Pregnancy outcomes among patients with recurrent pregnancy loss and chromosomal aberration (CA) without PGD

2018 ◽  
Vol 46 (7) ◽  
pp. 764-770 ◽  
Author(s):  
Maor Kabessa ◽  
Avi Harlev ◽  
Michael Friger ◽  
Ruslan Sergienko ◽  
Baila Litwak ◽  
...  
Keyword(s):  
Live Birth ◽  
Pregnancy Outcomes ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Control Group ◽  
Study Group ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Index Pregnancy ◽  
Significant Difference

Abstract Background: Recurrent pregnancy loss (RPL) is defined by two or more failed clinical pregnancies. Three to four percent of the couples with RPL have chromosomal aberrations (CA) in at least one partner. The parent’s structural chromosomal abnormalities may cause an unbalanced karyotype in the conceptus which could lead to implantation failure, early or late pregnancy loss, or delivery of a child with severe physical and/or mental disabilities. Objective: To compare live birth rates of couples with CA to couples with normal karyotypes and to investigate medical and obstetric characteristics and pregnancy outcomes of couples with CA and RPL who attend an RPL clinic at a tertiary hospital. Methods: A retrospective cohort study, including 349 patients with two or more consecutive pregnancy losses. The study group consisted of 52 patients with CA, and the control group consisted of 297 couples with normal karyotype. All patients were evaluated and treated in the RPL clinic at Soroka University Medical Center and had at least one subsequent spontaneous pregnancy. Results: The demographic and clinical characteristics were not found to be statistically different between the two groups. The group of carriers of CA had 28/52 (53.8%) live births in their index pregnancy vs. the normal 202/297 (68%) (P=0.067, CI 95%) in the control group. No statistically significant etiology was found between the study group and the control group. A statistically significant difference in live birth rates was found when comparing the total amount of pregnancies [index pregnancy (IP)+post index pregnancy (PIP)] between the study group and the control group (54.16% vs. 67.82%, respectively, P=0.0328). Conclusion: Patients with RPL and CA who have spontaneous pregnancies, have a good prognosis (63.4%) of a successful pregnancy with at least one of the pregnancies (index or post index) resulting in a live birth.

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 Preimplantation genetic testing for aneuploidy (PGT-A) reduces miscarriage and improves live birth rates in recurrent pregnancy loss patients

2019 ◽  
Vol 112 (3) ◽  
pp. e401 ◽  
Author(s):  
Julia G. Kim ◽  
Gayathree Murugappan ◽  
Ruth B. Lathi ◽  
Jonathan D. Kort ◽  
Brent M. Hanson ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Live Birth ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Birth Rates ◽  
Preimplantation Genetic Testing ◽  
Live Birth Rates

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 Relationship of insulin resistance with recurrent pregnancy loss

2017 ◽  
Vol 6 (4) ◽  
pp. 1312 ◽  
Author(s):  
Asifa Ali Wani ◽  
Irfan Gul ◽  
Farhat Jabeen ◽  
Shiveta Kaul ◽  
Farhat Ali Lone ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Fasting Glucose ◽  
Histopathological Examination ◽  
Control Group ◽  
Study Group ◽  
Fasting Insulin ◽  
Significant Difference ◽  
Mean Glucose

Background: The recurrent pregnancy loss (RPL) is defined as two and more failed pregnancies as documented by ultrasound and histopathological examination and suggested some assessment after each loss with a thorough evaluation after three or more losses. RPL is one of the most frustrating and difficult areas in reproductive medicine because the aetiology is often unknown and there are few evidence based diagnostic and treatment strategies.Methods: 150 Non pregnant females were taken as both cases and controls in the study. All the pregnancy losses were documented by ultrasound or histological examination after uterine curettage. The control group consisted of women with no RPL with at least one live birth. These two groups were matched on the basis of age and BMI. All the women underwent following examinations, viz. Hysterosalpingography, karyotype of both partners, serum TSH, FT4, prolactin and antibodies for APLA. In addition blood sample were taken for fasting serum glucose and serum insulin level later insulin resistance was calculate using three parameters Fasting insulin > 20IU/ml. Diagnostic of Insulin Resistance. (2) Fasting glucose / Fasting insulin. A ratio of < 4.5 being diagnostic of insulin resistance. (3) HOMA IR.        FG (mg/dl) x FPI (IU/ml) FG (mmol/l) x FPI (IU/ml)------------------------------------ OR -----------------------------------                                             405 22.5Where 1 mmol/l = 18mg/dl, A value of > 4.5 being diagnostic of insulin resistance.Results: 150 patients were enrolled in this study among which 75 were selected as cases and 75 as controls after fulfilling inclusion and exclusion criteria with mean age cases group was28.4+2.37 years and 29.1+2.70 years in control group mean miscarriage rate in study group was 3.17+83 and control group with 0.35+0.48 with statistically significant difference. Mean fasting glucose (96.5+ 7.86) mg/dl, Fasting Insulin (14.1±5.91) IU/ml. Mean Glucose Insulin ratio (8.1±3.39), HOMA-IR (3.4 ±1.51) in the study group and in control group mean fasting glucose was (87.1+11.49) mg/dl, Fasting Insulin (6.9 ± 4.99) IU/ml. Mean Glucose Insulin ratio (17.8 ±11.44), HOMA-IR (1.5 ±1.27) respectively with statistically significant difference.Conclusions: In women with recurrent pregnancy loss fasting insulin and insulin resistance are higher than those in women without spontaneous abortion. The most sensitive parameter for calculating insulin resistance was found to be fasting insulin followed by HOMA – IR and followed by fasting glucose/fasting insulin ratio. It is therefore important to recommend a fasting insulin and fasting glucose level while evaluating a case of recurrent pregnancy loss to assess for insulin resistance.

scholarly journals Dual trigger in normally-responding assisted reproductive technology patients increases the number of top-quality embryos

2020 ◽  
Vol 47 (4) ◽  
pp. 300-305
Author(s):  
Yavuz Emre Şükür ◽  
Hasan Ulubaşoğlu ◽  
Fatma Ceylan İlhan ◽  
Bülent Berker ◽  
Murat Sönmezer ◽  
...  
Keyword(s):  
Live Birth ◽  
Live Birth Rate ◽  
Controlled Ovarian Hyperstimulation ◽  
University Hospital ◽  
Control Group ◽  
Study Group ◽  
Hospital Data ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Low Dose Hcg

Objective: The feasibility of a gonadotropin-releasing hormone agonist (GnRHa) trigger in normal responders is still a matter of debate. The aim of this study was to compare the number of mature oocytes, the number of good-quality embryos, and the live birth rate in normal responders triggered by GnRHa alone, GnRHa and human chorionic gonadotropin (hCG; a dual trigger), and hCG alone.Methods: A retrospective cohort study was conducted at the infertility clinic of a university hospital. Data from 200 normal responders who underwent controlled ovarian hyperstimulation and intracytoplasmic sperm injection with a GnRH antagonist protocol between January 2016 and January 2017 were reviewed. The first study group consisted of patients with cycles triggered by GnRHa alone. The second study group consisted of patients with cycles triggered by both GnRHa and low-dose hCG (a dual trigger). The control group consisted of patients with cycles triggered by hCG alone.Results: The groups were comparable in terms of demographics and cycle characteristics. The numbers of total oocytes retrieved and metaphase II oocytes were similar between the groups. The total numbers of grade A embryos were 3.2±2.9 in the GnRHa group, 4.4±3.2 in the dual-trigger group, and 2.9±2.1 in the hCG group (p=0.014). The live birth rates were 21.4%, 30.5%, and 28.2% in those groups, respectively (p=0.126).Conclusion: In normal responders, a dual-trigger approach appears superior to an hCG trigger alone with regard to the number of top-quality embryos produced. However, no clinical benefit was apparent in terms of live birth rates.

P–760 Cycle outcomes in frozen-thawed single blastocyst transfers in overweight and obese women

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
U Göktürk ◽  
S Kahraman
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Endometrial Thickness ◽  
Control Group ◽  
Obese Patients ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Group I ◽  
Single Blastocyst Transfer ◽  
Significant Difference

Abstract Study question Are cycle outcomes different in frozen embryo transfer in obese and overweight women compared to normal weight cases? Summary answer As BMI increases, although implantation rates are similar, miscarriage rates increase and live birth rates decrease, especially in cases whose BMI value is above 30. What is known already Obesity has adverse effects on the reproductive system. Obesity causes ovulatory dysfunction and menstrual cycle disorders, thus reducing fertility. As BMI increases, the implantation, pregnancy and ongoing pregnancy rates decrease and the rate of clinical losses increases. In donor oocyte cycles, the BMI of the recipient has a statistically significant detrimental effect on obstetrics outcomes such as pregnancy rate and live birth rate. However, very few studies evaluate the impact of BMI on frozen-thawed single blastocyst transfer. Study design, size, duration This retrospective study was conducted at Istanbul Memorial Hospital, ART and Reproductive Center between 2011 and 2020. A total of 5642 frozen-thawed single blastocyst transfer cycles were examined. Patients were grouped according to the World Health Organisation BMI classification system: Group I (BMI 25–29.9) (n = 1663); Group II (BMI 30–34.9) (n = 598); Group III (BMI 35–39.9) (n = 150); Group IV (BMI&gt;40) (n = 30); Control Group (BMI 18.5–24.9) (n = 3201). Participants/materials, setting, methods: Patients between 17–42 years old were included. Preimplantation genetic diagnosis (PGD) was performed for patients &gt;37 years old. Exclusion criteria were: repeated pregnancy losses, Mullerian abnormalities, intrauterine adhesions, endometrial thickness &lt;7mm during frozen embryo transfer (FET) cycle. For endometrial preparation, modified natural cycle or artificial cycle were used. Single top/good quality blastocysts were transferred. Main results and the role of chance A total of 5642 FET cycles were analyzed. There was no significant difference in patient characteristics in terms of mean age, endometrial thickness on embryo transfer day and Anti Mullerian Hormone levels between the groups. Cycle outcomes were analysed according to the BMI groups. Mean age of groups were 32.1(17–42), 32(18–42), 32.6(20–42), 32.8(23–42) in groups I to IV respectively and 32(18–42) in the control group. Pregnancy rates were 70.9%(n = 1180) 70.7%(n = 423), 76%(n = 114) and 54.8%(n = 17) in groups I to IV respectively and 72.4% in the control group(n = 2321) (p &gt; 0,05). Clinical pregnancy losses rates were 18.9%(n = 196), 23.9%(n = 86), 23.1%(n = 22) and 23%(n = 3) in groups I to IV respectively and 15.1% in the control group(n = 316) (p &lt; 0,05). The live birth rates were 49.9%(n = 830) 45.1%(n = 270), 47.3%(n = 71) and 33.3%(n = 10) in groups I to IV, respectively and 54.9% (n = 1759) in the control group (p &lt; 0,05). There was no statistically significant difference in implantation rates between the groups but clinical pregnancy losses rates were higher in obese patients (groups II-III-IV) whereas live birth rates were lower compared to group I (overweight) and the control group. Limitations, reasons for caution The limitation of the study is its retrospective nature. Wider implications of the findings: Our study shows that, there is a significantly higher risk of negative cycle outcomes in obese patients. Pre-treatment counselling is therefore needed to increase patient awareness of the risks and to provide advice on weight loss. Trial registration number Not applicable

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