. For women over 30 there is a relationship between length of BCP use and a reduced risk of miscarriage.
• 7. For women who have had repeat miscarriages and who have polycystic ovaries, the use of hCG during pregnancy may improve the pregnancy outcome.
• 8. And, surprise, surprise, women who have miscarried often suffer from depression and anxiety (we could have told them that!) and these psychological factors are often worse for childless women.

2. (MEDLINE result)
Clifford K; Rai R; Regan L.
Future pregnancy outcome in unexplained recurrent first trimester miscarriage.
Human Reproduction, 1997 Feb, 12(2):387-9.
(UI: 97224179)
Abstract: The future pregnancy outcome of 201 consecutive women, median age 34 years (range 22-43), with a history of unexplained recurrent first trimester miscarriage (median 3; range 3-13), was studied. All women and their partners had normal peripheral blood karyotypes; none had antiphospholipid antibodies and none hypersecreted luteinizing hormone (LH). No pharmacological treatment was prescribed and early pregnancy supportive care was encouraged. Women aged < or = 30 years had a subsequent miscarriage rate of 25% (14/57) which rose to 52% (13/25) in women aged > or = 40 years (P = 0.02). After three consecutive miscarriages, the risk of miscarriage of the next pregnancy was 29% (34/119) but increased to 53% (9/17) after six or more previous losses (P = 0.04). A past history of a livebirth did not influence the outcome of the next pregnancy. Supportive care in early pregnancy conferred a significant beneficial effect on pregnancy outcome. Of 160 women who attended the early pregnancy clinic, 42 (26%) miscarried in the next pregnancy compared with 21 out of 41 (51%) who did not attend the clinic (P = 0.002). After thorough investigation, women with unexplained recurrent first trimester miscarriage have an excellent pregnancy outcome without pharmacological intervention if offered supportive care alone in the setting of a dedicated miscarriage clinic.

3. (MEDLINE result)
Christiansen OB.
A fresh look at the causes and treatments of recurrent miscarriage, especially its immunological aspects.
Hum Reprod Update, 1996 Jul-Aug, 2(4):271-93.
Pub type: Journal Article; Review; Review, Academic.
(UI: 97235078)
Abstract: The scientific basis for many traditionally accepted causes of recurrent miscarriage (RM) is weak. A significant proportion of RM cases with relatively few miscarriages can presumably be attributed to the random occurrence of consecutive chromosomally abnormal conceptions. New insights in the immunological interactions taking place at the feto-maternal interface provide us with the opportunity to propose detailed pathophysiological models for immunologically mediated RM. Scientific support for the theory that RM is a consequence of graft rejection-like alloimmune reactions against paternal human leukocyte antigens on the fetus is sparse. Conversely, there is considerable evidence that decidual natural killer cells play a role in the implantation and early invasion of the trophoblast and in the pathogenesis of RM. T helper (Th) cells from women with RM react against trophoblast antigens in vitro with the secretion of mainly interleukin-2 and interferon-gamma (a so-called Th1 response), which are known to inhibit trophoblast growth. The predisposition to a Th1 response against a given antigen may be determined by an individuals class II histocompatibility genes. In accordance with this, case-control, prospective and family studies indicate that maternal histocompatibility haplotypes comprising DR1 and DR3 alleles confer susceptibility to RM. The frequent occurrence of autoantibodies in women with RM is compatible with the theory of a Th1 response against trophoblast as a cause of the syndrome, but the autoantibodies themselves probably do not cause RM.

4. (MEDLINE result)
Bulletti C; Flamigni C; Giacomucci E.
Reproductive failure due to spontaneous abortion and recurrent miscarriage.
Hum Reprod Update, 1996 Mar-Apr, 2(2):118-36.
Pub type: Journal Article; Review; Review, Tutorial.
(UI: 97233219)
Abstract: The epidemiology, aetiology, diagnosis and clinical management of spontaneous and recurrent abortion and of the failure of embryo implantation are discussed in a retrospective overview of the major studies conducted since 1975 identified through a Medline search. Infertile women who experienced spontaneous single (32%) and recurrent (0.5%) abortion as well as those who became pregnant after induction of ovulation with gonadotrophins (abortion rate 17-31%) and those who underwent assisted fertilization programmes (abortion rate 18-34%) are considered. Causes and treatments are here reported. Medical treatments for immunologically mediated abortion (IMA) are based on prednisolone, heparin, aspirin and intravenous immunoglobulin. Efficacy of the medical treatment of patients with a history of IMA has yet to be completely demonstrated. Genetic disorders are possible causes of both failure in implantation and early abortion; this cause is more prominent with advanced age and currently cannot be treated. Endocrine factors may also be responsible for miscarriage, and correction of hormone abnormalities is discussed. Infections, endometriosis and psychological factors are other possible important causes of embryo loss without specific widely accepted treatments. Prominent areas of research are the identification of genetic preimplantation abnormalities, and pharmacological intervention for abnormal spontaneous uterine contractility. The data here reported are encouraging, but the efficacy of different treatments is still not convincing. The information available is sufficient to develop new diagnostic and therapeutic tools to evaluate their efficacy in reducing spontaneous abortion at an early stage.

5. (MEDLINE result)
Rai R; Cohen H; Dave M; Regan L.
Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies) [see comments]. Bmj (Clinical Research Ed.), 1997 Jan 25, 314(7076):253-7.
Pub type: Clinical Trial; Journal Article; Randomized Controlled Trial.
(UI: 97174827)
Abstract: OBJECTIVE: To determine whether treatment with low dose aspirin and heparin leads to a higher rate of live births than that achieved with low dose aspirin alone in women with a history of recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies), lupus anticoagulant, and cardiolipin antibodies (or anticardiolipin antibodies). DESIGN: Randomised controlled trial. SETTING: Specialist clinic for recurrent miscarriages. SUBJECTS: 90 women (median age 33 (range 22-43)) with a history of recurrent miscarriage (median number 4 (range 3-15)) and persistently positive results for phospholipid antibodies. INTERVENTION: Either low dose aspirin (75 mg daily) or low dose aspirin and 5000 U of unfractionated heparin subcutaneously 12 hourly. All women started treatment with low dose aspirin when they had a positive urine pregnancy test. Women were randomly allocated an intervention when fetal heart activity was seen on ultrasonography. Treatment was stopped at the time of miscarriage or at 34 weeks gestation. MAIN OUTCOME MEASURES: Rate of live births with the two treatments. RESULTS: There was no significant difference in the two groups in age or the number and gestation of previous miscarriages. The rate of live births with low dose aspirin and heparin was 71% (32/45 pregnancies) and 42% (19/45 pregnancies) with low dose aspirin alone (odds ratio 3.37 (95% confidence interval 1.40 to 8.10)). More than 90% of miscarriages occurred in the first trimester. There was no difference in outcome between the two treatments in pregnancies that advanced beyond 13 weeks gestation. Twelve of the 51 successful pregnancies (24%) were delivered before 37 weeks gestation. Women randomly allocated aspirin and heparin had a median decrease in lumbar spine bone density of 5.4% (range -8.6% to 1.7%). CONCLUSION: Treatment with aspirin and heparin leads to a significantly higher rate of live births in women with a history of recurrent miscarriage associated with phospholipid antibodies than that achieved with aspirin alone.

6. (MEDLINE result)
Neugebauer R; Kline J; Shrout P; Skodol A; O'Connor P; Geller PA; Stein Z; Susser M.
Major depressive disorder in the 6 months after miscarriage.
Jama, 1997 Feb 5, 277(5):383-8.
(UI: 97163350)
Abstract: OBJECTIVE: To test a priori hypotheses that miscarrying women are at increased risk for a first or recurrent episode of major depressive disorder in the 6 months following loss and that this increased risk is greater for childless women, women with prior reproductive loss, and women aged 35 years or older; and to evaluate whether risk varies by time of gestation or by attitude toward the pregnancy. DESIGN: Cohort study. SETTING: The miscarriage cohort consisted of women attending a medical center for a spontaneous abortion (n=229); the comparison group was a population-based cohort of women drawn from the community (n=230). PARTICIPANTS: Miscarriage was defined as the involuntary termination of a nonviable intrauterine pregnancy before 28 completed weeks of gestation. Half of all participants were between 25 and 34 years of age; 40% were white and 35% Hispanic; 55% had more than a high school education. Participants constituted 60% of miscarrying women and 72% of community women who completed the first phase of this cohort study. MAIN OUTCOME MEASURE: Major depressive disorder was measured using the Diagnostic Interview Schedule. RESULTS: Risk for an episode of major depressive disorder among miscarrying women in the 6 months following loss was compared with the 6-month risk among community women who had not been pregnant in the preceding year. Among miscarrying women, 10.9% experienced an episode of major depressive disorder, compared with 4.3% of community women. The overall relative risk (RR) for an episode of major depressive disorder for miscarrying women was 2.5 (95% confidence interval [CI], 1.2-5.1) and was substantially higher for childless women (RR, 5.0; 95% CI, 1.7-14.4) than for women with children (RR, 1.3; 95% CI, 0.5-3.5) (P<.06). Among miscarrying women, 72% of cases of major depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54% experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy. CONCLUSIONS: Physicians should monitor miscarrying women in the first weeks after reproductive loss, particularly women who are childless or who have a history of major depressive disorder. Where appropriate, supportive counseling or psychopharmacologic treatment should be considered.

7. (MEDLINE result)
Cuisinier M; Janssen H; de Graauw C; Bakker S; Hoogduin C. Pregnancy following miscarriage: course of grief and some determining factors.
Journal of Psychosomatic Obstetrics and Gynaecology, 1996 Sep, 17(3):168-74.
(UI: 97047243)
Abstract: This prospective study aimed to investigate the impact of both (the speediness of) a subsequent pregnancy and the birth of a viable child on grief arising from a previous pregnancy loss. Data were collected from a series of written questionnaires. Of the 2140 pregnant women who participated in the study, 227 lost a baby by miscarriage (85%) or perinatal death (15%). In 221 women, the loss concerned a singleton. At each of four post-loss assessments, these women completed the Perinatal Grief Scale. They also indicated whether they had conceived again and, if they had, related how they felt about that. Data were analyzed by means of hierarchical multiple regression. Both conceiving again and the birth of a living child lessened grief. A speedy new pregnancy was only rarely found to be detrimental. It is suggested that parents, at least following miscarriage, no longer be advised to wait a specific time before conceiving again. Preferably their individual situation should be discussed with them in order to help them make their own informed decision concerning the subsequent pregnancy.

8. (MEDLINE result)
France JT; Keelan J; Song L; Liddell H; Zanderigo A; Knox B. Serum
concentrations of human chorionic gonadotrophin and immunoreactive inhibin in early pregnancy and recurrent miscarriage: a longitudinal study.
Australian and New Zealand Journal of Obstetrics and Gynaecology, 1996 Aug, 36(3):325-30.
(UI: 97038168)
Abstract: Serum concentrations of immunoreactive inhibin (ir-inhibin) and human chorionic gonadotrophin (HCG) have been measured during the first trimester in a longitudinal study of pregnant women attending a recurrent miscarriage clinic. In 30 singleton pregnancies (Group 1) that continued successfully to term, the median concentration of ir-inhibin initially declined from 1,140 pg/mL at week 4-5 then rose back to comparable values between weeks 7 and 10 but to decline again to reach the significantly lower level of 840 pg/mL (p < 0.01) at week 15-16. Serum levels of HCG showed the classical profile of normal pregnancy reaching a median peak value of 65,600 IU/L (1st IRP) at week 8-9. In 7 pregnancies that miscarried but earlier had evidence on ultrasound of an active fetal heart, HCG levels in the first 9 weeks were consistently below the 10th percentile for Group 1 pregnancies (p < 0.001). Levels of ir-inhibin were also suppressed but to a lesser extent. In 6 of 7 a fetal pregnancies, HCG levels during the first 9 weeks were again markedly subnormal. The levels of ir-inhibin varied between high normal and subnormal. In none of the pregnancy groups was a correlation found between ir-inhibin and HCG concentrations. In a single pregnancy with an anencephalic fetus, while levels of ir-inhibin and HCG were not depressed, peak values were not reached until week 12. The study shows that the level of ir-inhibin in the maternal serum in early pregnancy is of little value as a prognostic indicator of pregnancy outcome. It confirms that a subnormal HCG level is a useful predictor of early pregnancy failure.

9. (MEDLINE result)
Clifford K; Rai R; Watson H; Franks S; Regan L.
Does suppressing luteinising hormone secretion reduce the miscarriage rate? Results of a randomised controlled trial.
Bmj (Clinical Research Ed.), 1996 Jun 15, 312(7045):1508-11.
Pub type: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
(UI: 96258730)
Abstract: OBJECTIVE--To determine whether prepregnancy pituitary suppression of luteinising hormone secretion with a luteinising hormone releasing hormone analogue improves the outcome of pregnancy in ovulatory women with a history of recurrent miscarriage, polycystic ovaries, and hypersecretion of luteinising hormone. DESIGN--Randomised controlled trial. SETTING--Specialist recurrent miscarriage clinic. SUBJECTS--106 women with a history of three or more consecutive first trimester miscarriages, polycystic ovaries, and hypersecretion of luteinising hormone. INTERVENTIONS--Women were randomised before conception to receive pituitary suppression with a luteinising hormone releasing hormone analogue followed by low dose ovulation induction and luteal phase progesterone (group 1) or were allowed to ovulate spontaneously and then given luteal phase progesterone alone or luteal phase placebo alone (group 2). No drugs were prescribed in pregnancy. MAIN OUTCOME MEASURES--Conception and live birth rates over six cycles. RESULTS--Conception rates in the pituitary suppression and luteal phase support groups were 80% (40/50 women) and 82% (46/56) respectively (NS). Live birth rates were 65% (26/40) and 76% (35/46) respectively (NS). In the luteal phase support group there was no difference in the outcome of pregnancy between women given progesterone and those given placebo pessaries. Live birth rates from an intention to treat analysis were 52% (26/50 pregnancies) in the group given pituitary suppression and 63% (35/56) in the controls (NS). CONCLUSIONS--Prepregnancy suppression of high luteinising hormone concentrations in ovulatory women with recurrent miscarriage and hypersecretion of luteinising hormone does not improve the outcome of pregnancy. The outcome of pregnancy without pituitary suppression is excellent.

10. (MEDLINE result)
Ikegawa A.
Prediction of first-trimester miscarriage from embryonic bradycardia and embryonic growth delay.
Journal of Obstetrics and Gynaecology, 1995 Dec, 21(6):537-44.
(UI: 96226741)
Abstract: OBJECTIVE: The purpose of this study was to determine whether subsequent and simultaneous measurements of embryonic heart rate (EHR) and crown-rump length (CRL) are useful in predicting miscarriage. STUDY DESIGN: A prospective cross-sectional study was performed on miscarriages with detectable embryonic heart rate (n = 33). Chromosomal tests were carried out in 9 of 33 cases. RESULT: In cases with embryonic bradycardia and/or embryonic growth delay, the mean CRL was 6.6 mm (n = 16), and embryonic death occurred at CRL values under 20 mm. In cases where neither bradycardia nor growth delay was detected, the CRL was 23.9 mm (n = 17) at embryonic death. Chromosomal abnormalities were present as triploidy (n = 5) and trisomy-16 (n = 2) in both and embryonic-growth-delay cases. CONCLUSION: Subsequent and simultaneous measurements of EHR and CRL are useful in predicting miscarriage in the first trimester, especially when the CRL is under 20 mm.

11. (MEDLINE result)
Ford JH; MacCormac L.
Pregnancy and lifestyle study: the long-term use of the contraceptive pill and the risk of age-related miscarriage.
Human Reproduction, 1995 Jun, 10(6):1397-402.
(UI: 96061113)
Abstract: Maternal ageing is a very important factor in aneuploidy. It is associated with an increased risk of a liveborn trisomy, especially Down's syndrome, and with a dramatic increase in trisomic conceptions, the majority of which miscarry. A total of 585 volunteer couples who were planning pregnancies participated in a prospective study of reproduction. The couples answered extensive questionnaires and early pregnancy tests (day 28) were conducted each month. The number of years of contraceptive pill use was correlated with pregnancy outcome. Lowered rates of miscarriage were found with increased years of pill use. The cut-off point for this positive effect appeared to be 9 years. Use of oral contraceptives for > or = 9 years was associated with a spontaneous abortion rate of 11.3%, which is about half the rate (23%) which was found in couples who had not used the pill. However, the effect of pill taking was correlated with female age, and when age was examined as an independent factor, the reduction in miscarriage was only statistically significant in women > 30 years old, where the rate of abortion reduced from 28 to 7%. Because age-related aneuploidy in humans probably occurs as a direct or an indirect result of follicle depletion, it is proposed that the long-term use of the oral contraceptive pill protects against abortion due to aneuploidy by preserving the number of follicles.

12. (MEDLINE result)
Katz VL; Kuller JA.
Recurrent miscarriage.
American Journal of Perinatology, 1994 Nov, 11(6):386-97.
Pub type: JOURNAL ARTICLE; REVIEW; REVIEW, ACADEMIC.
(UI: 95160823)
Abstract: The perinatologists are emerging as the physicians who evaluate and treat women with recurrent pregnancy loss. Recurrent miscarriage, previously referred to as habitual abortion, affects almost 1% of couples. The etiologies of recurrent miscarriage are diverse and may be divided into genetic defects, such as chromosomal anomalies; maternal reproductive anatomic disease, both developmental and acquired, such as septate uterus or cervical incompetence; and systemic maternal disease such as antiphospholipid antibody syndrome or maternal diabetes. A cause for recurrent miscarriage can be identified approximately 60% of the time. We emphasize the tremendous psychological impact of recurrent miscarriage. We contrast any proposed treatments with the empiric fact that with no treatment after recurrent losses, couples still have a 60 to 70% chance of delivering a viable infant.

13. (MEDLINE result)
Pearce JM; Hamid RI.
Randomised controlled trial of the use of human chorionic gonadotrophin in recurrent miscarriage associated with polycystic ovaries [retracted in Br J Obstet Gynaecol 1995 Nov;102(11):853].
British Journal of Obstetrics and Gynaecology, 1994 Aug, 101(8):685-8.
Pub type: Retracted Publication; CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL.
(UI: 95034506)
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 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.

14. (MEDLINE result)
Wyss P; Biedermann K; Huch A.
Relevance of the miscarriage-new pregnancy interval.
Journal of Perinatal Medicine, 1994, 22(3):235-41.
(UI: 95123586)
Abstract: There is a wide divergence of opinion concerning the interval a woman should wait after a miscarriage before attempting a new pregnancy ("pregnancy interval"). Many authors recommend waiting 3-4 months in order to reduce the risk of another miscarriage [3, 6, 17, 21]. This retrospective study investigated whether a longer pregnancy interval lowers the risk of repeat miscarriage (R-risk) and/or prematurity. The association between parity and R-risk was also analyzed. Results showed that there are no proven reasons to recommend a waiting period between a miscarriage and a subsequent pregnancy, because the R-risk was around 20% irrespective of interval duration. Prematurity too is not influenced by a waiting period after miscarriage. There was, however, an association between parity and R-risk and risk of prematurity: nulliparae were more likely to have a repeat miscarriage (p < 0.05) or a preterm delivery in the next pregnancy (p < 0.05) than women who had already given birth to a child.

15. (MEDLINE result)
Quenby SM; Farquharson RG.
Predicting recurring miscarriage: what is important?
Obstetrics and Gynecology, 1993 Jul, 82(1):132-8.
(UI: 93295630)
Abstract: OBJECTIVE: To audit the Miscarriage Clinic in Liverpool and to categorize women into those at low and high risk of a subsequent pregnancy loss. METHODS: Over 4 years (1989-1992), 203 consecutive couples attended the Miscarriage Clinic in Liverpool. A data base was designed and a mathematical model formulated that described the data base. RESULTS: A successful pregnancy outcome was most likely in the presence of the following features: menstrual regularity, fewer than four previous miscarriages, maternal age of less than 30 years, absence of antiphospholipid antibodies, and a previous live birth. Oligomenorrhea was a considerably more significant feature than any other in predicting a subsequent miscarriage. These high-risk oligomenorrheic women were found to have low luteal phase estradiol levels, but normal luteal phase progesterone profiles and normal LH profiles throughout the menstrual cycle. CONCLUSIONS: Women suffering from recurring miscarriage can be placed into differing risk categories. Women with a good prognosis require counseling alone. Women at high risk of a subsequent miscarriage had oligomenorrhea and an isolated deficiency of estradiol in the luteal phase of the menstrual cycle.

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