In vitro fertilization and embryo transfer for the treatment of couples with secondary infertility and a history of recurrent abortion.

Abstract

Objective: Management of couples with recurrent abortion and secondary infertility using assisted reproductive techniques has been reported in the past. Although the initial study reported promising pregnancy rates and outcome the results were not substantiated. The aim of this study was to assess the role of IVF-ET in couples with three or more abortions with no demonstrable cause.Design: Prospective case series.Materials/Methods: A total of 21 couples with secondary infertility and a history of unexplained recurrent abortion were enrolled. All couples were evaluated with a hysterosalpingogram/hysteroscopy, measurement of anticardiolipin IgG, IgM and lupus anticoagulant, and male and female karyotype analyses. Standard infertility evaluation with semen analysis and documentation of ovulation was performed for all couples. Of the 21 couples, laparoscopy had been performed in 16. IVF-ET or ICSI was performed according to semen analysis of the male. All women were down regulated with a luteal start GnRH analogue and stimulated with pure or recombinant FSH. Up to 4 embryos were replaced depending on embryo quality and female age. Preimplantation genetic diagnosis was not carried out due to the unavailability of the technique at the time of the study.Results: Of the 21 couples, 5 had mild-moderate male factor, 6 had endometriosis, and 3 had anovulation. Women with endometriosis had their lesions fulgurated during surgery. Mean female age was 33.5 years (26–44) and mean duration of infertility was 4.5 years (1–11). Mean number of previous abortions was 3.9 (3–9). A total of 25 cycles of IVF/ICSI was performed. A mean of 11.1 oocytes (3–26) were retrieved and 2.8 (1–4) embryos were transferred. One cycle was cancelled due to empty follicles. Clinical pregnancy per initiated cycle was 32% (8/25). Of the 8 pregnancies 2 delivered (1 singleton, 1 twin) and 5 ended in first trimester miscarriages. One twin pregnancy was terminated at 22 weeks due to severe preeclampsia. Take home baby rate was 8% (2/25) per cycle and 8.3% (2/24) per embryo transfer. At the same time period, clinical pregnancy rate per embryo transfer in our institution was 41% for all age groups included.Conclusions: Etiology of recurrent abortion is most probably multifactorial and complex. In couples with a history of recurrent abortion and secondary infertility, IVF/ICSI appears to yield very low delivery rates with most of the pregnancies achieved ending in spontaneous abortions. Preimplantation genetic diagnosis appears to be the approach of choice in these couples. Objective: Management of couples with recurrent abortion and secondary infertility using assisted reproductive techniques has been reported in the past. Although the initial study reported promising pregnancy rates and outcome the results were not substantiated. The aim of this study was to assess the role of IVF-ET in couples with three or more abortions with no demonstrable cause. Design: Prospective case series. Materials/Methods: A total of 21 couples with secondary infertility and a history of unexplained recurrent abortion were enrolled. All couples were evaluated with a hysterosalpingogram/hysteroscopy, measurement of anticardiolipin IgG, IgM and lupus anticoagulant, and male and female karyotype analyses. Standard infertility evaluation with semen analysis and documentation of ovulation was performed for all couples. Of the 21 couples, laparoscopy had been performed in 16. IVF-ET or ICSI was performed according to semen analysis of the male. All women were down regulated with a luteal start GnRH analogue and stimulated with pure or recombinant FSH. Up to 4 embryos were replaced depending on embryo quality and female age. Preimplantation genetic diagnosis was not carried out due to the unavailability of the technique at the time of the study. Results: Of the 21 couples, 5 had mild-moderate male factor, 6 had endometriosis, and 3 had anovulation. Women with endometriosis had their lesions fulgurated during surgery. Mean female age was 33.5 years (26–44) and mean duration of infertility was 4.5 years (1–11). Mean number of previous abortions was 3.9 (3–9). A total of 25 cycles of IVF/ICSI was performed. A mean of 11.1 oocytes (3–26) were retrieved and 2.8 (1–4) embryos were transferred. One cycle was cancelled due to empty follicles. Clinical pregnancy per initiated cycle was 32% (8/25). Of the 8 pregnancies 2 delivered (1 singleton, 1 twin) and 5 ended in first trimester miscarriages. One twin pregnancy was terminated at 22 weeks due to severe preeclampsia. Take home baby rate was 8% (2/25) per cycle and 8.3% (2/24) per embryo transfer. At the same time period, clinical pregnancy rate per embryo transfer in our institution was 41% for all age groups included. Conclusions: Etiology of recurrent abortion is most probably multifactorial and complex. In couples with a history of recurrent abortion and secondary infertility, IVF/ICSI appears to yield very low delivery rates with most of the pregnancies achieved ending in spontaneous abortions. Preimplantation genetic diagnosis appears to be the approach of choice in these couples.