Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Department of Obstetrics and Gynaecology, The Richie Centre, The School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
Am J Obstet Gynecol. 2023 Jan;228(1):66.e1-66.e9. doi: 10.1016/j.ajog.2022.08.014. Epub 2022 Aug 13.
Recurrent pregnancy loss negatively affects the reproductive outcomes of natural conception. Preimplantation genetic testing for aneuploidies has been the focus of interventions in women with recurrent pregnancy loss. However, the risk of no embryos being available, high costs, and uncertainties surrounding its effectiveness limit its use. Factors beyond euploidy, such as an appropriate intrauterine environment, are also important for improving the reproductive outcomes in women with recurrent pregnancy loss. It remains unknown whether a history of recurrent pregnancy loss can affect reproductive outcomes after fertility treatment.
This study aimed to investigate the impact of history of recurrent pregnancy loss on the reproductive outcomes of women undergoing fertility treatment.
This was a retrospective cohort study of women who underwent their first frozen embryo transfer cycle or intrauterine insemination cycle between January 2014 and July 2020 in Shanghai, China. We excluded couples with known karyotypic abnormalities (eg, balanced translocation) or uterine malformation. We performed multivariate binary logistic regressions for biochemical pregnancy, miscarriage, and live birth rates to investigate the associations between recurrent pregnancy loss history and reproductive outcomes.
A total of 29,825 women who underwent frozen embryo transfer cycles and 5476 women who underwent intrauterine insemination cycles were included in this study. In those who underwent frozen embryo transfer, history of recurrent pregnancy loss was not significantly associated with biochemical pregnancy (adjusted odds ratio, 1.19; 95% confidence interval, 0.87-1.63), miscarriage (adjusted odds ratio, 0.99; 95% confidence interval, 0.78-1.26), or live birth rates (adjusted odds ratio, 0.91; 95% confidence interval, 0.79-1.06). Similarly, in frozen embryo transfer cycles that led to clinical pregnancy, recurrent pregnancy loss history was not significantly associated with live birth (adjusted odds ratio, 0.99; 95% confidence interval, 0.76-1.28) or miscarriage rates (adjusted odds ratio, 1.04; 95% confidence interval, 0.81-1.35). In women with intrauterine insemination, history of recurrent pregnancy loss showed no significant associations with fertility outcomes in all cycles ([adjusted odds ratio, 1.36; 95% confidence interval, 0.88-2.10] for live birth rate and [adjusted odds ratio, 1.74; 95% confidence interval, 0.75-4.01], for miscarriage rate) and in cycles that led to clinical pregnancy ([adjusted odds ratio, 0.70; 95% confidence interval, 0.31-1.63] for live birth rate and [adjusted odds ratio, 1.45; 95% confidence interval, 0.58-3.63] for miscarriage rate).
In women without obvious chromosome abnormality and uterine malformation who undergo fertility treatment, recurrent pregnancy loss history was not significantly associated with miscarriage and live birth rates, suggesting that it has little or no prognostic value in predicting the reproductive outcomes of frozen embryo transfer or intrauterine insemination cycles.
复发性妊娠丢失会对自然受孕的生殖结局产生负面影响。胚胎植入前遗传学检测非整倍体一直是复发性妊娠丢失患者干预的焦点。然而，由于无胚胎可用、成本高以及其有效性的不确定性，限制了其使用。除了非整倍体外，合适的宫内环境等因素对改善复发性妊娠丢失患者的生殖结局也很重要。目前尚不清楚复发性妊娠丢失史是否会影响接受生育治疗后的生殖结局。
本研究旨在探讨复发性妊娠丢失史对接受生育治疗的女性生殖结局的影响。
这是一项在中国上海进行的回顾性队列研究，纳入了 2014 年 1 月至 2020 年 7 月期间首次进行冷冻胚胎移植周期或宫腔内人工授精周期的女性。我们排除了已知染色体异常（例如平衡易位）或子宫畸形的夫妇。我们进行了多变量二项逻辑回归分析，以研究复发性妊娠丢失史与生殖结局之间的关联，包括生化妊娠、流产和活产率。
共纳入 29825 名接受冷冻胚胎移植周期的女性和 5476 名接受宫腔内人工授精周期的女性。在接受冷冻胚胎移植的女性中，复发性妊娠丢失史与生化妊娠（调整后的优势比，1.19；95%置信区间，0.87-1.63）、流产（调整后的优势比，0.99；95%置信区间，0.78-1.26）或活产率（调整后的优势比，0.91；95%置信区间，0.79-1.06）均无显著相关性。同样，在导致临床妊娠的冷冻胚胎移植周期中，复发性妊娠丢失史与活产率（调整后的优势比，0.99；95%置信区间，0.76-1.28）或流产率（调整后的优势比，1.04；95%置信区间，0.81-1.35）均无显著相关性。在接受宫腔内人工授精的女性中，复发性妊娠丢失史在所有周期中均与生育结局无显著相关性（[调整后的优势比，1.36；95%置信区间，0.88-2.10]活产率和[调整后的优势比，1.74；95%置信区间，0.75-4.01]流产率），以及导致临床妊娠的周期中也无显著相关性（[调整后的优势比，0.70；95%置信区间，0.31-1.63]活产率和[调整后的优势比，1.45；95%置信区间，0.58-3.63]流产率）。
在无明显染色体异常和子宫畸形且接受生育治疗的女性中，复发性妊娠丢失史与流产率和活产率无显著相关性，提示其对预测冷冻胚胎移植或宫腔内人工授精周期的生殖结局几乎没有或没有预后价值。
