In early pregnancy, there are two hormones that tend to increase in the body following implantation -- progesterone and human chorionic gonadotropin (hCG). Levels of both hormones tend to rise in women with viable pregnancies but fall in women with an impending miscarriage. And in the past few decades, it's become common that doctors prescribe progesterone supplements to women having recurrent miscarriages, with the idea being that underproduction of progesterone might be a cause of miscarriage. Yet progesterone is a subject of much controversy among doctors, as many feel that low progesterone is a sign of a failing pregnancy rather than a contributing factor to the failed pregnancy, and progesterone supplements have yet to be proven beneficial for women at risk of miscarriage.
Far less attention has been paid to the idea of supplementing the other pregnancy hormone -- hCG -- to prevent miscarriages, even though hCG is the hormone measured in home pregnancy tests and the serial blood tests doctors use to evaluate early pregnancy viability. But is it fathomable that supplementing hCG might benefit women with recurrent miscarriages? Could underproduction of hCG actually contribute to miscarriage rather than simply being a sign of an impending miscarriage?
A few studies actually have investigated this possibility. Here is what UpToDate, an online health reference site for doctors and patients, had to say about hCG supplementation as a miscarriage treatment:
"Human chorionic gonadotropin (hCG) therapy during early gestation may be useful in preventing miscarriage since endogenous hCG is known to play a critical role in the establishment of pregnancy. A systematic review of four trials involving 180 women with RPL found hCG therapy was associated with a significantly reduced risk of miscarriage, particularly in women with oligomenorrhea. However, there were important methodological weaknesses in two of these studies. To date, there is insufficient evidence to recommend the use of hCG to prevent pregnancy loss in women with a history of unexplained RPL. Large randomized controlled trials are needed."
So, in other words, it is fathomable that hCG supplements could help prevent miscarriages. The hormone hCG plays a key role in helping a pregnancy get established, and it is theoretically possible that reduced hCG production could play a causal role in miscarriages. Existing research showed that the treatment might benefit women with infrequent and irregular periods (oligomenorrhea). But unfortunately, that doesn't mean you should go to your doctor and ask to be placed on hCG injections early on in your next pregnancy, even if you have oligomenorrhea. Too little is known about whether or not this treatment works and who would benefit. Assuming it even does work, more research is needed before the treatment can be widely used.
Unexplained miscarriages are tough to deal with, however, and they may raise a lot of questions...here are some common concerns.
I have had 5 miscarriages and my doctor can't tell me why. I want to try this treatment. I'll try anything at this point.
It's difficult to be patient with the pace of medical research. It's easy to be fed up with treatments that might be available in 10 years when you need help now. But it's also wisest not to rush into things. The story of DES is a good cautionary tale for the importance of not leaping headfirst into unproven treatments. Nevertheless, many women prefer to try unproven miscarriage therapies that are deemed unlikely to be harmful rather than continuing to try with no treatment. Talk to your doctor about your feelings regarding this, and if you're not happy with your current doctor, seek a second opinion. You may also want to ask about clinical trials that might be going on in your area.
What treatments are proven for helping with recurrent miscarriages?
Unfortunately, very few. But if you've had two or more miscarriages, ask your doctor about testing for antiphospholipid syndrome and structural problems in your uterus. These are two potential contributing factors to recurrent miscarriages that do have well established treatments that seem to boost the odds of a healthy pregnancy.
What's the best kind of specialist to see if I've had multiple miscarriages?
OB/GYNs are most qualified to address pregnancy-related issues, so if you're happy with your current doctor, you can ask your existing doctor about testing for miscarriage causes. But you might also want to consider a reproductive endocrinologist, an OB/GYN with additional specialized training in infertility and endocrinology of the reproductive system. These doctors are likely to spend a larger percentage of their time dealing with women who have difficulties related to becoming and staying pregnant, whereas OB/GYNs may spend more of their time dealing with women having normal pregnancies (and you're less likely to see visibly pregnant women in the waiting room when you attend your appointments).
Want to learn more? See UpToDate's topic, "Management of couples with recurrent pregnancy loss," for additional in-depth medical information.
Tulandi, Togas and Haya M Al-Fozan. "Management of couples with recurrent pregnancy loss." UpToDate. Accessed: June 2010.