Pregnancy in Essential Thrombocythemia (ET): Experience with 40 Pregnancies.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1511-1511
Author(s):  
Eeva Juvonen ◽  
Riitta Niittyvuopio ◽  
Risto Kaaja ◽  
Kalevi Oksanen ◽  
Heikki Hallman ◽  
...  
Keyword(s):  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Live Birth Rate ◽  
First Trimester ◽  
Common Complication ◽  
Platelet Counts ◽  
Complicated Pregnancy ◽  
First Time ◽  
In Pregnancy

Abstract 40 pregnancies of 16 women with ET were analyzed retrospectively. In 6 patients ET was diagnosed before the first pregnancy. In 10 patients thrombocytosis was detected for the first time during a pregnancy, and the diagnosis of ET was confirmed in the median of 17 months from the delivery. Of the pregnancies 45% (18/40) were complicated, 55% (22/40) uncomplicated, and 63% (25/40) resulted in live birth. 9/16 women had at least one complicated pregnancy. The most common complication was spontaneous abortion during the first trimester, seen in 33% of all pregnancies and comprising 72% of all complications. 2 intrauterine fetal deaths occurred at weeks 22 and 28. 3 pregnancies were complicated by eclampsia or pre-eclampsia. The non-pregnancy-related symptoms of ET or platelet counts before conception or during pregnancy did not correlate with the risk of complications. The median of maximum platelet counts during the first trimester in 16 pregnancies resulting in live birth was 757 x 109/l (255 – 1561 x 109/l) and in 13 pregnancies ending in pregnancy loss 835 x 109/l (697 – 1525 x 109/l) (p=0.25). The intrauterine fetal deaths occurred with platelet counts 553 and 574 x 109/l. In patients with eclampsia or pre-eclampsia the platelet counts were normal at the onset of the symptoms. Only 2 patients had other ET-related symptoms during pregnancy. 9 patients had ET-related symptoms before or between the pregnancies. In 4 of them the pregnancies were uncomplicated. Treatment for ET was or had been given to 11/16 (67%) women in 13 pregnancies either during the pregnancy or before conception or both. Acetylsalicylic acid (ASA) was given in 10 pregnancies of 9 patients. 2 continued with ASA throughout the pregnancy. In 7 patients ASA was started at 4–27 weeks of gestation, in 4 of them during the first trimester. 7 patients had received platelet lowering drugs before conception. 5 were on interferon (IFN) before conception; 3 of them switched over to ASA after conception, one continued with IFN after a 4-week break from week 15 onwards, one continued with IFN throughout the pregnancy. Both patients on IFN during the pregnancy received also ASA. 2 women had been treated with busulphan before conception; one because of previous recurrent miscarriages successfully before two pregnancies, and the other with no pregnancy planning 26 months before the conception. Pregnancy complications occurred in 18/27 (67%) pregnancies in women without any treatment and in 0/13 pregnancies in those with treatment before or during the pregnancy (p<0.001). The live-birth rate in the treated patients (13/13 pregnancies, 100%) was higher than that in the untreated patients (12/27 pregnancies, 44%)(p<0.001). 8/8 pregnancies with ASA alone resulted in live birth (difference from untreated patients p=0.01). Conclusion: Nearly half of the pregnancies in patients with ET were complicated and one third resulted in pregnancy loss. Treatment with ASA alone during pregnancy or platelet-lowering drugs before or during pregnancy was associated with lower risk of complications.

Gestational Platelet Trends and Outcomes in Women with Myeloproliferative Disorders Characterized by Thrombocytosis

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5251-5251
Author(s):  
Annemarie E. Fogerty ◽  
David Kuter ◽  
Jean M. Connors
Keyword(s):  
Platelet Count ◽  
Live Birth ◽  
Plasma Volume ◽  
Pregnancy Complications ◽  
Birth Rate ◽  
Post Partum ◽  
Live Birth Rate ◽  
Myeloproliferative Disorders ◽  
First Trimester ◽  
Platelet Counts

Abstract Myeloproliferative disorders (MPD), including essential thrombocythemia (ET) and polycythemia vera (PV) are most commonly diagnosed after the sixth decade, but as many as 20 percent of patients are younger than 40 years of age. This introduces the issue of disease management during gestation. Pregnant women with ET are reported to have an increased risk of pregnancy complications, with a successful live birth rate of 50 to 57 percent and a first trimester miscarriage rate of 26 to 36 percent (Harrison 2005). This is compared to an anticipated first trimester loss of 15 to 20 percent for women without ET (Hatasaka 1994). Late pregnancy loss has been reported to occur in 5 to 9.6 percent of ET pregnancies, compared to 0.5 percent of normal pregnancies (Cook 1995, Martinelli 2000). In this retrospective case series review, however, examination of 8 women with MPD (6 with ET; 2 with PV and thrombocytosis; 6 with the JAK2 mutation) and their combined 12 pregnancies reveals a 100 percent live birth rate with no disease related complications. Maternal age ranged from 27 to 41 years with gestational ages averaging 39.1 weeks (ranging from 36.9 to 41.3 weeks). There were no thrombotic or significant bleeding events observed. The majority of women were treated with only aspirin 325mg daily throughout gestation, with the 2 women with PV also receiving gestational enoxaparin 60mg daily that was continued for 6 weeks post-partum. Platelet counts decreased throughout gestation in all pregnancies, reaching a nadir at delivery before rebounding to pre-gestational range within 1 to 2 months post-partum. On average, the platelet count decreased by 53.1 percent during gestation (ranging from 28.4 to 70.9 percent). Forty-two percent of pregnancies demonstrated a normal platelet count at the time of delivery. The significant decline in platelet counts throughout gestation may be protective against thrombosis. This decrease is unlikely to represent hemodilution of pregnancy alone as platelet counts continued to decline until delivery, whereas rapid maternal plasma volume expansion occurs between weeks 9 and 34 of gestation, followed by only a modest increase in plasma volume thereafter. Moreover, benign gestational thrombocytopenia occurs in only 5 percent of normal pregnancies. In summary, use of aspirin or enoxaparin in this series did not result in any bleeding complications. The data from this cohort suggests that a diagnosis of ET or PV does not lead to increased pregnancy complications or loss. Platelets Trends Case Platelet Count on Day of Delivery Average Non-Gestational Platelet Count Highest Recorded Platelet Count % Platelet Reduction** *Twin delivery **Between average non-gestational platelet count and delivery date platelet count 1 436,000 756,500 855,000 42.4 2 331,000 840,000 1,168,000 60.6 3 220,000 757,000 757,000 70.9 4a 581,000 1,481,000 2,006,000 60.8 4b* 1,025,000 1,431,000 1,493,000 28.4 5a 389,000 1,038,000 1,236,000 62.5 5b 396,000 977,000 1,089,000 59.5 5c 552,000 1,145,000 1,145,000 54.4 6 Unknown 842,000 892,000 7 649,000 1,185,000 1,421,000 45.2 8a 702,000 1,298,000 1,398,000 45.9 8b 606,000 1,302,000 1,445,000 53.5 Figure Figure

scholarly journals Live Birth Rate of Fresh Embryo Transfer with GnRH Agonist Long Protocol is Higher Than Frozen Embryo Transfer

2020 ◽  
Author(s):  
Xiaoyan Ding ◽  
Jingwei Yang ◽  
Lan Li ◽  
Na Yang ◽  
Ling Lan ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Implantation Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Fresh Embryo Transfer ◽  
Long Protocol

Abstract Background: Along with progress in embryo cryopreservation, especially in vitrification has made freeze all strategy more acceptable. Some studies found comparable or higher live birth rate with frozen embryo transfer (FET) than with fresh embryo transfer（ET）in gonadotropin releasing hormone antagonist (GnRH-ant) protocol. But there were no reports about live birth rate differences between fresh ET and FET with gonadotropin releasing hormone agonist (GnRH-a) long protocol. The aim of this study is to analyze whether patients benefit from freeze all strategy in GnRH-a protocol from real-world data.Methods: This is a retrospective cohort study, in which women undergoing fresh ET or FET with GnRH-a long protocol at Chongqing Reproductive and Genetics Institute from January 2016 to December 2018 were evaluated. The primary outcome was live birth rate. The secondary outcomes were implantation rate, clinical pregnancy rate, pregnancy loss and ectopic pregnancy rate.Results: A total of 7,814 patients met inclusion criteria, implementing 5,216 fresh ET cycles and 2,598 FET cycles, respectively. The demographic characteristics of the patients were significantly different between two groups, except BMI. After controlling for a broad range of potential confounders (including age, infertility duration, BMI, AMH, no. of oocytes retrieved and no. of available embryos), multivariate logistic regression analysis demonstrated that there was no significant difference in terms of clinical pregnancy rate, ectopic pregnancy rate and pregnancy loss rate between two groups (all P>0.05). However, the implantation rate and live birth rate of fresh ET group were significantly higher than FET group (P<0.001 and P=0.012, respectively).Conclusion: Compared to FET, fresh ET following GnRH-a long protocol could lead to higher implantation rate and live birth rate in infertile patients underwent in vitro fertilization (IVF). The freeze all strategy should be individualized and made with caution especially with GnRH-a long protocol.

P-377 Association between antinuclear antibodies and pregnancy prognosis in recurrent pregnancy loss patients

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
H Yoshihara ◽  
M Sugiura-Ogasawara ◽  
T Kitaori ◽  
S Goto
Keyword(s):  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Recurrent Pregnancy Loss ◽  
Live Birth Rate ◽  
Negative Group ◽  
Birth Rates ◽  
Positive Group ◽  
Live Birth Rates ◽  
Uterine Anomaly

Abstract Study question Can antinuclear antibody (ANA) affect the subsequent live birth rate in patients with recurrent pregnancy loss (RPL) who have no antiphospholipid antibodies (aPLs)? Summary answer ANA did not affect the pregnancy prognosis of RPL women. What is known already The prevalence of ANA is well-known to be higher in RPL patients. Our previous study found no difference in the live birth rates of ANA-positive and -negative patients who had no aPLs. Higher miscarriage rates were also reported in ANA-positive patients compared to ANA-negative patients with RPL. The RPL guidelines of the ESHRE state that “ANA testing can be considered for explanatory purposes.” However, there have been a limited number of studies on this issue and sample sizes have been small, and the impact of ANA on the pregnancy prognosis is unclear. Study design, size, duration An observational cohort study was conducted at Nagoya City University Hospital between 2006 and 2019. The study included 1,108 patients with a history of 2 or more pregnancy losses. Participants/materials, setting, methods 4D-Ultrasound, hysterosalpingography, chromosome analysis for both partners, aPLs and blood tests for ANA and diabetes mellitus were performed before a subsequent pregnancy. ANAs were measured by indirect immunofluorescence. The cutoff dilution used was 1:40. In addition, patients were classified according to the ANA pattern on immunofluorescence staining. Live birth rates were compared between ANA-positive and ANA-negative patients after excluding patients with antiphospholipid syndrome, an abnormal chromosome in either partner and a uterine anomaly. Main results and the role of chance The 994 patients were analyzed after excluding 40 with a uterine anomaly, 43 with a chromosome abnormality in either partner and 32 with APS. The rate of ANA-positive patients was 39.2 % (390/994) when the 1: 40 dilution result was positive. With a 1:160 dilution, the rate of ANA-positive patients was 3.62 % (36/994). The live birth rate was calculated for 798 patients, excluding 196 patients with unexplained RPL who had been treated with any medication. With the use of the 1 40 dilution, the subsequent live birth rates were 71.34 % (219/307) for the ANA-positive group and 70.67 % (347/491) for the ANA-negative group (OR, 95%CI; 0.968, 0.707-1.326). After excluding miscarriages with embryonic aneuploidy, chemical pregnancies and ectopic pregnancies, live birth rates were 92.41 % (219/237) for the ANA-positive group and 92.04 % (347/377) for the ANA-negative group (0.951, 0.517-1.747). Using the 1:160 dilution, the subsequent live birth rates were 84.62 % (22/26) for the ANA-positive group, and 70.47 % (544/772) for the ANA-negative group (0.434, 0.148-1.273). Subgroup analyses were performed for each pattern on immunofluorescence staining, but there was no significant difference in the live birth rate between the two groups. Limitations, reasons for caution The effectiveness of immunotherapies could not be evaluated. However, the results of this study suggest that it is not necessary. Wider implications of the findings The measurement of ANA might not be necessary for the screening of patients with RPL who have no features of collagen disease. Trial registration number not applicable

scholarly journals Influence of surgical evacuation on pregnancy outcomes of subsequent embryo transfer cycle following miscarriage in an initial IVF cycle: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Junan Meng ◽  
Mengchen Zhu ◽  
Wenjuan Shen ◽  
Xiaomin Huang ◽  
Haixiang Sun ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
First Trimester ◽  
Miscarriage Rate ◽  
Significant Difference ◽  
Surgical Evacuation

Abstract Background It is still uncertain whether surgical evacuation adversely affects subsequent embryo transfer. The present study aims to assess the influence of surgical evacuation on the pregnancy outcomes of subsequent embryo transfer cycle following first trimester miscarriage in an initial in vitro fertilization and embryo transfer (IVF-ET) cycle. Methods A total of 645 patients who underwent their first trimester miscarriage in an initial IVF cycle between January 2013 and May 2016 in Nanjing Drum Tower Hospital were enrolled. Surgical evacuation was performed when the products of conception were retained more than 8 h after medical evacuation. Characteristics and pregnancy outcomes were compared between surgical evacuation patients and no surgical evacuation patients. The pregnancy outcomes following surgical evacuation were further compared between patients with ≥ 8 mm or < 8 mm endometrial thickness (EMT), and with the different EMT changes. Results The EMT in the subsequent embryo transfer cycle of surgical evacuation group was much thinner when compared with that in the no surgical evacuation group (9.0 ± 1.6 mm vs. 9.4 ± 1.9 mm, P = 0.01). There was no significant difference in implantation rate, clinical pregnancy rate, live birth rate or miscarriage rate between surgical evacuation group and no surgical evacuation group (P > 0.05). The live birth rate was higher in EMT ≥ 8 mm group when compared to < 8 mm group in surgical evacuation patients (43.0% vs. 17.4%, P < 0.05). Conclusions There was no significant difference in the pregnancy outcomes of subsequent embryo transfer cycle between surgical evacuation patients and no surgical evacuation patients. Surgical evacuation led to the decrease of EMT, especially when the EMT < 8 mm was association with a lower live birth rate.

Thromboprophylaxis for recurrent miscarriage in women with or without thrombophilia

2011 ◽  
Vol 105 (02) ◽  
pp. 295-301 ◽  
Author(s):  
Jantien Visser ◽  
Veli-Matti Ulander ◽  
Frans Helmerhorst ◽  
Katja Lampinen ◽  
Laure Morin-Papunen ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Live Birth ◽  
Pregnancy Complications ◽  
Birth Rate ◽  
Neonatal Outcome ◽  
Recurrent Miscarriage ◽  
Fetal Loss ◽  
Live Birth Rate ◽  
First Trimester ◽  
Significant Difference

SummaryRecurrent miscarriage affects 1–2% of women. In more than half of all recurrent miscarriage the cause still remains uncertain. Thrombophilia has been identified in about 50% of women with recurrent miscarriage and thromboprophylaxis has been suggested as an option of treatment. A randomised double-blind (for aspirin) multicentre trial was performed among 207 women with three or more consecutive first trimester (<13 weeks) miscarriages, two or more second trimester (13–24 weeks) miscarriages or one third trimester fetal loss combined with one first trimester miscarriage. Women were analysed for thrombophilia. After complete work-up, women were randomly allocated before seven weeks’ gestation to either enoxaparin 40 mg and placebo (n=68), enoxaparin 40 mg and aspirin 100 mg (n=63) or aspirin 100 mg (n=76). The primary outcome was live-birth rate. Secondary outcomes were pregnancy complications, neonatal outcome and adverse effects. The 0.92–1.48] was found for enoxaparin and placebo and 65% [RR 1.08, 95% CI 0.83–1.39] for enoxaparin and aspirin when compared to aspirin alone (61%, reference group). In the whole study group the live birth rate was 65% (95% CI 58.66–71.74) for women with three or more miscarriages (n=204). No difference in pregnancy complications, neonatal outcome or adverse effects was observed. No significant difference in live birth rate was found with enoxaparin treatment versus aspirin or a combination of both versus aspirin in women with recurrent miscarriage.

scholarly journals Association of a family history of autoimmune disease with time to pregnancy, pregnancy loss, and live birth rate

2017 ◽  
Vol 108 (3) ◽  
pp. e34
Author(s):  
T.C. Plowden ◽  
M.T. Connell ◽  
P. Mendola ◽  
K. Kim ◽  
C. Nobles ◽  
...  
Keyword(s):  
Family History ◽  
Autoimmune Disease ◽  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Time To Pregnancy ◽  
History Of

Preimplantation genetic testing for aneuploidy: a comparison of live birth rates in patients with recurrent pregnancy loss due to embryonic aneuploidy or recurrent implantation failure

2019 ◽  
Vol 34 (12) ◽  
pp. 2340-2348 ◽  
Author(s):  
Takeshi Sato ◽  
Mayumi Sugiura-Ogasawara ◽  
Fumiko Ozawa ◽  
Toshiyuki Yamamoto ◽  
Takema Kato ◽  
...  
Keyword(s):  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Recurrent Pregnancy Loss ◽  
Live Birth Rate ◽  
Not Given ◽  
Recurrent Implantation Failure ◽  
Miscarriage Rate ◽  
Preimplantation Genetic Testing ◽  
Biochemical Pregnancy

Abstract STUDY QUESTION Can preimplantation genetic testing for aneuploidy (PGT-A) improve the live birth rate and reduce the miscarriage rate in patients with recurrent pregnancy loss (RPL) caused by an abnormal embryonic karyotype and recurrent implantation failure (RIF)? SUMMARY ANSWER PGT-A could not improve the live births per patient nor reduce the rate of miscarriage, in both groups. WHAT IS KNOWN ALREADY PGT-A use has steadily increased worldwide. However, only a few limited studies have shown that it improves the live birth rate in selected populations in that the prognosis has been good. Such studies have excluded patients with RPL and RIF. In addition, several studies have failed to demonstrate any benefit at all. PGT-A was reported to be without advantage in patients with unexplained RPL whose embryonic karyotype had not been analysed. The efficacy of PGT-A should be examined by focusing on patients whose previous products of conception (POC) have been aneuploid, because the frequencies of abnormal and normal embryonic karyotypes have been reported as 40–50% and 5–25% in patients with RPL, respectively. STUDY DESIGN, SIZE, DURATION A multi-centre, prospective pilot study was conducted from January 2017 to June 2018. A total of 171 patients were recruited for the study: an RPL group, including 41 and 38 patients treated respectively with and without PGT-A, and an RIF group, including 42 and 50 patients treated respectively with and without PGT-A. At least 10 women in each age group (35–36, 37–38, 39–40 or 41–42 years) were selected for PGT-A groups. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients and controls had received IVF-ET for infertility. Patients in the RPL group had had two or more miscarriages, and at least one case of aneuploidy had been ascertained through prior POC testing. No pregnancies had occurred in the RIF group, even after at least three embryo transfers. Trophectoderm biopsy and array comparative genomic hybridisation (aCGH) were used for PGT-A. The live birth rate of PGT-A and non-PGT-A patients was compared after the development of blastocysts from up to two oocyte retrievals and a single blastocyst transfer. The miscarriage rate and the frequency of euploidy, trisomy and monosomy in the blastocysts were noted. MAIN RESULT AND THE ROLE OF CHANCE There were no significant differences in the live birth rates per patient given or not given PGT-A: 26.8 versus 21.1% in the RPL group and 35.7 versus 26.0% in the RIF group, respectively. There were also no differences in the miscarriage rates per clinical pregnancies given or not given PGT-A: 14.3 versus 20.0% in the RPL group and 11.8 versus 0% in the RIF group, respectively. However, PGT-A improved the live birth rate per embryo transfer procedure in both the RPL (52.4 vs 21.6%, adjusted OR 3.89; 95% CI 1.16–13.1) and RIF groups (62.5 vs 31.7%, adjusted OR 3.75; 95% CI 1.28–10.95). Additionally, PGT-A was shown to reduce biochemical pregnancy loss per biochemical pregnancy: 12.5 and 45.0%, adjusted OR 0.14; 95% CI 0.02–0.85 in the RPL group and 10.5 and 40.9%, adjusted OR 0.17; 95% CI 0.03–0.92 in the RIF group. There was no difference in the distribution of genetic abnormalities between RPL and RIF patients, although double trisomy tended to be more frequent in RPL patients. LIMITATIONS, REASONS FOR CAUTION The sample size was too small to find any significant advantage for improving the live birth rate and reducing the clinical miscarriage rate per patient. Further study is necessary. WIDER IMPLICATION OF THE FINDINGS A large portion of pregnancy losses in the RPL group might be due to aneuploidy, since PGT-A reduced the overall incidence of pregnancy loss in these patients. Although PGT-A did not improve the live birth rate per patient, it did have the advantage of reducing the number of embryo transfers required to achieve a similar number live births compared with those not undergoing PGT-A. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Japan Society of Obstetrics and Gynecology and grants from the Japanese Ministry of Education, Science, and Technology. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A

scholarly journals Fertility outcomes in women after controlled ovarian stimulation with gonadotropin releasing hormone agonist long protocol: fresh versus frozen embryo transfer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoyan Ding ◽  
Jingwei Yang ◽  
Lan Li ◽  
Na Yang ◽  
Ling Lan ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Implantation Rate ◽  
Live Birth Rate ◽  
Gonadotropin Releasing Hormone ◽  
Releasing Hormone ◽  
Long Protocol

Abstract Background Along with progress in embryo cryopreservation, especially the vitrification, freeze all strategy has become more acceptable than ever. Some studies have found comparable or higher live birth rate with frozen embryo transfer (FET) than with fresh embryo transfer(ET)in gonadotropin releasing hormone antagonist (GnRH-ant) protocol. However from our literature research, there have been no reports about live birth rate comparison between fresh ET and FET with gonadotropin releasing hormone agonist (GnRH-a) long protocol. The aim of this study is to retrospectively investigate whether patients benefit from freeze all strategy in GnRH-a protocol using real-world data. Methods This is a retrospective cohort study, in which women undergoing fresh ET or FET with GnRH-a long protocol at Chongqing Reproductive and Genetics Institute from January 2016 to December 2018 were evaluated. The primary outcome was live birth rate. The secondary outcomes were implantation rate, clinical pregnancy rate, pregnancy loss and ectopic pregnancy rate. Results A total of 7,814 patients met inclusion criteria, implementing 5,216 fresh ET cycles and 2,598 FET cycles, respectively. The demographic characteristics of the patients were significantly different between fresh ET and FET groups, except BMI. After controlling for a broad range of potential confounders including age, infertility duration, BMI, AMH, number of oocytes retrieved and of available embryos, multivariate logistic regression analysis demonstrated that there was no significant difference in clinical pregnancy rate, ectopic pregnancy rate and pregnancy loss rate between two groups (all P > 0.05). However, the implantation rate and live birth rate in fresh ET group were significantly higher than FET group (P < 0.001 and P = 0.012, respectively). Conclusions Under GnRH-a long protocol, compared to FET, fresh ET was associated with higher implantation rate and live birth rate in infertile patients that underwent in vitro fertilization (IVF). The freeze all strategy should be individualized and made with caution especially with GnRH-a long protocol.

scholarly journals Systematic meta-analysis of subsequent pregnancy outcomes in recurrent pregnancy loss couples with parental abnormal chromosomal karyotype

2021 ◽  
Author(s):  
Peng-Sheng Zheng ◽  
Shan Li ◽  
Jing Jing He
Keyword(s):  
Live Birth ◽  
Pregnancy Outcomes ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Recurrent Pregnancy Loss ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Sufficient Evidence ◽  
Current Evidence ◽  
Miscarriage Rate

Background Parental abnormal chromosomal karyotypes are considered as reasons for recurrent pregnancy loss. Objective This systematic meta-analysis evaluated the current evidence on pregnancy outcomes amongst couples with abnormal versus normal chromosomal karyotypes. Search strategy Two independent reviewers screened titles and abstracts identified in EMBASE and PubMed from inception to January 2021. Selection criteria Studies were included if they provided a description of pregnancy outcomes of parental chromosomal abnormality. Data collection and analysis Random effects meta-analysis was used to compare odds of pregnancy outcomes associated with noncarriers and carriers. Main results A significantly lower first pregnancy live birth rate (FPLBR) was found in carriers than in noncarriers with RPL (OR: 0.55; 95% CI: 0.46-0.65; p<0.00001). Regarding FPLBR between translocation or inversion carriers and noncarriers, a markedly decreased FPLBR was found in translocation (OR: 0.44; 95% CI: 0.31–0.61; p<0.00001) but not inversion carriers. The accumulated live birth rate (ALBR) (OR: 0.96; 95% CI: 0.90–1.03; p=0.26) was similar, while the miscarriage rate (MR) of accumulated pregnancies (OR: 2.21; 95% CI: 1.69–2.89; p<0.00001) was significantly higher in the carriers than in noncarriers with RPL. The ALBR was not significant (OR: 1.82; 95% CI: 0.38–8.71; p=0.45) but the MR (OR: 5.75; 95% CI: 2.57–12.86; p<0.0001) was markedly lower for carriers who choose PGD than natural conception. Conclusions Carriers with RPL had higher risk of miscarriage but obtained a satisfying pregnancy outcome through multiple attempts. No sufficient evidence was found PGD could enhance the ALBR but it was an alternative to decrease the MR.

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