No Increase in Embryo Aneuploidy Found Among Young Women With History of RPL
Embryo aneuploidy rates are not elevated among women aged 35 years or younger with a history of recurrent pregnancy loss (RPL), according to results from a new analysis. Furthermore, in vitro fertilization (IVF) with preimplantation genetic screening enables women with RPL to achieve live birth rates similar to those among women without RPL.
Jorge Rodriguez-Purata, MD, of Reproductive Medicine Associates of New York in New York City, presented results from the retrospective cohort study at the Scientific Congress & Expo of the American Society for Reproductive Medicine held October 15 to 19, 2016, in Salt Lake City, UT.
RPL is a multifactorial disorder with risk factors such as blood clotting, infection, hormonal imbalance, and fetal chromosomal abnormalities accounting for many cases. However, the etiology of RPL is unknown in 40% to 50% of cases. Although sporadic pregnancy loss occurs in up to 50% of pregnancies, 5% of women will be diagnosed with RPL based on a history of at least 2 spontaneous abortions.
Limited clinical evidence is available to guide the management of patients with RPL, who often express anxiety around outcomes associated with future spontaneous abortions. IVF with preimplantation genetic screening has been evaluated as a treatment strategy for patients with RPL and includes goals of shortening time to pregnancy, decreasing rates of spontaneous abortion, and increasing live birth rates. The current retrospective study was designed to evaluate whether aneuploidy rates are elevated in patients with RPL.
In total, 139 women aged 35 years or younger who underwent a fresh autologous IVF cycle with preimplantation genetic screening and single embryo transfer between January 2010 and March 2016 were included in the analysis. Patient outcomes were stratified by history of RPL. The primary end points were aneuploidy rate and clinical pregnancy rate.
Results showed no differences between the RPL and non-RPL groups (Table). Ovarian reserve markers, including day 3 follicle-stimulating hormone and anti-mullerian hormone levels, were comparable in the RPL and non-RPL groups. All embryologic end points were also similar, including the mean number of oocytes retrieved, number of embryos on days 1 and 5, and number of embryos biopsied per IVF cycle.
Table. Results Based on History of RPL
| Variable | RPL (n = 75) | Non-RPL (n = 64) |
Odds Ratio (95% CI) |
| Age, y | 32.0 | 31.9 | — |
| Total IVF cycles, n | 86 | 75 | — |
| Day 3 FSH level, mIU/mL | 12.0 | 11.6 | — |
| AMH level, ng/mL | 7.8 | 7.7 | — |
| Mean oocytes retrieved, n | 18.3 | 17.8 | — |
| Mean day 1 embryos ongoing, n | 12.0 | 11.6 | — |
| Mean day 5 embryos ongoing, n | 7.8 | 7.7 | — |
| Mean embryos biopsied per cycle, n | 6.6 | 5.9 | — |
| Proportion of aneuploid embryos, % | 32.6 | 33.6 | 1.1 (0.8-1.4) |
| Clinical pregnancy rate, % | 57.6 | 58.3 | 0.97 (0.5-1.9) |
AMH = anti-mullerian hormone, CI = confidence interval, FSH = follicle-stimulating hormone, IVF = in vitro fertilization, RPL = recurrent pregnancy loss.
The proportion of aneuploid embryos was equivalent in the RPL and non-RPL groups (32.6% vs 33.6%, respectively). The clinical pregnancy rate was 57.6% for the RPL group and 58.3% for the non-RPL group (see Table).
Rodriguez-Purata said that these results are reassuring for women with a history of RPL. “RPL patients aged 35 years and younger who seek IVF treatment with preimplantation genetic screening have similar chances of achieving a pregnancy, as do patients without a history of RPL,” he explained.
The research team concluded that clinicians should consider evaluating other potential underlying causes of RPL in these patients.
Source: Nonez H, Rodriguez-Purata J, Lee JA, et al. Aneuploidy rates are not increased in patients with recurrent pregnancy loss. Presented at: American Society for Reproductive Medicine 2016 Scientific Congress & Expo; October 15-19, 2016; Salt Lake City, UT. Abstract O-261.