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Li S, Zheng PS, Ma HM, Feng Q, Zhang YR, Li QS, He JJ, Liu WF. Systematic review of subsequent pregnancy outcomes in couples with parental abnormal chromosomal karyotypes and recurrent pregnancy loss. Fertil Steril 2022; 118:906-914. [PMID: 36175209 DOI: 10.1016/j.fertnstert.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/24/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the current evidence of pregnancy outcomes among couples with recurrent pregnancy loss (RPL) with abnormal karyotypes vs. those with normal karyotypes and among couples with RPL and abnormal karyotypes after receiving expectant management vs. preimplantation genetic diagnosis (PGD). DESIGN Systematic review and meta-analysis. SETTING Academic medical centers. PATIENT(S) Pregnancy outcomes in 6,301 couples with RPL who conceived without medical intervention in 11 studies were analyzed. However, only 2 studies addressed the outcomes of couples with RPL and abnormal karyotypes after expectant management (75 cases) vs. PGD (50 cases). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The pregnancy outcomes in couples with RPL with abnormal and normal karyotypes across included studies were evaluated. RESULT(S) Compared with those with a normal karyotype, a significantly lower first pregnancy live birth rate (LBR) was found in couples with RPL with abnormal karyotypes (58.5% vs. 71.9%; odds ratio [OR], 0.55; 95% confidence interval [CI], 0.46-0.65; I2 =27%). A markedly decreased first pregnancy LBR was found in couples with a translocation (52.9% vs. 72.4%; OR, 0.44; 95% CI, 0.31-0.61; I2 =33%) but not in couples with an inversion. However, the differences in accumulated LBR (81.4% vs. 74.8%; OR, 0.96; 95% CI, 0.90-1.03; I2 = 0) were nonsignificant, whereas the miscarriage rate was distinctly higher in couples with RPL and abnormal karyotypes (53.0% vs. 34.7%; OR, 2.21; 95% CI, 1.69-2.89; I2 = 0). Compared with those who chose expectant management, differences in accumulated LBR were nonsignificant (60% vs. 68%; OR, 0.55; 95% CI, 0.11-2.62; I2 =71%), whereas the miscarriage rate (24% vs. 65.3%; OR, 0.15; 95% CI, 0.04-0.51; I2 = 45) was markedly low in couples with RPL and abnormal karyotypes who chose PGD. CONCLUSION(S) Couples with RPL and abnormal karyotypes had a higher miscarriage rate than couples with normal karyotypes but achieved a noninferior accumulated LBR through multiple conception attempts. In couples with RPL and abnormal karyotypes, PGD treatment did not increase the accumulated LBR but markedly reduced miscarriage rate compared with expectant management.
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Affiliation(s)
- Shan Li
- Department of Reproductive Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, People's Republic of China
| | - Peng-Sheng Zheng
- Department of Reproductive Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, People's Republic of China; Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education of the People's Republic of China, Shaanxi, Xi'an, People's Republic of China.
| | - Hong Mei Ma
- Department of Reproductive Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, People's Republic of China
| | - Qian Feng
- Department of Reproductive Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, People's Republic of China
| | - Yan Ru Zhang
- Department of Reproductive Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, People's Republic of China
| | - Qin Shu Li
- Department of Reproductive Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, People's Republic of China
| | - Jing Jing He
- Department of Reproductive Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, People's Republic of China
| | - Wen Fang Liu
- Department of Reproductive Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, People's Republic of China
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Ghazaey S, Keify F, Mirzaei F, Maleki M, Tootian S, Ahadian M, Abbaszadegan MR. Chromosomal analysis of couples with repeated spontaneous abortions in northeastern iran. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:47-54. [PMID: 25918592 PMCID: PMC4410037 DOI: 10.22074/ijfs.2015.4208] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 01/28/2014] [Indexed: 12/12/2022]
Abstract
Background Cytogenetic study of reproductive wastage is an important aspect in determining the genetic background of early embryogenesis. Approximately 15 to 20% of all
pregnancies in humans are terminated as recurrent spontaneous abortions (RSAs). The
aim of this study was to detect chromosome abnormalities in couples with RSAs and to
compare our results with those reported previously. Materials and Methods In this retrospective study, the pattern of chromosomal aberrations was evaluated during a six-year period from 2005 to 2011. The population under
study was 728 couples who attended genetic counseling services for their RSAs at Pardis
Clinical and Genetics Laboratory, Mashhad, Iran. Results In this study, about 11.7% of couples were carriers of chromosomal aberrations. The majority of abnormalities were found in couples with history of abortion, without stillbirth or livebirth. Balanced reciprocal translocations, Robertsonian
translocations, inversions and sex chromosome aneuploidy were seen in these cases.
Balanced reciprocal translocations were the most frequent chromosomal anomalies
(62.7%) detected in current study. Conclusion These findings suggest that chromosomal abnormalities can be one of the
important causes of RSAs. In addition, cytogenetic study of families who experienced
RSAs may prevent unnecessary treatment if RSA are caused by chromosomal abnormalities. The results of cytogenetic studies of RSA cases will provide a standard protocol for
the genetic counselors in order to follow up and to help these families.
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Affiliation(s)
- Saeedeh Ghazaey
- Medical Genetics Research Center, Medical School, Mashhad University of Medical Sciences, Mashhad, Iran ; Pardis Clinical and Genetics Laboratory, Mashhad, Iran
| | - Fatemeh Keify
- Pardis Clinical and Genetics Laboratory, Mashhad, Iran
| | | | | | | | - Mitra Ahadian
- Pardis Clinical and Genetics Laboratory, Mashhad, Iran
| | - Mohammad Reza Abbaszadegan
- Pardis Clinical and Genetics Laboratory, Mashhad, Iran ; Division of Human Genetics, Immunology Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Seror J, Verspyck E, Borg JY, Berkane N, Marpeau L. [Predictive value of uterine artery velocity waveforms in monitoring of pregnancies with high obstetrical risk antiphospholipid syndrome: the Rouen experience]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2010; 38:447-454. [PMID: 20579918 DOI: 10.1016/j.gyobfe.2010.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 04/29/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Anti-phospholipid syndrome (APLS) and obstetrical complications have been associated for years. The purpose of this study was to define a high obstetrical risk subpopulation of APLS and search predictive criteria of complications likely to improve monitoring of pregnancy. PATIENTS AND METHODS We conducted a retrospective study at the CHU of Rouen between 1998 and January 2008. Pregnancies were included for patients with APLS according to the criteria of Sydney without repeated miscarriages item. RESULTS The study involved 20 pregnancies from eight patients. Fourteen pregnancies gave birth to living children or 70 %, 28.6 % were complicated with pre-eclampsia, 50 % of haemolysis elevated liver enzymes low platelets (HELLP) syndrome associated with a 28.6 % stunting and 42 % of premature birth. Patients received treatment involving aspirin and heparin. The obstetrical prognosis was significantly poorer in the subgroup with APLS notch bilateral persistent middle of the term of birth of 35.5 versus 28 weeks of gestation, and median birth weight of 950 g versus 2780 g (p<0.05). DISCUSSION AND CONCLUSION Patients were selected according to the more specific criteria of APLS (thrombosis and fetal loss) and a history of severe obstetrical complications. In some series, these complications play a major role; in others, they are unsignificant. Rate, in this study, is high (47 %) and the presence of bilateral notch seems to be an excellent predictive marker of vascular complications in this population.
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Affiliation(s)
- J Seror
- Clinique gynécologique et obstétricale, CHU de Rouen, Rouen cedex, France.
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Franssen MTM, Korevaar JC, van der Veen F, Leschot NJ, Bossuyt PMM, Goddijn M. Reproductive outcome after chromosome analysis in couples with two or more miscarriages: index [corrected]-control study. BMJ 2006; 332:759-63. [PMID: 16495333 PMCID: PMC1420685 DOI: 10.1136/bmj.38735.459144.2f] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare reproductive outcomes in couples carrying a structural chromosome abnormality and non-carrier couples referred for chromosome analysis after two or more miscarriages. DESIGN Index [corrected]-control study. SETTING Six centres for clinical genetics in the Netherlands. PARTICIPANTS 278 carrier couples and 427 non-carrier couples referred for chromosome analysis between 1992 and 2000 after two or more miscarriages before 20 weeks of gestation. Couples were followed up for at least 24 months after chromosome analysis. MAIN OUTCOME MEASURES The birth of at least one healthy child, at least one more miscarriage, and viable offspring with unbalanced chromosomal abnormalities after parental chromosome analysis. RESULTS Mean follow-up after chromosome analysis was 5.8 years. 120 of 247 (49%) carrier couples had one or more miscarriage after chromosome analysis compared with 122 of 409 (30%) non-carrier couples (difference 19%, 95% confidence interval 11% to 26%; P < 0.01). The percentage of couples with at least one healthy child was not significantly different in carrier couples (83%) and non-carrier couples (84%) (difference -1%, - 7% to 5%). Among 550 pregnancies in carrier couples, two viable unbalanced chromosome abnormalities were detected at prenatal diagnosis (0.4%) and the fetuses aborted and two children with an unbalanced karyotype were born (0.4%). CONCLUSIONS Couples whose carrier status was ascertained after two or more miscarriages have a low risk of viable offspring with unbalanced chromosomal abnormalities. Their chances of having a healthy child are as high as non-carrier couples, despite a higher risk of miscarriage.
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Affiliation(s)
- Maureen T M Franssen
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, 1100 DD Amsterdam, Netherlands.
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Christiansen OB, Nybo Andersen AM, Bosch E, Daya S, Delves PJ, Hviid TV, Kutteh WH, Laird SM, Li TC, van der Ven K. Evidence-based investigations and treatments of recurrent pregnancy loss. Fertil Steril 2005; 83:821-39. [PMID: 15820784 DOI: 10.1016/j.fertnstert.2004.12.018] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Revised: 12/14/2004] [Accepted: 12/14/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To give an overview of currently used investigations and treatments offered to women with recurrent pregnancy loss (RPL) and, from an evidence-based point of view, to evaluate the usefulness of these interventions. DESIGN Ten experts on epidemiologic, genetic, anatomic, endocrinologic, thrombophilic, immunologic, and immunogenetic aspects of RPL discussed methodologic problems threatening the validity of research in RPL during and after an international workshop on the evidence-based management of RPL. CONCLUSION(S) Most RPL patients have several risk factors for miscarriage, and an extensive investigation for all major factors should always be undertaken. There is an urgent need for agreement concerning the thresholds for detecting what is normal and abnormal, irrespective of whether laboratory tests or uterine abnormalities are concerned. A series of lifestyle factors should be reported in future studies of RPL because they might modify the effect of laboratory or anatomic risk factors. More and larger randomized controlled trials, including trials of surgical procedures, are urgently needed, and to achieve this objective multiple centers have to collaborate. Current meta-analyses evaluating the efficacy of treatments of RPL are generally pooling very heterogeneous patient populations and treatments. It is recommended that future meta-analyses look at subsets of patients and treatment protocols that are more combinable.
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Affiliation(s)
- Ole B Christiansen
- Fertility Clinic 4071, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Abstract
Between 0.5 and 1.0% of couples experience recurrent pregnancy loss (RPL), which is defined as three or more consecutive miscarriages. Losses are classified as pre-embryonic (<5 weeks), embryonic (5-10 weeks) or fetal (>10 weeks). Genetic abnormalities are responsible for RPL in 2-4% of these couples. Inadequate progesterone production has been proposed a cause of RPL and progesterone is given to prevent miscarriage, despite a lack of supportive evidence. The factor V Leiden and prothrombin G20210A mutations are common inherited thrombophilias also associated with RPL. Antenatal thromboprophylaxis is sometimes recommended although no data exist regarding efficacy. Antiphospholipid syndrome is known to cause RPL and antenatal thromboprophylaxis reduces the risk of miscarriage. Uterine abnormalities might also result in RPL. About 50% of cases of RPL have no identifiable cause. Alloimmune incompatibility has been proposed as a cause for RPL in these women. The concept of alloimmune-related RPL has not been scientifically validated.
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Affiliation(s)
- T Flint Porter
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Maternal-Fetal Medicine, LDS Hospital, 8th Avenue and C Street, Salt Lake City, Utah 84143, USA.
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Geis W, Branch DW. Obstetric implications of antiphospholipid antibodies: pregnancy loss and other complications. Clin Obstet Gynecol 2001; 44:2-10. [PMID: 11219242 DOI: 10.1097/00003081-200103000-00002] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- W Geis
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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Abstract
The birth-weight ratio, a convenient measure of fetal growth, has been used to assess the importance of antecedent and perinatal factors in a retrospective analysis of 605 cases of congenital cerebral palsy. All had been seen by the author at a special clinic over a period of three decades. The ratio (normally 1) is high in the very premature, falls in the middle of the third trimester, then begins to rise again at term. Abnormalities of pregnancy, or a history of maternal pregnancy-losses, depress the ratio perceptibly. In both singletons and twins, there is no significant relationship between a low ratio and the severity of the clinical condition, and presumably the extent of the brain damage. The findings suggest that growth retardation is an association and not a cause of perinatal vascular-anoxic lesions.
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Affiliation(s)
- J Foley
- South West Regional Health Authority, Chelsea, London, UK
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Aoki K, Hayashi Y, Hirao Y, Yagami Y. Specific antiphospholipid antibodies as a predictive variable in patients with recurrent pregnancy loss. Am J Reprod Immunol 1993; 29:82-7. [PMID: 8329109 DOI: 10.1111/j.1600-0897.1993.tb00570.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PROBLEM Antiphospholipid antibodies (APLs) consist of very heterogenous autoantibodies. It has not been fully explored what kind of specificities are most relevant to recurrent pregnancy loss. Thus, we investigated the effects of specific APLs on recurrent aborters. METHOD IgG and IgM antibodies against PE (treated with 1% acetic acid) and five negatively-charged phospholipids were measured by ELISA among 334 recurrent aborters without autoimmune disease. The relationships between APL specificities and subsequent pregnancy outcome were prospectively investigated in 38 recurrent aborters with positive APL who did not receive treatment with prednisolone and aspirin. Antibody levels exceeding the 99th percentile of 280 healthy women were considered positive. RESULTS Positive IgG and/or IgM APLs were detected in 14%, IgG APLs in 12%, and IgG antibodies against PA, PG, PI, PS, CL and PE, respectively, in 9%, 7%, 7%, 7%, 8%, and 8%. In a prospective study of the 38 untreated patients, fetal loss recurred in 82% of the 33 IgG APL-positive patients, but in 40% of the five patients positive for only IgM APLs. The incidence of fetal loss in the next pregnancy of patients with IgG specific APL-positive against PE, PI, PS, or Cl was even higher at 90% and over, and fetal loss recurred in all of 21 patients with two or more IgG APL-positive against PE, PI, PS, or CL. CONCLUSION These results suggest the possibility that two or more IgG APL-positive value against treated PE, PI, PS, or CL, may be more accurate as a predictive variable than that of only one IgG APL-positive in patients with recurrent pregnancy loss.
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Affiliation(s)
- K Aoki
- Department of Obstetrics and Gynecology, Nagoya City University Medical School, Japan
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Smith A, Gaha TJ. Data on families of chromosome translocation carriers ascertained because of habitual spontaneous abortion. Aust N Z J Obstet Gynaecol 1990; 30:57-62. [PMID: 2346453 DOI: 10.1111/j.1479-828x.1990.tb03197.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cytogenetic studies were performed on 1,180 individuals--490 couples + 200 females presenting with habitual spontaneous abortion (HSA). These revealed 24 abnormal results (2.03%)--15 were apparently balanced reciprocal translocations and 9 were Robertsonian translocations. Of 97 pregnancies among the translocation carriers, there were 10 living children and 87 pregnancy losses--a loss rate of 89.7%. There were 11 familial translocations. In 10 familial cases with a full family tree, there were 27 spontaneous abortions and 64 livebirths among the 30 adult translocation carrier relatives--a loss rate of 29.6%. This is twice the risk found in the general population but not as high as in the probands, who had 6 times the abortion rate in the general population. Mechanisms are suggested for this difference. The subsequent pregnancy history of 12 index translocation couples showed an apparently improved pregnancy outcome with 13 further fetal losses and 13 living children, over a follow-up time per patient ranging from 1-5.5 years. However, when the pregnancy losses at ascertainment were combined with postascertainment losses, the overall rate of pregnancy loss remained the same.
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Affiliation(s)
- A Smith
- Oliver Latham Laboratory Department of Health, New South Wales
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Esrig SM, Leonardi DE. Spontaneous abortion after amniocentesis in women with a history of spontaneous abortion. Prenat Diagn 1985; 5:321-8. [PMID: 4070171 DOI: 10.1002/pd.1970050504] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The incidence of spontaneous abortion after amniocentesis (19 to 28 weeks gestation) in women who have had previous spontaneous abortions is compared with the rate in women who have not had previous spontaneous abortions. The outcome of the pregnancy after amniocentesis and the previous history of spontaneous abortion is reported for 691 pregnancies. The rate of spontaneous abortion after amniocentesis was found to be significantly higher in women who had one or more previous spontaneous abortions, 12/238 (5 per cent), than in women who did not, 6/453 (1.3 per cent). In women who reported two or more previous spontaneous abortions, the rate was 7/81 (8.6 per cent). No statistically significant effect of maternal age or gravidity was detected. The incidence of spontaneous abortion after amniocentesis was greater in the three weeks following the procedure (three for each of the three weeks) than in the subsequent seven weeks (nine for seven weeks).
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Kasai R, Narahara K, Kikkawa K, Takahashi Y, Wakita Y, Kimura S, Kataoka N, Kimoto H. Reproductive risk of paracentric inversion carriers: report of two unrelated cases with paracentric inversion of the long arm of chromosome 3. JINRUI IDENGAKU ZASSHI. THE JAPANESE JOURNAL OF HUMAN GENETICS 1985; 30:57-67. [PMID: 3841372 DOI: 10.1007/bf01873578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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FitzSimmons J, Tunis S, Jackson D, Wapner RJ, Jackson L. Factors related to subsequent reproductive outcome in couples with repeated pregnancy loss. AMERICAN JOURNAL OF MEDICAL GENETICS 1984; 18:407-11. [PMID: 6476001 DOI: 10.1002/ajmg.1320180308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Specific factors in a couple's history may influence the recurrence risk following repeated pregnancy loss (RPL). Couples with RPL were contacted several years following evaluation and information concerning subsequent pregnancies was obtained. Linear regression analysis was utilized to determine which factors in the history were significant predictors of pregnancy outcome following evaluation. A family history of RPL or a "genetic defect" was a highly significant predictor of subsequent unsuccessful pregnancies. Surgical, but not medical, treatment for RPL was a significant predictor of eventual successful outcome. The number of abortions prior to evaluation for RPL, presence of a liveborn child, maternal age at evaluation, and intercurrent infertility all failed to be significant predictors of pregnancy outcome after evaluation.
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