# Alpha-Lipoic Acid and Leucine as Adjunct Therapy for Persistent First-Trimester Subchorionic Hematomas in Assisted Reproductive Technology Pregnancies

## TL;DR

This study suggests that alpha-lipoic acid may help resolve persistent first-trimester bleeding in ART pregnancies, with no reported side effects.

## Contribution

The novel contribution is the use of alpha-lipoic acid as a safe and effective adjunct therapy for persistent subchorionic hematomas in ART pregnancies.

## Key findings

- All three patients stopped vaginal bleeding within four to seven days of starting alpha-lipoic acid therapy.
- Subchorionic hematomas resolved completely within two to four weeks in all cases.
- No maternal or fetal adverse effects were observed, and all pregnancies progressed to the second trimester.

## Abstract

Subchorionic hematoma (SCH) is a frequent cause of first-trimester bleeding, particularly in pregnancies conceived through assisted reproductive technologies (ART), and is associated with adverse pregnancy outcomes when persistent. Management is largely conservative, with limited targeted therapeutic options. This descriptive case series evaluated the effectiveness and safety of oral alpha-lipoic acid (ALA) as an adjunct therapy in three primigravida women with ART-conceived pregnancies complicated by persistent first-trimester SCH unresponsive to conventional management, including progesterone support and hemostatic agents. ALA was administered orally at a dose of 600 mg once daily, alongside continued standard therapy. Clinical symptoms and hematoma progression were monitored through serial transvaginal ultrasonography. All three patients experienced cessation of vaginal bleeding within four to seven days of initiating ALA therapy. Complete sonographic resolution of the hematoma was observed within two to four weeks in all cases. No maternal or fetal adverse effects were reported, and all pregnancies progressed uneventfully into the second trimester. These findings suggest that oral ALA may represent a safe and potentially effective adjunctive therapy for persistent first-trimester SCH in ART pregnancies, warranting further evaluation in larger prospective studies.