Department of Obstetrics and Gynecology, Universidade Federal do Pará, Belém, Pará, Brazil.
Clinica de Reprodução Assistida Pronatus, Belém, Pará, Brazil.
Am J Reprod Immunol. 2020 May;83(5):e13226. doi: 10.1111/aji.13226. Epub 2020 Feb 6.
We aimed to investigate the main causes of recurrent miscarriage (RM) in patients with losses after spontaneous gestation (SG) and after in vitro fertilization (IVF).
A prospective case-control study was conducted. The eligible patients were women who had experienced two or more consecutive abortions after <12 weeks' gestation, two consecutive losses after SG, or two consecutive losses after IVF. All patients were subjected to the following evaluations: karyotyping of the aborted material, alloimmune and autoimmune marker testing, and acquired and hereditary thrombophilia marker testing.
In total, 58 patients were eligible: 32 patients with RM after SG and 26 patients with RM after IVF. The factors associated with RM were genetic (29%), immune (14%), thrombophilic (21%), and thrombophilic and immune (24%), and only 12% of the cases were idiopathic. Comparing the two study groups (SG and IVF), all studied factors were similar, except for a higher ANA positivity observed in the SG group (SG 30.4% vs IVF 5.3%, OR 8.6 (CI 1.1-21.1, P .048).
Our study identified the possibly factors associated with recurrent miscarriage in 86% of the cases, and these factors appear to be similar in patients with recurrent miscarriage after spontaneous gestation and IVF. This study demonstrates that IVF with PGT-A with euploid embryo transfer could reduce abortions by up to 29%, but other factors need to be investigated even in patients undergoing in vitro fertilization.
我们旨在探究自然妊娠（SG）和体外受精（IVF）后流产患者复发性流产（RM）的主要原因。
进行了一项前瞻性病例对照研究。合格的患者是经历过两次或更多次连续流产<12 周、两次连续 SG 流产或两次连续 IVF 流产的女性。所有患者均接受以下评估：流产材料的核型分析、同种免疫和自身免疫标志物检测以及获得性和遗传性血栓形成倾向标志物检测。
共有 58 名患者符合条件：32 名 SG 后 RM 患者和 26 名 IVF 后 RM 患者。与 RM 相关的因素有遗传（29%）、免疫（14%）、血栓形成倾向（21%）和血栓形成倾向和免疫（24%），只有 12%的病例为特发性。比较两组研究（SG 和 IVF），除了 SG 组观察到更高的 ANA 阳性率（SG 30.4%比 IVF 5.3%，OR 8.6（CI 1.1-21.1，P=.048）外，所有研究因素均相似。
我们的研究确定了 86%的复发性流产病例中可能相关的因素，这些因素似乎在 SG 后和 IVF 后复发性流产患者中相似。这项研究表明，PGT-A 与整倍体胚胎移植的体外受精可以将流产率降低 29%，但即使在进行体外受精的患者中，也需要研究其他因素。
