Elsevier

Fertility and Sterility

Volume 98, Issue 3, September 2012, Pages 675-680
Fertility and Sterility

Original article
Idiopathic recurrent miscarriage is caused mostly by aneuploid embryos

https://doi.org/10.1016/j.fertnstert.2012.05.025Get rights and content

Objective

To determine any beneficial effects of preimplantation genetic screening (PGS) of all chromosomes by array comparative genomic hybridization (aCGH), with either day 3 or blastocyst biopsy, for idiopathic recurrent pregnancy loss (RPL) patients compared with their expected loss rate.

Design

Case series report.

Setting

Multiple fertility centers.

Patient(s)

A total of 287 cycles of couples with idiopathic RPL (defined as two or more losses).

Intervention(s)

PGS was done with day 3 biopsy (n = 193) or blastocyst biopsy (n = 94), followed by analysis with aCGH.

Main Outcome Measure(s)

Spontaneous abortion rate, euploidy rate.

Result(s)

A total of 2,282 embryos were analyzed, of which 35% were euploid and 60% were aneuploid. There were 181 embryo transfer cycles, of which 100 (55%) became pregnant with an implantation rate of 45% (136 sacs/299 replaced embryos) and 94 pregnancies (92%) were ongoing (past second trimester) or delivered. The miscarriage rate was found to be only 6.9% (7/102), compared with the expected rate of 33.5% in an RPL control population and 23.7% in an infertile control population.

Conclusion(s)

Current PGS results with aCGH indicate a significant decrease in the miscarriage rate of idiopathic RPL patients and high pregnancy rates. Furthermore, this suggests that idiopathic recurrent miscarriage is mostly caused by chromosomal abnormalities in embryos.

Section snippets

Patient Population

Patients with normal karyotypes, without uterine anomalies or endocrine disorders, and with a history of two or more previous unexplained (idiopathic RPL) miscarriages that occurred after ≤20 weeks of gestation were included in the study. All translocation carriers were excluded. Patients included 287 cycles of both fertile and infertile couples. Couples were undergoing assisted reproductive technologies (ART) at multiple fertility centers (mainly NYU Fertility Center, New York, NY; ART

Results

In total, 2,282 embryos were analyzed (1,710 biopsied at day 3, 572 biopsied at the blastocyst stage) from 44 centers and 287 cycles. The average maternal age at biopsy was 36.7 ± 4.2 (range 21–45) years, and these patients had an average of 3.3 ± 1.2 (range 2–7) prior losses. When comparing those that had a day 3 biopsy to those that had a day 5 biopsy there was no statistical difference in the maternal age at biopsy or number of prior losses. In addition, when comparing those <35 years old

Discussion

Earlier PGS results using FISH 15, 16, 17, 18 showed that the miscarriage rate in idiopathic RPL patients was significantly reduced from 26% to 10% in patients <35 years old, and from 39% to 13% in older patients. However, no randomized control trial has ever been performed for this population, with the exception of one that, surprisingly, did not report on miscarriage outcome (21). The present PGS results with aCGH technology indicate a further significant decrease in the miscarriage rate of

Acknowledgments

The authors thank the embryology staff, nurses, and physicians at the various fertility centers who have contributed to the care of the patients.

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    • Cited by (0)

    B.H.-W. has nothing to disclose. J.G. has nothing to disclose. S.G. has nothing to disclose. B.K. has nothing to disclose. C.A.L. has nothing to disclose. M.G. has nothing to disclose. S.M. has nothing to disclose.

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