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Shen L, Zeng H, Fu Y, Ma W, Guo X, Luo G, Hua R, Wang X, Shi X, Wu B, Luo C, Quan S. Specific plasma microRNA profiles could be potential non-invasive biomarkers for biochemical pregnancy loss following embryo transfer. BMC Pregnancy Childbirth 2024; 24:351. [PMID: 38720272 PMCID: PMC11080217 DOI: 10.1186/s12884-024-06488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 04/07/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Plasma microRNAs act as biomarkers for predicting and diagnosing diseases. Reliable non-invasive biomarkers for biochemical pregnancy loss have not been established. We aim to analyze the dynamic microRNA profiles during the peri-implantation period and investigate if plasma microRNAs could be non-invasive biomarkers predicting BPL. METHODS In this study, we collected plasma samples from patients undergoing embryo transfer (ET) on ET day (ET0), 11 days after ET (ET11), and 14 days after ET (ET14). Patients were divided into the NP (negative pregnancy), BPL (biochemical pregnancy loss), and CP (clinical pregnancy) groups according to serum hCG levels at day11~14 and ultrasound at day28~35 following ET. MicroRNA profiles at different time-points were detected by miRNA-sequencing. We analyzed plasma microRNA signatures for BPL at the peri-implantation stage, we characterized the dynamic microRNA changes during the implantation period, constructed a microRNA co-expression network, and established predictive models for BPL. Finally, the sequencing results were confirmed by Taqman RT-qPCR. RESULTS BPL patients have distinct plasma microRNA profiles compared to CP patients at multiple time-points during the peri-implantation period. Machine learning models revealed that plasma microRNAs could predict BPL. RT-qPCR confirmed that miR-181a-2-3p, miR-9-5p, miR-150-3p, miR-150-5p, and miR-98-5p, miR-363-3p were significantly differentially expressed between patients with different reproductive outcomes. CONCLUSION Our study highlights the non-invasive value of plasma microRNAs in predicting BPL.
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Affiliation(s)
- Lang Shen
- Reproductive Center of Gynecology and Obstetrics Department, NanFang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hong Zeng
- Reproductive Center of Gynecology and Obstetrics Department, NanFang Hospital, Southern Medical University, Guangzhou, 510515, China
- Department of Reproductive Medicine Center, Foshan Maternal and Child Health Care Hospital, Southern Medical University, Foshan, 528000, China
| | - Yu Fu
- Reproductive Center of Gynecology and Obstetrics Department, NanFang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Wenmin Ma
- Department of Reproductive Medicine Center, Foshan Maternal and Child Health Care Hospital, Southern Medical University, Foshan, 528000, China
| | - Xiaoling Guo
- Department of Reproductive Medicine Center, Foshan Maternal and Child Health Care Hospital, Southern Medical University, Foshan, 528000, China
| | - Guoqun Luo
- Department of Reproductive Medicine Center, Foshan Maternal and Child Health Care Hospital, Southern Medical University, Foshan, 528000, China
| | - Rui Hua
- Reproductive Center of Gynecology and Obstetrics Department, NanFang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaocong Wang
- Reproductive Center of Gynecology and Obstetrics Department, NanFang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiao Shi
- Reproductive Center of Gynecology and Obstetrics Department, NanFang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Biao Wu
- Reproductive Center of Gynecology and Obstetrics Department, NanFang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Chen Luo
- Reproductive Center of Gynecology and Obstetrics Department, NanFang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Song Quan
- Reproductive Center of Gynecology and Obstetrics Department, NanFang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Cho K, Fayek B, Liu Y(D, Albert A, Wiesenthal E, Dobrer S, AbdelHafez FF, Lisonkova S, Bedaiwy MA. A history of recurrent pregnancy loss is associated with increased perinatal complications, but not necessarily a longer birth interval: a population study spanning 18 years. Hum Reprod 2024; 39:1105-1116. [PMID: 38390658 PMCID: PMC11063561 DOI: 10.1093/humrep/deae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
STUDY QUESTION Is there a difference in the time interval between the first and second live births among individuals with and without recurrent pregnancy loss (RPL)? SUMMARY ANSWER Primary RPL (two or more pregnancy losses before the first live birth) is associated with a shorter time interval between the first and second live births compared with individuals without RPL, but this association is reversed in patients with secondary RPL (RPL patients with no or one pregnancy loss before the first live birth). WHAT IS KNOWN ALREADY There is limited information regarding the ability to have more than one child for patients with RPL. Previous studies have investigated the time to live birth and the live birth rate from the initial presentation to clinical providers. Most of the previous studies have included only patients treated at specialized RPL clinics and thus may be limited by selection bias, including patients with a more severe condition. STUDY DESIGN, SIZE, DURATION We conducted a population-based retrospective cohort study of 184 241 participants who delivered in British Columbia, Canada, and had at least two recorded live births between 2000 and 2018. The aim was to study the differences in the time interval between the first and second live births and the prevalence of pregnancy complications in patients with and without RPL. Additionally, 198 319 individuals with their first live birth between 2000 and 2010 were studied to evaluate cumulative second live birth rates. PARTICIPANTS/MATERIALS, SETTING, METHODS Among individuals with at least two recorded live births between 2000 and 2018, 12 321 patients with RPL and 171 920 participants without RPL were included. RPL was defined as at least two pregnancy losses before 20 weeks gestation. Patients with primary RPL had at least two pregnancy losses occurring before the first live birth, while patients with secondary RPL had no or one pregnancy loss before the first live birth. We compared the time interval from the first to second live birth in patients with primary RPL, those with secondary RPL, and participants without RPL using generalized additive models to allow for a non-linear relationship between maternal age and time interval between first and second live births. We also compared prevalence of pregnancy complications at the first and second live births between the groups using non-parametric Kruskal-Wallis H test and Fisher's exact test for continuous and categorical variables, respectively. We assessed the cumulative second live birth rates in patients with primary RPL and those without RPL, among participants who had their first live birth between 2000 and 2010. Cox proportional hazards model was used to estimate and compare hazard ratios between the two groups using a stratified modelling approach. MAIN RESULTS AND THE ROLE OF CHANCE The adjusted time interval between the first and second live births was the longest in patients with secondary RPL, followed by individuals without RPL, and the shortest time interval was observed in patients with primary RPL: 4.34 years (95% CI: 4.09-4.58), 3.20 years (95% CI: 3.00-3.40), and 3.05 years (95% CI: 2.79-3.32). A higher frequency of pregnancy losses was associated with an increased time interval between the first and second live births. The prevalence of pregnancy complications at the first and second live births, including gestational diabetes, hypertensive disorder of pregnancy, preterm birth, and multiple gestations was significantly higher in patients with primary RPL compared with those without RPL. The cumulative second live birth rate was significantly lower in patients with primary RPL compared with individuals without RPL. LIMITATIONS, REASONS FOR CAUTION This study may be limited by its retrospective nature. Although we adjusted for multiple potential confounders, there may be residual confounding due to a lack of information about pregnancy intentions and other factors, including unreported pregnancy losses. WIDER IMPLICATIONS OF THE FINDINGS The results of this study provide information that will help clinicians in the counselling of RPL patients who desire a second child. STUDY FUNDING/COMPETING INTEREST(S) This study was supported in part by a grant from the Canadian Institutes of Health Research (CIHR): Reference Number W11-179912. M.A.B. reports research grants from CIHR and Ferring Pharmaceutical. He is also on the advisory board for AbbVie, Pfizer, and Baxter. The other authors report no conflict of interest. TRIAL REGISTRATION NUMBER NCT04360564.
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Affiliation(s)
- Kristy Cho
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bahi Fayek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Yang (Doris) Liu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC, Canada
| | - E Wiesenthal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sabina Dobrer
- Women’s Health Research Institute, Vancouver, BC, Canada
| | - Faten F AbdelHafez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sarka Lisonkova
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Exacoustos C, Ticconi C, Colombi I, Iorio GG, Vaquero E, Selntigia A, Chiaramonte B, Soreca G, Rizzo G. Type and Location of Adenomyosis in Women with Recurrent Pregnancy Loss: A Transvaginal Ultrasonographic Assessment. Reprod Sci 2024:10.1007/s43032-024-01541-8. [PMID: 38619796 DOI: 10.1007/s43032-024-01541-8] [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: 11/02/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
The current knowledge on adenomyosis as a risk factor for RPL is very scant. Overall 120 women were included in this retrospective observational study. They were divided in three groups each of which consisted of 40 subjects: Group 1: women with RPL who were diagnosed to have adenomyosis on transvaginal ultrasound (TVS); Group 2: patients with RPL without ultrasonographic findings of adenomyosis; Group 3: patients with ultrasound diagnosis of adenomyosis without RPL and at least one live birth pregnancy. The copresence of endometriosis was also investigated. Among women with RPL, patients with adenomyosis (Group 1) had higher number of pregnancy losses (p = 0.03) and lower age at first pregnancy loss (p = 0.03) than women without adenomyosis (Group 2). Moreover, they had more frequently primary RPL (p = 0.008). Adenomyosis of the inner myometrium was found more frequently (p = 0.04) in patients of Group 1 than in patients of Group 3 in which adenomyosis was mainly in the outer myometrium (p= 0.02). No differences were found in the severity of adenomyosis between these two groups of women. TVS findings for endometriosis were observed more frequently in women with adenomyosis without RPL (Group 3) than in the other two groups of patients. Adenomyosis can be a factor involved in RPL. Differences in adenomyosis localization are associated with different risks for RPL. Patients with RPL should be investigated for the presence of adenomyosis and also for the type and localization of the disease in the different myometrial layers.
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Affiliation(s)
- Caterina Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Carlo Ticconi
- Department of Surgical Sciences, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy.
| | - Irene Colombi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic University of Siena, Siena, Italy
| | - Giuseppe Gabriele Iorio
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - Elena Vaquero
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Aikaterini Selntigia
- Department of Surgical Sciences, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Barbara Chiaramonte
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Giorgia Soreca
- Department of Surgical Sciences, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Giuseppe Rizzo
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
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Chen W, Mi C, Zhang Y, Yang Y, Huang W, Xu Z, Zhao J, Wang R, Wang M, Wan S, Wang X, Zhang H. Defective Homologous Recombination Repair By Up-Regulating Lnc-HZ10/Ahr Loop in Human Trophoblast Cells Induced Miscarriage. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2207435. [PMID: 38286681 PMCID: PMC10987163 DOI: 10.1002/advs.202207435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/27/2023] [Indexed: 01/31/2024]
Abstract
Human trophoblast cells are crucial for healthy pregnancy. However, whether the defective homologous recombination (HR) repair of dsDNA break (DSB) in trophoblast cells may induce miscarriage is completely unknown. Moreover, the abundance of BRCA1 (a crucial protein for HR repair), its recruitment to DSB foci, and its epigenetic regulatory mechanisms, are also fully unexplored. In this work, it is identified that a novel lnc-HZ10, which is highly experssed in villous tissues of recurrent miscarriage (RM) vs their healthy control group, suppresses HR repair of DSB in trophoblast cell. Lnc-HZ10 and AhR (aryl hydrocarbon receptor) form a positive feedback loop. AhR acts as a transcription factor to promote lnc-HZ10 transcription. Meanwhile, lnc-HZ10 also increases AhR levels by suppressing its CUL4B-mediated ubiquitination degradation. Subsequently, AhR suppresses BRCA1 transcription; and lnc-HZ10 (mainly 1-447 nt) interacts with γ-H2AX; and thus, impairs its interactions with BRCA1. BPDE exposure may trigger this loop to suppress HR repair in trophoblast cells, possibly inducing miscarriage. Knockdown of murine Ahr efficiently recovers HR repair in placental tissues and alleviates miscarriage in a mouse miscarriage model. Therefore, it is suggested that AhR/lnc-HZ10/BRCA1 axis may be a promising target for alleviation of unexplained miscarriage.
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Affiliation(s)
- Weina Chen
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
- Key Laboratory of Environment and Female Reproductive HealthWest China School of Public Health & West China Fourth HospitalSichuan UniversityChengdu610041China
| | - Chenyang Mi
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Ying Zhang
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Yang Yang
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Wenxin Huang
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Zhongyan Xu
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Jingsong Zhao
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Rong Wang
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Manli Wang
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Shukun Wan
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Xiaoqing Wang
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
| | - Huidong Zhang
- Research Center for Environment and Female Reproductive HealthThe Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhen518033China
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Hsiao YY, Tsai NC, Su YT, Lin YJ, Chiang HJ, Kung FT, Lan KC. Comparison of miscarriage rates in low prognosis patients according to the POSEIDON criteria. Taiwan J Obstet Gynecol 2024; 63:199-204. [PMID: 38485315 DOI: 10.1016/j.tjog.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE The POSEIDON criteria stratified patients with poor ovarian response into four subgroups with exclusive characteristics and assisted reproductive technology success rates. However, limited studies focused on miscarriage in the POSEIDON population. This study aimed to explore whether the miscarriage rate different among low prognosis patients according to POSEIDON criteria. MATERIALS AND METHODS This is a retrospective observational study. All clinical pregnancies achieved after in vitro fertilization or intracytoplasmic sperm injection treatment between January 1998 and April 2021 were analyzed. The primary outcome was miscarriage, defined as the pregnancy loss before 20 weeks of gestation age. Miscarriage rate was estimated per clinical pregnancy and gestational sac. RESULTS A total of 1222 clinical pregnancies from 1088 POSEIDON patients met the inclusion criteria. The miscarriage rates per clinical pregnancy in each POSEIDON subgroup were as follows: Group 1: 11.7 %, Group 2: 26.5 %, Group 3: 20.9 %, and Group 4: 37.5 %. The miscarriage rate per gestational sac showed a similar trend as the clinical miscarriage rate. Multivariate regression analysis showed that advanced maternal age is an independent factor for miscarriage (Group 2 vs. 1: OR 2.476; Group 4 vs. 3: OR 2.252). Patients with diminished ovarian reserve (DOR) have higher miscarriage risks but without significance (Group 3 vs. 1: OR 1.322; Group 4 vs. 2: OR 1.202). CONCLUSION Miscarriage rates differed among low prognosis patients according to the POSEIDON criteria. Age remains a determined risk for miscarriage. DOR might be a potential factor for miscarriage, but it didn't account for a significant impact in POSEIDON patients.
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Affiliation(s)
- Yu-Yang Hsiao
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ni-Chin Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ting Su
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ju Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Ju Chiang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Menopause and Reproductive Medicine Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Jen-Ai Hospital, Taichung, Taiwan.
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Zhang Q, Yang G, Tan J, Xiong Y, Xu Y, Xu Y, Gu F. Antibiotic cured chronic endometritis remains a risk factor for early pregnancy loss in the subsequent frozen euploid embryo transfer. Reprod Biomed Online 2024; 48:103611. [PMID: 38118232 DOI: 10.1016/j.rbmo.2023.103611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 12/22/2023]
Abstract
RESEARCH QUESTION Do patients with antibiotic-cured chronic endometritis (CCE) have a comparable pregnancy outcome to those with non-chronic endometritis (NCE) in the subsequent frozen embryo transfer (FET) cycle? DESIGN A retrospective cohort analysis included 833 patients in their first FET cycles with single euploid embryo transfer. Chronic endometritis (≥5 CD138+ plasma cells per high-power field [CD138+/HPF]) was treated with standard antibiotic therapy. Patients were classified into two groups: the NCE group (n = 611, <5 CD138+/HPF) and the CCE group (n = 222, ≥5 CD138+/HPF and cured after antibiotic treatment). Pregnancy outcomes were compared. NCE group was divided into subgroup 1 (CD138+/HPF = 0) and subgroup 2 (CD138+/HPF = 1-4) for further analysis. RESULTS The rate of early pregnancy loss (EPL), incorporating all losses before 10 weeks' gestation, was significantly higher in the CCE group than the NCE group (21.2% versus 14.2%, P = 0.016), and the difference was statistically significant (adjusted odds ratio [AOR] 1.68, 95% confidence interval [CI] 1.11-2.55). No significant differences were observed between the two groups with regard to other pregnancy outcomes. In the subgroup analysis, the EPL rate and biochemical pregnancy rate were significantly higher in subgroup 2 than subgroup 1 (17.2% versus 9.4%, AOR 2.21, 95% CI 1.30-3.74; 12.2% versus 6.9%, AOR 2.01, 95% CI 1.09-3.68). CONCLUSIONS Chronic endometritis cured by standard antibiotic therapy remains a risk factor for EPL in FET cycles, although no differences were found in live birth rates between patients with CCE or with NCE.
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Affiliation(s)
- Qingyan Zhang
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Guoxia Yang
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Jinfeng Tan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yujing Xiong
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Yan Xu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Yanwen Xu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China.
| | - Fang Gu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China.
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7
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Ticconi C, Nicastri E, D'Ippolito S, Chiaramonte C, Pietropolli A, Scambia G, Di Simone N. Diagnostic factors for recurrent pregnancy loss: an expanded workup. Arch Gynecol Obstet 2023; 308:127-142. [PMID: 36964323 DOI: 10.1007/s00404-023-07001-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/01/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE There is limited information on the risk factors for recurrent pregnancy loss (RPL). METHODS In this study, a patient-based approach was used to investigate the possible involvement and relative relevance of a large number of diagnostic factors in 843 women with RPL who underwent an extensive diagnostic workup including 44 diagnostic factors divided into 7 major categories. RESULTS The rates of abnormalities found were: (1) genital infections: 11.74%; (2) uterine anatomic defects: 23.72%; (3) endocrine disorders: 29.42%; (4) thrombophilias: 62%; (5) autoimmune abnormalities: 39.2%; (6) parental karyotype abnormalities 2.25%; (7) clinical factors: 87.78%. Six hundred and fifty-nine out of eight hundred and forty-three women (78.17%) had more than one abnormality. The mean number of pregnancy losses increased by increasing the number of the abnormalities found (r = 0.86949, P < 0.02). The factors associated with the highest mean number of pregnancy losses were cervical isthmic incompetence, anti-beta-2-glycoprotein-1 antibodies, unicornuate uterus, anti-prothrombin A antibodies, protein C deficiency, and lupus anticoagulant. The majority of the considered abnormalities had similar, non-significant prevalence between women with 2 versus ≥ 3 pregnancy losses with the exception of age ≥ 35 years and MTHFR A1298C heterozygote mutation. No difference was found between women with primary and secondary RPL stratified according to the number of abnormalities detected (Chi-square: 8.55, P = 0.07). In these women, the only factors found to be present with statistically different rates were age ≥ 35 years, cigarette smoking, and genital infection by Ureaplasma. CONCLUSION A patient-based diagnostic approach in women with RPL could be clinically useful and could represent a basis for future research.
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Affiliation(s)
- Carlo Ticconi
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, Rome, Italy.
| | - Elena Nicastri
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, Rome, Italy
| | - Silvia D'Ippolito
- U.O.C. di Ostetricia e Patologia Ostetrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Chiaramonte
- Department of Biomedicine and Prevention, University Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Adalgisa Pietropolli
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, Rome, Italy
| | - Giovanni Scambia
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
- U.O.C. di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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8
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Boje AD, Egerup P, Westergaard D, Bertelsen MLMF, Nyegaard M, Hartwell D, Lidegaard Ø, Nielsen HS. Endometriosis is associated with pregnancy loss: a nationwide historical cohort study. Fertil Steril 2023; 119:826-835. [PMID: 36608920 DOI: 10.1016/j.fertnstert.2022.12.042] [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: 05/24/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To study whether endometriosis is associated with pregnancy loss and recurrent pregnancy loss (RPL). DESIGN Nationwide historical cohort study with a nested case-control analysis. SETTING National health registers. PATIENT(S) A total of 29,563 women born between 1957 and 1997 were identified in the national health registers, diagnosed with endometriosis between 1977 and 2017, and age-matched 1:10 with 295,630 women without endometriosis. The number of pregnancy losses was assessed, and data were analyzed with conditional logistic regression. INTERVENTION(S) Endometriosis (International Classification of Diseases, 8th Revision, 62530-62539, and International Classification of Diseases, 10th Revision, DN80.0-9). MAIN OUTCOME MEASURE(S) The primary outcomes of interest were the numbers of pregnancy losses categorized as 0, 1, 2, and ≥ 3 losses, unadjusted and adjusted for gravidity, and RPL. The secondary outcome measures were the predefined types of pregnancy losses. Pregnancy loss was defined as the spontaneous demise of a pregnancy until 22 weeks of gestation. Primary RPL was defined as 3 or more consecutive pregnancy losses with no prior live birth or stillbirth, and secondary RPL was defined as 1 or more births followed by 3 or more consecutive losses. RESULT(S) A total of 18.9%, 3.9%, and 2.1% of ever-pregnant women with endometriosis had 1, 2, and ≥ 3 pregnancy losses compared with 17.3%, 3.5%, and 1.5% of the women without endometriosis, corresponding to the odds ratios of 1.13 (95% confidence interval, 1.09-1.17), 1.18 (1.10-1.26), and 1.44 (1.31-1.59), respectively. When adjusted also for gravidity, the corresponding results were 1.37 (95% confidence interval, 1.32-1.42), 1.75 (1.62-1.89), and 2.57 (2.31-2.85), respectively. The following predefined subgroups of RPL were positively associated with endometriosis: primary; secondary; secondary after giving birth to a boy; after a complicated delivery; and ≥ 3 pregnancy losses before the age of 30 years. Six endometriosis subgroup analyses found an association between endometriosis and pregnancy loss. These analyses were women diagnosed in the 4 decades between 1977 and 2017, women with adenomyosis, and women with adenomyosis only. CONCLUSION(S) This nationwide cohort study found endometriosis to be associated with pregnancy loss and RPL, and the association strengthened with an increasing number of losses.
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Affiliation(s)
- Amalie Dyhrberg Boje
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Pia Egerup
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - David Westergaard
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Dorthe Hartwell
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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9
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Cao M, Zhang Q, Zhou W, Zhu Y, Li H, Yan J. Analysis of Aneuploidy Rate and Pregnancy Outcomes in Unexplained Recurrent Pregnancy Loss Couples With Chromosome Polymorphism After PGT-A. Front Med (Lausanne) 2022; 9:803988. [PMID: 35433744 PMCID: PMC9008326 DOI: 10.3389/fmed.2022.803988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe study aims to investigate whether chromosomal polymorphism affects embryo development and pregnancy outcomes of unexplained recurrent pregnancy loss (uRPL) couples undergoing PGT-A.MethodsA total of 585 couples with uRPL history who performed PGT-A were included in the retrospective study from January 2016 to December 2020. We included 415 couples with normal karyotype and 170 couples with chromosomal polymorphism. Furthermore, the polymorphism group was divided into two subgroups: 113 couples in the male group and 57 couples in the female group. The embryo development and pregnancy outcomes were analyzed in different groups.ResultsThe blastocyst rate and aneuploidy rate are statistically different in the normal group, male polymorphism group, and female polymorphism group. Compared with normal and female groups, the male group has a lower blastocyst rate, which is statistically different (48.3 vs. 53.9%, p = 0.003; 48.3 vs. 54.1%, p = 0.043). Moreover, the aneuploidy rate of the male polymorphism group is significantly higher than female carriers (29.5 vs. 18.6%, p = 0.003). However, there were no statistically significant differences in clinical pregnancy rate, early miscarriage rate, and live birth rate after PGT-A (p > 0.05).ConclusionMale with chromosome polymorphism (CPM) have a lower blastocyst rate and a higher aneuploidy rate than female carriers in uRPL couples undergoing PGT-A. However, when a euploid blastocyst was first transferred, no difference in pregnancy outcomes was found between the male and female polymorphism carriers. It indicated that CPM may have an adverse effect on the embryos of male carriers with uRPL history, and the occurrence of uRPL may be decreased in male polymorphism carriers after PGT-A.
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Affiliation(s)
- Mingzhu Cao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Qian Zhang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Wei Zhou
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Yueting Zhu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Hongchang Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Junhao Yan
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- *Correspondence: Junhao Yan,
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10
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Live Birth Rate in Women with Recurrent Pregnancy Loss after In Vitro Fertilization with Concomitant Intravenous Immunoglobulin and Prednisone. J Clin Med 2022; 11:jcm11071894. [PMID: 35407500 PMCID: PMC9000183 DOI: 10.3390/jcm11071894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/15/2022] [Accepted: 03/22/2022] [Indexed: 01/08/2023] Open
Abstract
Pregnancy loss after in vitro fertilization (IVF) is at least as common as after spontaneous conception. Recurrent pregnancy loss (RPL) may often have an immunological background, and it is therefore relevant to test immune-based interventions in these patients. The objective was to investigate the effect of immunotherapy with intravenous immunoglobulin (IvIg) and prednisone (PRS) as concomitant therapy to IVF in women with RPL after earlier IVF treatments. In a cohort study conducted at The Danish RPL Clinic, 41 women with three or more consecutive pregnancy losses after IVF underwent at least one further IVF cycle with concomitant immunotherapy from 2012 to 2017. The immunotherapy with IvIg and PRS was given before embryo transfer and repeatedly in the first trimester when pregnancy was achieved. Fourteen women (34.2%) achieved a live birth after the first embryo transfer with immunotherapy, and a total of 32/41 (78%) achieved a live birth after up to 4 embryo transfers. Baseline characteristics and the presence of autoantibodies were not significantly different among women achieving live birth or not. The observed 34% birth rate in women with RPL after IVF receiving immunotherapy appears higher than the expected 16-19% birth rate without immunotherapy and is similar to findings in a previous cohort from our clinic. Concomitant immunotherapy as described may be a promising intervention for women with RPL after IVF; however, the effect must be tested in a randomized controlled trial.
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11
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Cimsir MT, Yildiz MS. Could fibrinogen to albumin ratio be a predictive marker for recurrent pregnancy loss. Int J Clin Pract 2021; 75:e14520. [PMID: 34120391 DOI: 10.1111/ijcp.14520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 01/05/2023] Open
Abstract
AIMS Recurrent pregnancy loss (RPL) is usually defined by two or more consecutive clinical miscarriages, which causes psychological trauma for couples. In this study, we aimed to investigate the predictive role of fibrinogen to albumin ratio (FAR) in patients with RPL. METHODS Pregnant women in their first trimester of pregnancy were included in the study and divided into two groups as RPL patients (n: 44) and patients with no previous recurrent miscarriage (n: 60) as control group. Demographical parameters and routine blood parameters (fibrinogen, D-dimer, FAR, neutrophil to lymphocyte ratio [NLR], platelet count, main platelet volume [MPV], and red cell distribution width [RDW] values) were compared between the RPL group and the control group. RESULTS The groups were determined to be statistically different in regard to gravidity and parity (P < .001). The difference between the groups was statistically different in regard to fibrinogen (mg/dL), albumin (g/dL), FAR (%), NLR (%), RDW-coefficient of variation (%), RDW-standard deviation (fl), and platelet counts (10-3 /μL). However, MPV (fl) and D-dimer (μg/L) levels were similar in both groups. The receiver operating characteristic curve analysis revealed that the NLR levels were 84.1% sensitive and 75% specific with a cut-off value of 4.27 and the FAR levels were 79.5% sensitive and 88.3% specific with a cut-off value of 105.69 for predicting RPL. CONCLUSION Our results indicate that the FAR and NLR levels seem to be effective parameters for predicting RPL with high sensitivity and specificity.
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Affiliation(s)
- Meral Tugba Cimsir
- Department of Obstetrics and Gynecology, Medical School of Alaaddin Keykubat University, Alanya, Turkey
| | - Muhammet Serhat Yildiz
- Department of Obstetrics and Gynecology, Alanya Research and Education Hospital, Alanya, Turkey
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12
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Kolte AM, Westergaard D, Lidegaard Ø, Brunak S, Nielsen HS. Chance of live birth: a nationwide, registry-based cohort study. Hum Reprod 2021; 36:1065-1073. [PMID: 33394013 DOI: 10.1093/humrep/deaa326] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/19/2020] [Indexed: 12/25/2022] Open
Abstract
STUDY QUESTION Does the sequence of prior pregnancy events (pregnancy losses, live births, ectopic pregnancies, molar pregnancy and still birth), obstetric complications and maternal age affect chance of live birth in the next pregnancy and are prior events predictive for the outcome? SUMMARY ANSWER The sequence of pregnancy outcomes is significantly associated with chance of live birth; however, pregnancy history and age are insufficient to predict the outcome of an individual woman's next pregnancy. WHAT IS KNOWN ALREADY Adverse pregnancy outcomes decrease the chance of live birth in the next pregnancy, whereas the impact of prior live births is less clear. STUDY DESIGN, SIZE, DURATION Nationwide, registry-based cohort study of 1 285 230 women with a total of 2 722 441 pregnancies from 1977 to 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS All women living in Denmark in the study period with at least one pregnancy in either the Danish Medical Birth Registry or the Danish National Patient Registry. Data were analysed using logistic regression with a robust covariance model to account for women with more than one pregnancy. Model discrimination and calibration were ascertained using 20% of the women in the cohort randomly selected as an internal validation set. MAIN RESULTS AND THE ROLE OF CHANCE Obstetric complications, still birth, ectopic pregnancies and pregnancy losses had a negative effect on the chance of live birth in the next pregnancy. Consecutive, identical pregnancy outcomes (pregnancy losses, live births or ectopic pregnancies) immediately preceding the next pregnancy had a larger impact than the total number of any outcome. Model discrimination was modest (C-index = 0.60, positive predictive value = 0.45), but the models were well calibrated. LIMITATIONS, REASONS FOR CAUTION While prior pregnancy outcomes and their sequence significantly influenced the chance of live birth, the discriminative abilities of the predictive models demonstrate clearly that pregnancy history and maternal age are insufficient to reliably predict the outcome of a given pregnancy. WIDER IMPLICATIONS OF THE FINDINGS Prior pregnancy history has a significant impact on the chance of live birth in the next pregnancy. However, the results emphasize that only taking age and number of losses into account does not predict if a pregnancy will end as a live birth or not. A better understanding of biological determinants for pregnancy outcomes is urgently needed. STUDY FUNDING/COMPETING INTEREST(S) The work was supported by the Novo Nordisk Foundation, Ole Kirk Foundation and Rigshospitalet's Research Foundation. The authors have no financial relationships that could appear to have influenced the work. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Astrid M Kolte
- Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospital, Rigshospitalet, Fertility Clinic 4071, 2100 Copenhagen Ø, and Hvidovre Hospital, 2650 Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - David Westergaard
- Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospital, Rigshospitalet, Fertility Clinic 4071, 2100 Copenhagen Ø, and Hvidovre Hospital, 2650 Hvidovre, Denmark.,Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200 Copenhagen N, Denmark.,Methods and Analysis, Statistics Denmark, 2100 Copenhagen Ø, Denmark
| | - Øjvind Lidegaard
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark.,Department of Gynaecology 4232, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen Ø, Denmark
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Henriette Svarre Nielsen
- Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospital, Rigshospitalet, Fertility Clinic 4071, 2100 Copenhagen Ø, and Hvidovre Hospital, 2650 Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark.,Department of Gynaecology-and-Obstetrics, Copenhagen University Hospital, Hvidovre Hospital, 2650 Hvidovre, Denmark
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13
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Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Fisher J, Brosens JJ, Brewin J, Ramhorst R, Lucas ES, McCoy RC, Anderson R, Daher S, Regan L, Al-Memar M, Bourne T, MacIntyre DA, Rai R, Christiansen OB, Sugiura-Ogasawara M, Odendaal J, Devall AJ, Bennett PR, Petrou S, Coomarasamy A. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet 2021; 397:1658-1667. [PMID: 33915094 DOI: 10.1016/s0140-6736(21)00682-6] [Citation(s) in RCA: 417] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/24/2022]
Abstract
Miscarriage is generally defined as the loss of a pregnancy before viability. An estimated 23 million miscarriages occur every year worldwide, translating to 44 pregnancy losses each minute. The pooled risk of miscarriage is 15·3% (95% CI 12·5-18·7%) of all recognised pregnancies. The population prevalence of women who have had one miscarriage is 10·8% (10·3-11·4%), two miscarriages is 1·9% (1·8-2·1%), and three or more miscarriages is 0·7% (0·5-0·8%). Risk factors for miscarriage include very young or older female age (younger than 20 years and older than 35 years), older male age (older than 40 years), very low or very high body-mass index, Black ethnicity, previous miscarriages, smoking, alcohol, stress, working night shifts, air pollution, and exposure to pesticides. The consequences of miscarriage are both physical, such as bleeding or infection, and psychological. Psychological consequences include increases in the risk of anxiety, depression, post-traumatic stress disorder, and suicide. Miscarriage, and especially recurrent miscarriage, is also a sentinel risk marker for obstetric complications, including preterm birth, fetal growth restriction, placental abruption, and stillbirth in future pregnancies, and a predictor of longer-term health problems, such as cardiovascular disease and venous thromboembolism. The costs of miscarriage affect individuals, health-care systems, and society. The short-term national economic cost of miscarriage is estimated to be £471 million per year in the UK. As recurrent miscarriage is a sentinel marker for various obstetric risks in future pregnancies, women should receive care in preconception and obstetric clinics specialising in patients at high risk. As psychological morbidity is common after pregnancy loss, effective screening instruments and treatment options for mental health consequences of miscarriage need to be available. We recommend that miscarriage data are gathered and reported to facilitate comparison of rates among countries, to accelerate research, and to improve patient care and policy development.
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Affiliation(s)
- Siobhan Quenby
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, UK; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
| | - Ioannis D Gallos
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Rima K Dhillon-Smith
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Marcelina Podesek
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Mary D Stephenson
- University of Illinois Recurrent Pregnancy Loss Program, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Joanne Fisher
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Jan J Brosens
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, UK; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jane Brewin
- Tommy's Charity, Laurence Pountney Hill, London, UK
| | - Rosanna Ramhorst
- CONICET, Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - Emma S Lucas
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, UK; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Rajiv C McCoy
- Department of Biology, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Anderson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Shahd Daher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lesley Regan
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Maya Al-Memar
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - David A MacIntyre
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Raj Rai
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Ole B Christiansen
- Centre for Recurrent Pregnancy Loss of Western Denmark, Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | - Mayumi Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Joshua Odendaal
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, UK; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Adam J Devall
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Thomsen CK, Steffensen R, Nielsen HS, Kolte AM, Krog MC, Egerup P, Larsen EC, Hviid TV, Christiansen OB. HLA-DRB1 polymorphism in recurrent pregnancy loss: New evidence for an association to HLA-DRB1*07. J Reprod Immunol 2021; 145:103308. [PMID: 33725525 DOI: 10.1016/j.jri.2021.103308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/15/2021] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Abstract
Many cases of recurrent pregnancy loss (RPL) defined as ≥3 consecutive pregnancy losses are suggested to be caused by an aberrant maternal immune response against the fetus or trophoblast. Human leukocyte antigen (HLA)-DRB1 and -DQB1 polymorphisms are associated with most autoimmune disorders and studies of HLA-DBB1 polymorphism in RPL patients are thus relevant. In previous studies, the HLA-DRB1*03 allele was found with increased prevalence in RPL patients. We wanted to clarify whether HLA-DRB1 alleles indeed were associated with RPL among women of Caucasian descent. A total of 1078 women with unexplained RPL and 2066 bone marrow donors were HLA-DRB1-typed and subsets were also HLA-DQB1 typed. All patients were initially HLA-DRB1-typed by DNA-based low-resolution techniques and subsets of patients and all controls were typed by high-resolution techniques. Among patients, the HLA-DRB1*07 allele frequency was significantly increased compared with controls; OR 1.29 (95 % CI 1.09-1.52), p < 0.0025; after correction for multiple comparisons pc = 0.031. The HLA-DRB1*07/*07 genotype was highly increased in patients with RPL compared with controls: OR 2.27 (1.31-3.93), p = 0.0027. The frequency of the HLA-DRB1*07 phenotype in RPL patients had increased significantly (p = 0.002) in three studies from our group published 1994-2021. The allele frequency of HLA-DRB1*03 was not increased in RPL patients compared with controls; OR 0.96 (0.83-1.12). In conclusion, the previous association between HLA-DRB1*03 and RPL could not be confirmed in our study whereas an association to HLA-DRB1*07 was detected for the first time. Since the latter association is a new finding, it should be confirmed in future studies.
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Affiliation(s)
- C K Thomsen
- Centre for Recurrent Pregnancy Loss of Western Denmark, Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | - R Steffensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - H S Nielsen
- Recurrent Pregnancy Loss Unit Capital Region, Copenhagen University Hospital, Rigshospitalet and Hvidovre Hospital, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - A M Kolte
- Recurrent Pregnancy Loss Unit Capital Region, Copenhagen University Hospital, Rigshospitalet and Hvidovre Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - M C Krog
- Recurrent Pregnancy Loss Unit Capital Region, Copenhagen University Hospital, Rigshospitalet and Hvidovre Hospital, Copenhagen, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - P Egerup
- Recurrent Pregnancy Loss Unit Capital Region, Copenhagen University Hospital, Rigshospitalet and Hvidovre Hospital, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - E C Larsen
- Recurrent Pregnancy Loss Unit Capital Region, Copenhagen University Hospital, Rigshospitalet and Hvidovre Hospital, Copenhagen, Denmark
| | - T V Hviid
- Department of Clinical Biochemistry, Centre for Immune Regulation and Reproductive Immunology (CIRRI), the ReproHealth Research Consortium ZUH, Zealand University Hospital and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - O B Christiansen
- Centre for Recurrent Pregnancy Loss of Western Denmark, Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark; Recurrent Pregnancy Loss Unit Capital Region, Copenhagen University Hospital, Rigshospitalet and Hvidovre Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aalborg University, Denmark.
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15
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Abstract
Recurrent pregnancy loss is a distressing pregnancy disorder experienced by ~2.5% of women trying to conceive. Recurrent pregnancy loss is defined as the failure of two or more clinically recognized pregnancies before 20-24 weeks of gestation and includes embryonic and fetal losses. The diagnosis of an early pregnancy loss is relatively straightforward, although progress in predicting and preventing recurrent pregnancy loss has been hampered by a lack of standardized definitions, the uncertainties surrounding the pathogenesis and the highly variable clinical presentation. The prognosis for couples with recurrent pregnancy loss is generally good, although the likelihood of a successful pregnancy depends on maternal age and the number of previous losses. Recurrent pregnancy loss can be caused by chromosomal errors, anatomical uterine defects, autoimmune disorders and endometrial dysfunction. Available treatments target the putative risk factors of pregnancy loss, although the effectiveness of many medical interventions is controversial. Regardless of the underlying aetiology, couples require accurate information on their chances of having a baby and appropriate support should be offered to reduce the psychological burden associated with multiple miscarriages. Future research must investigate the pathogenesis of recurrent pregnancy loss and evaluate novel diagnostic tests and treatments in adequately powered clinical trials.
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16
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van Dijk MM, Kolte AM, Limpens J, Kirk E, Quenby S, van Wely M, Goddijn M. Recurrent pregnancy loss: diagnostic workup after two or three pregnancy losses? A systematic review of the literature and meta-analysis. Hum Reprod Update 2020; 26:356-367. [PMID: 32103270 PMCID: PMC7161667 DOI: 10.1093/humupd/dmz048] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/09/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recurrent pregnancy loss (RPL) occurs in 1–3% of all couples trying to conceive. No consensus exists regarding when to perform testing for risk factors in couples with RPL. Some guidelines recommend testing if a patient has had two pregnancy losses whereas others advise to test after three losses. OBJECTIVE AND RATIONALE The aim of this systematic review was to evaluate the current evidence on the prevalence of abnormal test results for RPL amongst patients with two versus three or more pregnancy losses. We also aimed to contribute to the debate regarding whether the investigations for RPL should take place after two or three or more pregnancy losses. SEARCH METHODS Relevant studies were identified by a systematic search in OVID Medline and EMBASE from inception to March 2019. A search for RPL was combined with a broad search for terms indicative of number of pregnancy losses, screening/testing for pregnancy loss or the prevalence of known risk factors. Meta-analyses were performed in case of adequate clinical and statistical homogeneity. The quality of the studies was assessed using the Newcastle-Ottawa scale. OUTCOMES From a total of 1985 identified publications, 21 were included in this systematic review and 19 were suitable for meta-analyses. For uterine abnormalities (seven studies, odds ratio (OR) 1.00, 95% CI 0.79–1.27, I2 = 0%) and for antiphospholipid syndrome (three studies, OR 1.04, 95% CI 0.86–1.25, I2 = 0%) we found low quality evidence for a lack of a difference in prevalence of abnormal test results between couples with two versus three or more pregnancy losses. We found insufficient evidence of a difference in prevalence of abnormal test results between couples with two versus three or more pregnancy losses for chromosomal abnormalities (10 studies, OR 0.78, 95% CI 0.55–1.10), inherited thrombophilia (five studies) and thyroid disorders (two studies, OR 0.52, 95% CI: 0.06–4.56). WIDER IMPLICATIONS A difference in prevalence in uterine abnormalities and antiphospholipid syndrome is unlikely in women with two versus three pregnancy losses. We cannot exclude a difference in prevalence of chromosomal abnormalities, inherited thrombophilia and thyroid disorders following testing after two versus three pregnancy losses. The results of this systematic review may support investigations after two pregnancy losses in couples with RPL, but it should be stressed that additional studies of the prognostic value of test results used in the RPL population are urgently needed. An evidenced-based treatment is not currently available in the majority of cases when abnormal test results are present.
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Affiliation(s)
- Myrthe M van Dijk
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Astrid M Kolte
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Emma Kirk
- Department of Obstetrics and Gynaecology, Royal Free Hospital NHS Trust, London, UK
| | - Siobhan Quenby
- University Hospital Coventry, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Madelon van Wely
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariëtte Goddijn
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Acrocentric Chromosome Polymorphic Variants on Chinese Female Have Possible Association with Unexplained Recurrent Pregnancy Loss. Reprod Sci 2020; 28:575-584. [PMID: 33025528 DOI: 10.1007/s43032-020-00332-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Recurrent pregnancy loss (RPL) occurs frequently in Chinese patients, but the causes for 40-50% RPL remain unexplained. This study aims to explore possible association between recurrent pregnancy loss and chromosome polymorphism. We performed a retrospective cohort study including a total number of 2967 Chinese patients from January in 2013 to December in 2019.These participants were divided into two groups: group I (RPL group) and group II (control group). Group I included 1791 patients who underwent RPL. Group II included 1176 individuals who underwent primary infertility. Their chromosome karyotype analyses were performed by Giemsa banding protocol. Pearson chi-squared test and Fisher's exact test were employed to evaluate the difference in frequency of chromosomal polymorphic variations between both groups. Chromosomal polymorphism occurred more frequently in RPL group compared with control group, the differences for 9qh+, inv(9), and Yqh+ between both groups were (χ2 = 6.697, p = 0.01), (χ2 = 6.242, p = 0.012), and (χ2 = 4.587, p = 0.032), respectively. The most significant difference of chromosomal polymorphism karyotype between RPL group and control group was found for acrocentric chromosome (D/G group) variants (χ2 = 30.7, p < 0.001). Moreover, the difference in frequency of D/G group variants between women and men in RPL group was remarkably significant (χ2 = 55.3, p < 0.001), and furthermore, D/G group variants occurred more frequently among women in RPL group than women in control group (χ2 = 44.3, p < 0.001). We found that acrocentric chromosomal polymorphism occurred preferentially on Chinese women with RPL. The fascinating finding provides us novel insight into the potential association of higher frequency of acrocentric chromosomal variations on Chinese women with unexplained RPL.
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18
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When the Path to Parenthood Does Not Go as Planned: Genetic Counseling for Infertility and Miscarriage. CURRENT GENETIC MEDICINE REPORTS 2020. [DOI: 10.1007/s40142-020-00189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Davidesko S, Wainstock T, Sheiner E, Landau D, Walfisch A. Maternal history of recurrent pregnancy loss increases the risk for long-term pediatric respiratory morbidity of the offspring. Pediatr Pulmonol 2020; 55:1765-1770. [PMID: 32426952 DOI: 10.1002/ppul.24813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/30/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND While the etiology in many cases of recurrent pregnancy loss (RPL) is unclear, recent evidence suggests possible immunological dysfunction, which is also implicated in the pathophysiology of many pediatric respiratory diseases. OBJECTIVE We sought to investigate whether maternal history of RPL is associated with long-term respiratory morbidity of the offspring. STUDY DESIGN A population based cohort analysis was performed comparing the risk of long-term respiratory morbidity (up to the age of 18 years) of children born to mothers with and without a history of RPL (defined as two or more losses). Respiratory morbidity included hospitalizations involving a predefined set of ICD-9 codes, as recorded in the hospital medical records. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. A Kaplan-Meier survival curve was constructed to compare cumulative respiratory morbidity, and a Cox proportional hazards model was used to control for confounders. RESULTS During the study period, 242 187 newborns met the inclusion criteria; 5% (n = 12 182) of which were offspring to mothers with a history of RPL. Respiratory morbidity was significantly more common in the exposed group (6.0% vs 4.8%, P < .001). Specifically, offspring to mothers with a history of RPL had higher rates of obstructive sleep apnea and asthma (P < .05). The Kaplan-Meier survival curve exhibited a higher cumulative incidence of total respiratory morbidity in offspring of mothers with a history of RPL (Log rank P < .001). In the Cox regression, maternal history of RPL was independently associated with increased pediatric respiratory morbidity of the offspring with an adjusted hazard ratio of 1.24 (95 % confidence interval [95%CI], 1.15-1.34, P < .001). CONCLUSION Maternal history of RPL is associated with a higher risk of future pediatric respiratory morbidity of the offspring; possibly explained by a common immunological etiology.
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Affiliation(s)
- Sharon Davidesko
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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20
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Wu B, Yan B, Hu R, Tian S, Ni Y, Liang Y, Wang Y, Zhang Y. Comparison between embryos transferred with self-spent and fresh medium on reproductive outcomes: a prospective randomized trial. Syst Biol Reprod Med 2020; 66:322-328. [PMID: 32475262 DOI: 10.1080/19396368.2020.1764132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As the final and critical step in in vitro fertilization (IVF), embryo transfer has always received much attention and deserves continuous optimization. In the present study, to explore the role of autocrine factors in embryo self-spent culture media, we prospectively compared embryo transfer with self-spent culture medium and fresh medium on clinical pregnancy outcomes. A total of 318 fresh IVF/intracytoplasmic sperm injection (ICSI) cycles were randomly allocated into two subgroups based on their transfer media (using a self-spent culture medium or new pre-equilibrated culture media), and the clinical outcomes were compared between groups. The implantation rates, clinical pregnancy rates and live birth rates for transfer using self-spent medium instead of new pre-equilibrated culture medium were slightly improved without statistical significance. Interestingly, however, biochemical pregnancy rate was found to be significantly decreased after transfer using self-spent medium for Day 3 embryos compared with new pre-equilibrated culture media. In short, embryo transfer with self-spent culture medium has shown some advantages, and large sample size studies are still needed to confirm these observations. ABBREVIATIONS ART: assisted reproductive technologies; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; ET: embryo transfer.
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Affiliation(s)
- Bin Wu
- Reproductive Medicine Department, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences , Jinan, China.,Reproductive Medicine Department, Jinan Central Hospital Affiliated to Shandong University , Jinan, China.,Cheeloo College of Medicine, Shandong University , Jinan, China.,Department of Obstetrics & Gynecology, College of Medicine, Howard University , Washington, DC, USA
| | - Bo Yan
- Reproductive Medicine Center, Gansu Provincial Maternity and Child-Care Hospital , Lanzhou, China
| | - Rui Hu
- Reproductive Medicine Department, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences , Jinan, China.,Reproductive Medicine Department, Jinan Central Hospital Affiliated to Shandong University , Jinan, China
| | - Shan Tian
- Reproductive Medicine Department, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences , Jinan, China.,Reproductive Medicine Department, Jinan Central Hospital Affiliated to Shandong University , Jinan, China
| | - Yali Ni
- Reproductive Medicine Center, Gansu Provincial Maternity and Child-Care Hospital , Lanzhou, China
| | - Yu Liang
- School of Life Science, Shandong University , Jinan, China
| | - Yunshan Wang
- Cheeloo College of Medicine, Shandong University , Jinan, China.,Clinical Laboratory Diagnostic Center, Jinan Central Hospital Affiliated to Shandong University , Jinan, China
| | - Yingchun Zhang
- Reproductive Medicine Department, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences , Jinan, China.,Reproductive Medicine Department, Jinan Central Hospital Affiliated to Shandong University , Jinan, China
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21
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Tarín JJ, Pascual E, Gómez R, García-Pérez MA, Cano A. Predictors of live birth in women with a history of biochemical pregnancies after assisted reproduction treatment. Eur J Obstet Gynecol Reprod Biol 2020; 248:198-203. [PMID: 32240893 DOI: 10.1016/j.ejogrb.2020.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To ascertain whether women with a history of biochemical pregnancies (BPs) in in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycles have decreased chances of live birth (LB); and (2) to build a predictive model for LB in this particular population of infertile women. METHODS In order to achieve the first objective, data from 1536 women that had a LB using autologous fresh or frozen embryos, or dropped out of further IVF/ICSI treatments after completing one to three unsuccessful treatment cycles were retrospectively analyzed. A subpopulation of 90 women that experienced one or more BPs in our assisted reproduction unit were selected to build a predictive logistic regression model for LB. RESULTS LB percentages significantly decreased from a value of 55.3 % in women with no history of previous BPs to 30.9 % and 11.1 % in women that displayed a history of one or more than one BP, respectively. Three out of 35 selected potential predictors were finally included into the model: "number of the last embryo transfer cycle resulting in a BP", "women's age", and "oligo-, astheno-, and/or teratozoospermia". The value of the c-statistic was 0.819 (asymptotic 95 % CI: 0.724-0.913). The model adequately fitted the data with no significant over or underestimation of predictor effects. CONCLUSION (1) A history of BPs is negatively associated with later chance of LB in women undergoing a series of IVF/ICSI treatment cycles; and (2) LB probability of women with a history of BPs can be predicted using a model with excellent discriminatory capacity.
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Affiliation(s)
- Juan J Tarín
- Department of Cellular Biology, Functional Biology and Physical Anthropology, Faculty of Biological Sciences, University of Valencia, Dr. Moliner 50, Burjassot, Valencia, 46100, Spain; Research Unit on Women's Health-Institute of Health Research INCLIVA, Av. de Menéndez y Pelayo, 4, 46010, Valencia, Spain.
| | - Eva Pascual
- Research Unit on Women's Health-Institute of Health Research INCLIVA, Av. de Menéndez y Pelayo, 4, 46010, Valencia, Spain; Service of Obstetrics and Gynecology, University Clinic Hospital, Av. de Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Raúl Gómez
- Research Unit on Women's Health-Institute of Health Research INCLIVA, Av. de Menéndez y Pelayo, 4, 46010, Valencia, Spain
| | - Miguel A García-Pérez
- Research Unit on Women's Health-Institute of Health Research INCLIVA, Av. de Menéndez y Pelayo, 4, 46010, Valencia, Spain; Department of Genetics, Faculty of Biological Sciences, University of Valencia, Dr. Moliner 50, Burjassot, Valencia, 4610, Spain
| | - Antonio Cano
- Research Unit on Women's Health-Institute of Health Research INCLIVA, Av. de Menéndez y Pelayo, 4, 46010, Valencia, Spain; Service of Obstetrics and Gynecology, University Clinic Hospital, Av. de Blasco Ibáñez, 17, 46010, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Av. de Blasco Ibáñez, 15, 46010, Valencia, Spain
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22
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Ni T, Wu Q, Zhu Y, Jiang W, Zhang Q, Li Y, Yan J, Chen ZJ. Comprehensive analysis of the associations between previous pregnancy failures and blastocyst aneuploidy as well as pregnancy outcomes after PGT-A. J Assist Reprod Genet 2020; 37:579-588. [PMID: 32103397 PMCID: PMC7125264 DOI: 10.1007/s10815-020-01722-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/13/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate the associations of previous pregnancy failures, including implantation failures (IFs), biochemical pregnancy losses (BPLs), and early (EMs) and late miscarriages (LMs), with blastocyst aneuploidy and pregnancy outcomes after PGT-A. METHODS This study included 792 couples who underwent PGT-A after multiple pregnancy failures. Subgroup analyses were used to compare the blastocyst aneuploidy rate (BAR), implantation rate (IR), early miscarriage rate (EMR), and live birth rate (LBR). Multiple linear and logistic regression models were used to evaluate the associations. The control group comprised couples with ≤ 2 IFs, ≤ 1 BPL, ≤ 1 EM, and no LM. RESULTS Notably, a history of ≥ 4 IFs was significantly associated with an increase in aneuploid blastocysts (42.86% vs. 33.05%, P = 0.044, B = 10.23 for 4 IFs; 48.80% vs. 33.05%, P = 0.002, B = 14.43 for ≥ 5 IFs). Women with ≥ 4 prior EMs also harbored more aneuploid blastocysts (41.00% vs. 33.05%, P = 0.048; B = 9.23). Compared with the control group, women with ≥ 4 prior EMs had a significantly higher EMR (6.58% vs. 31.11%, P < 0.001, OR = 6.49) and a lower LBR (53.49% vs. 34.18%, P = 0.007, OR = 0.56) after euploid transfer. Moreover, a history of LM(s) was associated with adverse pregnancy outcomes after PGT-A (OR for EM = 3.16; OR for live birth = 0.48). However, previous BPLs and 2 EMs were not associated significantly with blastocyst aneuploidy and pregnancy outcomes after PGT-A. CONCLUSION A history of high-order IFs or EMs and existence of LM(s) were significantly associated with blastocyst aneuploidy and adverse pregnancy outcomes after PGT-A, whereas no such associations were observed with BPLs or 2 EMs.
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Affiliation(s)
- Tianxiang Ni
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Qianqian Wu
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Yueting Zhu
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Wenjie Jiang
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Qian Zhang
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Yan Li
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
| | - Junhao Yan
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China.
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China.
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China.
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, 157 Jingliu Road, Jinan, 250001, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, 157 Jingliu Road, Jinan, 250001, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, 157 Jingliu Road, Jinan, 250001, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, 845 Lingshan Road, Shanghai, 200000, China
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23
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Youssef A, Vermeulen N, Lashley ELO, Goddijn M, van der Hoorn MLP. Comparison and appraisal of (inter)national recurrent pregnancy loss guidelines. Reprod Biomed Online 2019; 39:497-503. [DOI: 10.1016/j.rbmo.2019.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/17/2019] [Indexed: 12/27/2022]
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Zanetti BF, Braga DPDAF, Setti AS, Iaconelli A, Borges E. Predictive factors for biochemical pregnancy in intracytoplasmic sperm injection cycles. Reprod Biol 2019; 19:55-60. [PMID: 30745201 DOI: 10.1016/j.repbio.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate which factors contribute to the incidence of biochemical pregnancy (BP) in intracytoplasmic sperm injection (ICSI) cycles. This cohort study included cycles performed from June 2010 to September 2016 in a private, university-affiliated IVF centre. Cycles were split into four groups, depending on the pregnancy outcomes: Clinical Pregnancy (CP, n = 903), Biochemical Pregnancy (BP, n = 55), Miscarriage (MI, n = 142) and Negative Pregnancy (NP, n = 2034). The effects of ovarian stimulation, laboratory data and seminal parameters on pregnancy outcomes were evaluated using adjusted general linear models. Discriminant analyses were conducted to construct a model for pregnancy prediction and to establish cut-offs for BP. The total sperm count (p = 0.035), total and progressive sperm motility (p = 0.001 and p = 0.023, respectively), total motile sperm count (TMSC, p = 0.029) and the endometrial thickness (p < 0.001) were lower among BP group cycles. Lower rates of high-quality cleavage-stage embryos were observed in the BP group compared to CP and MI groups (p < 0.001). In discriminant analyses, cut-offs for BP prediction were established for the following factors: endometrial thickness < 11 mm, sperm motility < 55.5% and total dose of follicle-stimulating hormone (FSH)> 2400 IU. The incidence of biochemical pregnancy was four times higher when the aforementioned factors did not meet the defined cut-offs. The combination of suboptimal endometrial development and poor seminal and embryo quality contribute to an increased incidence of biochemical pregnancy in ICSI cycles.
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Affiliation(s)
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo, SP, 01401-002, Brazil; Instituto Sapientiae, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo, SP, 04503-040, Brazil
| | - Amanda Souza Setti
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo, SP, 01401-002, Brazil; Instituto Sapientiae, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo, SP, 04503-040, Brazil
| | - Assumpto Iaconelli
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo, SP, 01401-002, Brazil; Instituto Sapientiae, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo, SP, 04503-040, Brazil
| | - Edson Borges
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo, SP, 01401-002, Brazil; Instituto Sapientiae, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo, SP, 04503-040, Brazil.
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25
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Turienzo A, Lledó B, Ortiz JA, Morales R, Sanz J, Llácer J, Bernabeu R. Prevalence of candidate single nucleotide polymorphisms on p53, IL-11, IL-10, VEGF and APOE in patients with repeated implantation failure (RIF) and pregnancy loss (RPL). HUM FERTIL 2018; 23:117-122. [PMID: 30332901 DOI: 10.1080/14647273.2018.1524935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Recurrent pregnancy loss (RPL; defined as the loss of three or more consecutive pregnancies) and recurrent implantation failure (RIF; when implantation is not achieved after at least three cycles of IVF) are two of the major challenges that reproductive medicine faces. Some polymorphisms have been identified as possible causes of an increased risk of these diseases. This paper studies the prevalence of the polymorphisms in p53, VEGF, IL-10, IL-11 and APOE in RIF and RPL patients that determines the risk for these pathologies. A total of 255 patients were selected (89 RPL patients, 77 RIF patients and 89 controls) and genotyped for p53-R72P; IL-11-1082-AG; VEGF-1154-AG; IL-10; APOE-R112C; APOE-R158C. Statistically significant differences were found in the prevalence of the E4 isoform (R122-R158) of the APOE gene in RPL patients (p < 0.05), and in RIF patients, the R72P polymorphism of the p53 gene and the 1154-AG of the VEGF gene showed different distribution (p < 0.05). Regarding the p53 and IL-11 studied polymorphisms, PP of p53 gene and GG of IL-11 are more prevalent in RPL patients without reaching statistical significance. In conclusion, our results suggest patients carrying variants in p53 and VEGF would be at risk of RIF, and those carrying variants in APOE gene would suffer RPL.
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Affiliation(s)
| | - Belén Lledó
- Molecular Biology, Instituto Bernabeu Biotech, Alicante, Spain
| | - José A Ortiz
- Molecular Biology, Instituto Bernabeu Biotech, Alicante, Spain
| | - Ruth Morales
- Molecular Biology, Instituto Bernabeu Biotech, Alicante, Spain
| | - Juan Sanz
- Molecular Biology, Instituto Bernabeu Biotech, Alicante, Spain
| | - Joaquín Llácer
- Reproductive medicine, Instituto Bernabeu, Alicante, Spain
| | - Rafael Bernabeu
- Molecular Biology, Instituto Bernabeu Biotech, Alicante, Spain.,Reproductive medicine, Instituto Bernabeu, Alicante, Spain
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26
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Ticconi C, Capogna MV, Martelli F, Borelli B, Bruno V, Ergasti R, Sorge R, Piccione E, Pietropolli A. Ectopic pregnancy in women with recurrent miscarriage. J Obstet Gynaecol Res 2018; 44:852-860. [PMID: 29442402 DOI: 10.1111/jog.13607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/08/2018] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to investigate the possible association between recurrent miscarriage (RM) and ectopic pregnancy (EP). METHODS In this case-control retrospective study, the clinical cards of women followed as outpatients in the RM and low-risk pregnancy offices of the Obstetrics and Gynecology Unit at the Policlinico Tor Vergata University Hospital were carefully reviewed for the occurrence of EP. RESULTS Overall, 598 women with RM and 2043 normal women without RM (controls) were included in the study. Among these women, 4974 pregnancies were analyzed, in which 2028 miscarriages occurred. The EP rate (3.51%) was significantly higher in RM than in control women (1.51%) [odds ratio = 2.31 (95% confidence interval: 2.3-2.4)]; it was particularly high in women with primary RM (5.11%). However, when EP rates were calculated not by women but by overall pregnancies, no differences could be found between RM and control women. In control women, the absence of a miscarriage in the reproductive history was associated with a lower rate of EP. CONCLUSIONS Women with RM, particularly primary RM, are at increased risk of EP. This increased risk seems to be dependent on the high number of pregnancies occurring in women with RM rather than to specific characteristics of these women.
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Affiliation(s)
- Carlo Ticconi
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.,Clinical Department of Surgery, Section of Gynecology and Obstetrics, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Maria V Capogna
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.,Clinical Department of Surgery, Section of Gynecology and Obstetrics, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Federica Martelli
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.,Clinical Department of Surgery, Section of Gynecology and Obstetrics, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Barbara Borelli
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.,Clinical Department of Surgery, Section of Gynecology and Obstetrics, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Valentina Bruno
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.,Clinical Department of Surgery, Section of Gynecology and Obstetrics, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Raffaella Ergasti
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.,Clinical Department of Surgery, Section of Gynecology and Obstetrics, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Roberto Sorge
- Laboratory of Biometry, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Emilio Piccione
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.,Clinical Department of Surgery, Section of Gynecology and Obstetrics, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Adalgisa Pietropolli
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.,Clinical Department of Surgery, Section of Gynecology and Obstetrics, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
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Mas J, Sabouni R, Bocca S. A novel male 2;4;14 complex chromosomal translocation with normal semen parameters but 100% embryonic aneuploidy. J Assist Reprod Genet 2018; 35:907-912. [PMID: 29380280 DOI: 10.1007/s10815-018-1126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/19/2018] [Indexed: 12/11/2022] Open
Abstract
We report a case of a couple with a history of six spontaneous miscarriages in which a novel complex chromosomal rearrangement was detected in the male partner who had a totally normal semen analysis. Preimplantation genetic testing of their embryos demonstrated 100% aneuploidy.
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Affiliation(s)
- Jade Mas
- Stamford Hospital, Stamford, CT, 06902, USA
| | - Reem Sabouni
- The Jones Institute for Reproductive Medicine, EVMS, 601 Colley Ave, Norfolk, VA, 23507, USA
| | - Silvina Bocca
- The Jones Institute for Reproductive Medicine, EVMS, 601 Colley Ave, Norfolk, VA, 23507, USA.
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Abstract
BACKGROUND Pregnancy loss can have physical and psychological consequences for women and their families. Though a previous study described an increase in the risk of self-reported pregnancy loss from 1970 to 2000, more recent examinations from population-based data of US women are lacking. METHODS We used data from the 1995, 2002, 2006-2010, 2011-2015 National Survey of Family Growth on self-reported pregnancy loss (miscarriage, stillbirth, ectopic pregnancy) among US women (15-44 years) who reported at least one pregnancy conceived during 1990-2011 that did not result in induced termination (n = 20 012 women; n = 42 526 pregnancies). Trends in the risk of self-reported pregnancy loss and early pregnancy loss (<12 weeks) were estimated, separately, by year of pregnancy conception (limited to 1990-2011 to ensure a sufficient sample of pregnancies for each year and maternal age group) using log-Binomial and Poisson models, adjusted for maternal- and pregnancy-related factors. RESULTS Among all self-reported pregnancies, excluding induced terminations, the risk of pregnancy loss was 19.7% and early pregnancy loss was 13.5% during 1990-2011. Risk of pregnancy loss increased by a relative 2% (rate ratio [RR] 1.02, 95% confidence interval [CI] 1.01, 1.02) per year in unadjusted models and 1% per year (RR 1.01, 95% CI 1.00, 1.02) during 1990-2011, after adjustment for maternal characteristics and pregnancy-related factors. In general, trends were similar for early pregnancy loss. CONCLUSION From 1990 to 2011, risk of self-reported pregnancy loss increased among US women. Further work is needed to better understand the drivers of this increase in reported pregnancy loss in the US.
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Affiliation(s)
- Lauren M. Rossen
- Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Katherine A. Ahrens
- Office of Population Affairs, Office of the Assistant Secretary for Health, Rockville, MD
| | - Amy M. Branum
- Office of the Center Director, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
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29
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Lichtman Y, Sheiner E, Wainstock T, Segal I, Landau D, Walfisch A. Maternal history of recurrent pregnancy loss is associated with increased risk for long-term pediatric gastrointestinal morbidity in the offspring. Am J Reprod Immunol 2017; 79. [DOI: 10.1111/aji.12799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/20/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Eyal Sheiner
- Soroka University Medical Center; Beer Sheva Israel
| | | | - Idit Segal
- Israel Ministry of Health; Jerusalem Israel
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30
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Kling C, Hedderich J, Kabelitz D. Fertility after recurrent miscarriages: results of an observational cohort study. Arch Gynecol Obstet 2017; 297:205-219. [PMID: 29038842 PMCID: PMC5762794 DOI: 10.1007/s00404-017-4532-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/12/2017] [Indexed: 11/24/2022]
Abstract
Purpose Recurrent pregnancy losses (RPL) are considered a pathological condition associated with heterogeneous laboratory and clinical findings, and are also linked to subfertility. We attempt to rank parameters derived from past history and diagnostic results with regard to the prognosis. Methods Observational trial on 719 consecutive couples who were referred to a tertiary immunological care centre (2006–2014) after three or more primary miscarriages. Information on past obstetric history and diagnostic procedures at baseline were correlated with cumulative pregnancy and delivery rates using Kaplan–Meier estimation, logistic regression and multivariate analysis. Results At baseline, median female age was 34.1 years, waiting time 3 years (1–17), number of preceding miscarriages 3 (3–9), 147 women (20.4%) had conceived at least once in ART or AIH cycles. After a median follow-up of 33.7 (1.7–123.0) months, 5-year pregnancy and delivery rates were 86.1 and 64.5%. Female age (< 35 years), waiting time (< 3 years) until baseline, tubal competence, and male factor fertility significantly correlated with favourable outcome (p < 0.001), while body mass index (> 29 kg/m2), number of preceding miscarriages (> 4), late miscarriages, preclinical losses and smoking revealed non-significant negative trends. Mode of conception until baseline (spontaneously or ART/AIH) and classification into idiopathic and non-idiopathic RPL showed no prognostic relevance. Conclusion Although in general, chances to conceive a child are retained after three or more miscarriages, factors related to subfertility of both partners have an important impact on the outcome. Therefore, prolonged time to pregnancy (> 6–9 months) should result in preventive gynaecological care from the first miscarriage on, so that fertility can be preserved as best as possible.
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Affiliation(s)
- Christiane Kling
- Institute of Immunology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus 17, 24105, Kiel, Germany. .,MVZ Dr. Fenner and Colleagues, Bergstr. 14, 20095, Hamburg, Germany.
| | - Jürgen Hedderich
- Institute of Medical Statistics and Informatics, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus 31, 24105, Kiel, Germany
| | - Dieter Kabelitz
- Institute of Immunology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus 17, 24105, Kiel, Germany
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31
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Abstract
The challenging nature of recurrent pregnancy loss (RPL) is multifactorial, but largely begins with determining who meets diagnostic criteria for RPL as definitions vary and frequently change. Many patients seek obstetrical intervention after losses, even if they do not meet the criteria for RPL, and even those strictly meeting criteria often present a conundrum as to the etiology of their condition. The contribution of hereditary thrombophilia to RPL, the impact of each disorder on the clotting cascade, available evidence regarding pregnancy outcomes, and current recommendations for evaluation and treatment is presented.
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32
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Abstract
Endocrine disruptions may be important in patients experiencing recurrent pregnancy loss (RPL). This review focuses on data available on RPL and the endocrine system to investigate relevant, and perhaps modifiable, endocrine factors of importance for the disorder. Evidence indicates that some hormones may be important as immune modulators and a better understanding of this interplay has potential for improving pregnancy outcome in RPL. To date there is a lack of consensus on the effect of endocrine treatment options in RPL and there is a strong need for large randomized-controlled trials.
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33
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Rasmark Roepke E, Matthiesen L, Rylance R, Christiansen OB. Is the incidence of recurrent pregnancy loss increasing? A retrospective register-based study in Sweden. Acta Obstet Gynecol Scand 2017; 96:1365-1372. [DOI: 10.1111/aogs.13210] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/02/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Emma Rasmark Roepke
- Department of Obstetrics and Gynecology; Skåne University Hospital; Lund University; Malmö Sweden
| | - Leif Matthiesen
- Department of Obstetrics and Gynecology; Helsingborg Hospital; Affiliated Lund University; Helsingborg Sweden
| | - Rebecca Rylance
- Department of Research and Development; Skåne University Hospital; Lund Sweden
| | - Ole Bjarne Christiansen
- Fertility Clinic 4071; University Hospital Rigshospitalet; Copenhagen Denmark
- Department of Obstetrics and Gynecology; Aalborg University Hospital; Clinical Institute at Aalborg University; Aalborg Denmark
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34
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Detection of an Inherited Deletion in Products of Conception in a Patient With Recurrent Losses and Normal Karyotype. Obstet Gynecol 2017; 130:126-129. [PMID: 28594768 DOI: 10.1097/aog.0000000000002104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Microarray analysis testing on products of conception can provide valuable information in the evaluation of recurrent pregnancy loss beyond ploidy status. CASE A maternally inherited deletion on the X chromosome was detected by microarray analysis performed on products of conception in a couple with recurrent pregnancy loss. The mother had a previously demonstrated normal karyotype with standard cytogenetic analysis but was subsequently determined to have the same X chromosome deletion by oligonucleotide single-nucleotide polymorphism (SNP) microarray analysis. CONCLUSION Direct testing of products of conception using oligonucleotide SNP microarray identified a maternally inherited microdeletion on the X chromosome in a patient with recurrent losses and normal karyotype. Going forward, the couple may use preimplantation genetic diagnosis testing to identify embryos free of this deletion for transfer.
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35
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Reid S, Nadim B, Bignardi T, Lu C, Martins WP, Condous G. Association between three-dimensional transvaginal sonographic markers and outcome of pregnancy of unknown location: a pilot study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:650-655. [PMID: 27854392 DOI: 10.1002/uog.15923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/13/2016] [Accepted: 03/03/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the accuracy of three-dimensional (3D) transvaginal sonographic (TVS) parameters in predicting the evolution of a pregnancy of unknown location (PUL). METHODS This was a prospective observational study performed at the early pregnancy unit of a university hospital from September 2008 to June 2012. Women with a positive pregnancy test without any signs of intra- or extrauterine pregnancy at their first TVS examination were considered eligible and a 3D dataset containing the entire uterus was acquired. An experienced observer analyzed all 3D datasets for assessment of the following parameters: endometrial thickness, volume, mean gray-scale index and asymmetry. Women were followed until they were classified as having: (i) non-visualized pregnancy loss (NVPL); (ii) intrauterine pregnancy (IUP); or (iii) ectopic pregnancy or persistent PUL. We compared the values of the TVS parameters across the three groups. We also assessed the area under the receiver-operating characteristics curve of the 3D-TVS parameters in comparison to that for serum β-human chorionic gonadotropin (β-hCG) ratio (48 h/baseline) to predict PUL outcome. We then evaluated whether combining the 3D-TVS parameters with serum β-hCG ratio improved the predictive accuracy for PUL outcome by performing a logistic regression analysis. RESULTS During the study period 4939 consecutive pregnant women presented at the unit for their initial TVS examination and 325 (7%) were classified as having a PUL, of whom 161 women were enrolled and had a 3D scan of the uterus. However, 19 were excluded because of incomplete follow-up. Data from 142 women with PUL were therefore included in the analysis and the outcomes of these women were: NVPL in 98 (69%), IUP in 27 (19%) and ectopic pregnancy + persistent PUL in 14 + 3 = 17 (12%). Endometrial thickness, endometrial volume and the proportion of women with asymmetric endometrial shape differed significantly between the outcome groups. Endometrial thickness and volume could be used as reasonable predictors of both NVPL and IUP, whereas asymmetric endometrial shape and mean gray-scale index could be used as reasonable predictors of IUP only. The best single parameter to predict PUL outcomes was the β-hCG ratio. Regression analysis demonstrated that endometrial volume and endometrial shape asymmetry added significantly to the β-hCG ratio in predicting IUP but not NVPL. CONCLUSIONS 3D-TVS markers have a low diagnostic accuracy in predicting PUL outcome. The addition of endometrial volume and shape asymmetry improves the accuracy of the β-hCG ratio in predicting IUP. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Reid
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Penrith, NSW, Australia
| | - B Nadim
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Penrith, NSW, Australia
| | - T Bignardi
- Department of Obstetrics and Gynecology, A.O. Niguarda Ca' Granda, Milan, Italy
| | - C Lu
- Department of Computer Sciences, Aberystwyth University, Aberystwyth, UK
| | - W P Martins
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Penrith, NSW, Australia
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36
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Egerup P, Kolte AM, Larsen EC, Krog M, Nielsen HS, Christiansen OB. Recurrent pregnancy loss: what is the impact of consecutive versus non-consecutive losses? Hum Reprod 2016; 31:2428-2434. [PMID: 27591241 DOI: 10.1093/humrep/dew169] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/31/2016] [Accepted: 06/08/2016] [Indexed: 12/21/2022] Open
Abstract
STUDY QUESTION Is there a different prognostic impact for consecutive and non-consecutive early pregnancy losses in women with secondary recurrent pregnancy loss (RPL)? SUMMARY ANSWER Only consecutive early pregnancy losses after the last birth have a statistically significant negative prognostic impact in women with secondary RPL. WHAT IS KNOWN ALREADY The risk of a new pregnancy loss increases with the number of previous pregnancy losses in patients with RPL. Second trimester losses seem to exhibit a stronger negative impact than early losses. It is unknown whether the sequence of pregnancy losses plays a role for the prognosis in patients with a prior birth. STUDY DESIGN, SIZE, DURATION This retrospective cohort study of pregnancy outcome in patients with unexplained secondary RPL included in three previously published, Danish double-blinded placebo-controlled trials of intravenous immunoglobulin (IvIg) conducted from 1991 to 2014. No other treatments were given. Patients with documented explained pregnancy losses (ectopic pregnancies and aneuploid miscarriages) were excluded. PARTICIPANTS/MATERIALS, SETTING, METHODS Of the 168 patients included in the trials, 127 had secondary RPL and experienced a subsequent live birth or unexplained pregnancy loss in the first pregnancy after giving informed consent to participate in the trials (the index pregnancy). Data analyzed by multivariate analysis included the independent variables age, the number of early pregnancy losses before and after the last birth, respectively and a second trimester pregnancy loss before or after the last birth, respectively. The outcome variable was unexplained loss in the index pregnancy. MAIN RESULTS AND THE ROLE OF CHANCE In patients with secondary RPL, both a late and each early loss before the last birth did not significantly influence the risk of a new pregnancy loss in the index pregnancy: incidence rate ratio (IRR) 1.31 (95% CI 0.62-2.77) and IRR 0.88 (95% CI 0.70-1.11), respectively. In contrast, the impact on risk of pregnancy loss conferred by a late and by each early pregnancy loss occurring after the birth was significant: IRR 2.15 (95% CI 1.57-2.94, P < 0.0001) and IRR 1.14 (95% CI 1.04-1.24, P = 0.002), respectively. LIMITATIONS, REASONS FOR CAUTION Of the patients, 48% were treated with IvIg, which could influence the results. However, allocation to IvIg was random and prognostic variables were equally distributed in IvIg and placebo-treated patients. WIDER IMPLICATIONS OF THE FINDINGS A birth in women with secondary RPL eradicates the negative prognostic impact of previous pregnancy losses and this finding is important for our understanding of the pathogenesis. It indicates that only consecutive pregnancy losses should count in the definition of RPL. STUDY FUNDING/COMPETING INTERESTS There was no particular funding for this study. The authors declare that there is no conflict of interest. TRIAL REGISTRATION NUMBER Not applicable for two of the included randomized controlled trials. For the last trial: Clinical.Gov NCT00722475.
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Affiliation(s)
- P Egerup
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - A M Kolte
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - E C Larsen
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - M Krog
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - H S Nielsen
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - O B Christiansen
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark .,Department of Obstetrics and Gynaecology, Aalborg University Hospital, Reberbansgade, DK-9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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37
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Abstract
Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and post-traumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy.
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Affiliation(s)
- Amritha Bhat
- Department of Psychiatry, University of Washington, Box 35650, Seattle, WA, 98195, USA.
| | - Nancy Byatt
- Departments of Psychiatry and Obstetrics and Gynecology, UMass Medical School, Worcester, MA, USA
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38
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Kolte AM, Bernardi LA, Christiansen OB, Quenby S, Farquharson RG, Goddijn M, Stephenson MD. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Hum Reprod 2014; 30:495-8. [PMID: 25376455 DOI: 10.1093/humrep/deu299] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pregnancy loss prior to viability is common and research in the field is extensive. Unfortunately, terminology in the literature is inconsistent. The lack of consensus regarding nomenclature and classification of pregnancy loss prior to viability makes it difficult to compare study results from different centres. In our opinion, terminology and definitions should be based on clinical findings, and when possible, transvaginal ultrasound. With this Early Pregnancy Consensus Statement, it is our goal to provide clear and consistent terminology for pregnancy loss prior to viability.
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Affiliation(s)
- A M Kolte
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, University Hospital Copenhagen, Rigshospitalet, København Ø, Denmark
| | - L A Bernardi
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - O B Christiansen
- Recurrent Pregnancy Loss Unit, Fertility Clinic 4071, University Hospital Copenhagen, Rigshospitalet, København Ø, Denmark Department of Obstetrics and Gynaecology, Aalborg Hospital, Aalborg, Denmark
| | - S Quenby
- Clinical Sciences Research Institute, University Hospital Coventry, Warwick Medical School, Warwick, UK
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, Liverpool, UK
| | - M Goddijn
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - M D Stephenson
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, USA
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Coccia ME, Rizzello F, Capezzuoli T, Spitaleri M, Riviello C. Recurrent pregnancy losses and gestational age are closely related: an observational cohort study on 759 pregnancy losses. Reprod Sci 2014; 22:556-62. [PMID: 25305129 DOI: 10.1177/1933719114553063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To assess the accurate dating of the cessation of pregnancy in patients with recurrent pregnancy loss (RPL) and to evaluate the incidence and recurrence rate of pregnancy losses in similar gestational age. In a retrospective cohort study, couples with history of RPL and availability of precise documentation regarding previous pregnancy losses were included. The vast majority of losses occurred within the first trimester. In patients experiencing more than 2 miscarriages in the same gestational stage, a tendency for recurrent losses around the same period of gestation was observed. Overall, the probability of losses at different gestational stages goes down with increasing number of miscarriages at the same stage. The study supports the need to ascertain data regarding the timing of pregnancy loss as accurately as possible for prognosis of future pregnancies and management of couples. A classification for unexplained RPL based on gestational age of miscarriages could help researchers to better investigate RPL.
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Affiliation(s)
- Maria Elisabetta Coccia
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Francesca Rizzello
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Tommaso Capezzuoli
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Marina Spitaleri
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Chiara Riviello
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
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40
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Immunomodulatory treatment with intravenous immunoglobulin and prednisone in patients with recurrent miscarriage and implantation failure after in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril 2014; 102:1650-5.e1. [PMID: 25256927 DOI: 10.1016/j.fertnstert.2014.08.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess outcome in terms of live-birth rate after fresh or frozen IVF/intracytoplasmic sperm injection assisted reproductive technology (ART) cycles where immunomodulation was given to patients with recurrent pregnancy loss after prior ART treatments. DESIGN Retrospective cohort study. SETTING Tertiary care university hospital. PATIENT(S) Fifty-two patients with a history of at least three consecutive pregnancy losses after ART who underwent at least one further ART cycle with concurrent immunomodulation in 2003-2012. INTERVENTION(S) Immunomodulation with IV immunoglobulin and prednisone starting from before ET and continuing in the first trimester if pregnancy was established. MAIN OUTCOME MEASURE(S) Live-birth rate per ET and cumulative live-birth rate after up to five ETs. RESULT(S) Nineteen patients (36.5%) achieved a live birth after the first ET with immunomodulation, and a total of 32 patients achieved a live birth in the study period, resulting in a cumulative live-birth rate of 61.5%. There was no significant difference in baseline and immunological parameters between the patients achieving a live birth or not. The live-birth rate after the first immunomodulated ART cycle in our patients is higher than that reported in a previous study. CONCLUSION(S) Immunomodulation with a combination of IV immunoglobulin and prednisone is a promising treatment for recurrent pregnancy loss after ART, but randomized placebo-controlled trials are needed.
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41
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Christiansen OB. Recurrent miscarriage is a useful and valid clinical concept. Acta Obstet Gynecol Scand 2014; 93:852-7. [PMID: 25040853 DOI: 10.1111/aogs.12456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 07/14/2014] [Indexed: 01/10/2023]
Abstract
Although epidemiological, clinical and biochemical risk factors are known for recurrent miscarriage (RM), the etiology is mainly unknown. Two main hypotheses dominate: that RM is mainly caused by aneuploid conceptions and other conception errors and that the recurrence rate is explained by the combination of chance and increased risk, or that maternal endocrinological, thrombophilic or immunological abnormalities play a main role in causing loss of euploid conceptions. Believers of the former hypothesis advocate that management of RM should be conservative and that the spontaneous prognosis is very favorable. Believers of the latter hypothesis think that treatments aimed at the woman may improve pregnancy outcome, but that testing of such treatments in randomized controlled trials is needed. In this article in favor of RM being a specific and useful clinical concept, arguments are advanced that a significant subset of RM patients exhibit a poor spontaneous prognosis and should be offered relevant investigations, close surveillance during pregnancy, and treatment, preferably as part of randomized controlled trials.
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Affiliation(s)
- Ole B Christiansen
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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