Doxycycline for chronic endometritis did not raise live births in recurrent miscarriage

The edition in brief

A double-blind trial of 438 women with recurrent miscarriage and chronic endometritis, defined by CD138-positive cells on biopsy, found no difference in live birth or ongoing pregnancy between preconception doxycycline and placebo (52% vs 50%, adjusted RR 1.02, credible interval 0.85 to 1.21). A narrative review of GLP-1 receptor agonist exposure around conception found no clear safety signal in observational data, but the data are small and cannot exclude important risks. A meta-analysis of 13 observational studies found that unoperated unilateral endometriomas gave oocyte yields comparable to the healthy contralateral ovary, though heterogeneity was high. A secondary analysis of two trials in 291 women managed expectantly for preterm pre-eclampsia found that higher 24-hour proteinuria was associated with shorter latency and more maternal complications, but not perinatal ones. The pearl restates that proteinuria is not required to diagnose pre-eclampsia. The practice-changing item is the doxycycline trial: where guidelines advise testing and treating, this trial gives no support for doing so on CD138 staining alone.