Impact of age on reproductive outcome in women with recurrent spontaneous abortions and infertility of immune etiology.

Abstract

The objective of this paper is to determine whether age has any impact on conception rate, pregnancy outcome, or autoimmune status in women with recurrent spontaneous abortions (RSA) and infertility of immune etiology. One hundred twenty-four women with 3 or more RSA and 36 women with unexplained infertility were prospectively studied. Maternal antipaternal lymphocyte antibodies and autoantibodies to phospholipids and nuclear antigens were tested. All achieved an adequate alloimmune recognition after lymphocyte immunization and followed for 1 year with optimal preconception autoimmune treatment. Conception rate and pregnancy outcome were prospectively studied. 1) 10.1% of women with RSA and 30.6% of women with infertility failed to achieve a pregnancy after 1 year of trial (P = 0.0084); 2) in women with RSA, the number of previous fetal death after 28 weeks of gestation was significantly higher in women who failed to achieve a pregnancy within 1 year when compared to women who became pregnant (P = 0.0296). Conception rate was not different with advancing age; 3) women with infertility demonstrated significantly higher incidence of anti-phosphatidylethanolamine antibody when compared to women with RSA (P = 0.052); 4) in women with infertility, those who failed to achieve a pregnancy were significantly older (P = 0.0012) and demonstrated a higher incidence of autoantibodies to phosphatidic acid than women with infertility who became pregnant (P = 0.0339); 5) the subsequent spontaneous abortion rate while on optimal immune therapy was the same in the women with RSA (39.3%) and women with infertility (32%). Spontaneous abortion rate of women with RSA or infertility was not different among four age groups; 6) the presence of anticardiolipin antibody (P = 0.0055) and higher gravidity (P = 0.0354) correlated significantly with pregnancy failure in women with a history of infertility. The prevalence of auto-antibodies to phospholipids and nuclear components was not different among four age groups in women with RSA or infertility. Age does not affect pregnancy outcome or conception rate in women with RSA. In women with infertility of immune etiology, conception rate was significantly reduced over age 40 although pregnancy outcome was no different with advanced age.