P-910: Etiology of recurrent pregnancy loss (RPL) in 1018 women

Abstract

ObjectiveRecurrent Pregnancy Loss (RPL) is a devastating problem that affects 2%-4% of reproductive age couples and represents a major concern for reproductive medicine specialists. Great advances have been made to identify the etiologic factors associated with RPL, yet questions remain. One such question is whether the expense and time of a full evaluation of a couple is warranted after two consecutive losses, or if a full evaluation should only be undertaken after three losses. A second question is whether full evaluations should be given to couples with secondary RPL because the couples already have demonstrated fertility. The goal of this study is to address these questions by categorizing the etiologies of RPL relative to primary and secondary losses, as well as to the number of pregnancy losses.DesignProspective, single-center evaluation of women who were referred for evaluation for RPL.Materials and methodsPatients who sought treatment for RPL were included in this study if they had experienced two or more consecutive losses with the same partner, and if information was available for at least four of the seven possible categories. These categories included genetic (karyotypes), anatomic (defects identified by hysterosalpingogram or hysteroscopy), endocrinologic (TSH, prolactin, midluteal progesterone, fasting insulin and glucose), immunologic (LAC, anticardiolipin and antiphosphatidyl serine antibodies), thrombophilic, (protein C, protein S, antithrombin, activated protein C resistance or Factor V Leiden, and homocysteine or MTHFR), microbiologic (cervical cultures for chlamydia, mycoplasma and ureaplasma), and social factors (self-reporting of tobacco, ethanol, and illicit drug use). Patients were categorized by the type and number of pregnancy losses. Primary RPL was characterized as two (P2) or more (P3) consecutive losses with the same partner without carrying a fetus to viability, and secondary RPL was categorized as two (S2) or more (S3) consecutive losses following at least one viable pregnancy with the same partner.ResultsResults from 1018 patients were used in the analysis. Most women included in this study had primary RPL (66%) and had experienced three or more losses (60%). Approximately 75% of patients had one or more abnormalities. One abnormality was present in 38% of patients while 36% of women with RPL had two or more abnormal findings. Patients with three or more losses were no more likely to have abnormal findings than patients with only two losses. Patients with secondary RPL were no more likely to have abnormal findings than those with primary RPL.ConclusionEvaluation of women with 2 or more consecutive pregnancy losses is recommended, whether or not their losses are primary or secondary. An evaluation of all etiologies is advised because more than one-third of patients will have multiple abnormalities. If a full evaluation is performed, an etiology can be found in over 70% of the patients. When no cause is found, supportive care is recommended. ObjectiveRecurrent Pregnancy Loss (RPL) is a devastating problem that affects 2%-4% of reproductive age couples and represents a major concern for reproductive medicine specialists. Great advances have been made to identify the etiologic factors associated with RPL, yet questions remain. One such question is whether the expense and time of a full evaluation of a couple is warranted after two consecutive losses, or if a full evaluation should only be undertaken after three losses. A second question is whether full evaluations should be given to couples with secondary RPL because the couples already have demonstrated fertility. The goal of this study is to address these questions by categorizing the etiologies of RPL relative to primary and secondary losses, as well as to the number of pregnancy losses. Recurrent Pregnancy Loss (RPL) is a devastating problem that affects 2%-4% of reproductive age couples and represents a major concern for reproductive medicine specialists. Great advances have been made to identify the etiologic factors associated with RPL, yet questions remain. One such question is whether the expense and time of a full evaluation of a couple is warranted after two consecutive losses, or if a full evaluation should only be undertaken after three losses. A second question is whether full evaluations should be given to couples with secondary RPL because the couples already have demonstrated fertility. The goal of this study is to address these questions by categorizing the etiologies of RPL relative to primary and secondary losses, as well as to the number of pregnancy losses. DesignProspective, single-center evaluation of women who were referred for evaluation for RPL. Prospective, single-center evaluation of women who were referred for evaluation for RPL. Materials and methodsPatients who sought treatment for RPL were included in this study if they had experienced two or more consecutive losses with the same partner, and if information was available for at least four of the seven possible categories. These categories included genetic (karyotypes), anatomic (defects identified by hysterosalpingogram or hysteroscopy), endocrinologic (TSH, prolactin, midluteal progesterone, fasting insulin and glucose), immunologic (LAC, anticardiolipin and antiphosphatidyl serine antibodies), thrombophilic, (protein C, protein S, antithrombin, activated protein C resistance or Factor V Leiden, and homocysteine or MTHFR), microbiologic (cervical cultures for chlamydia, mycoplasma and ureaplasma), and social factors (self-reporting of tobacco, ethanol, and illicit drug use). Patients were categorized by the type and number of pregnancy losses. Primary RPL was characterized as two (P2) or more (P3) consecutive losses with the same partner without carrying a fetus to viability, and secondary RPL was categorized as two (S2) or more (S3) consecutive losses following at least one viable pregnancy with the same partner. Patients who sought treatment for RPL were included in this study if they had experienced two or more consecutive losses with the same partner, and if information was available for at least four of the seven possible categories. These categories included genetic (karyotypes), anatomic (defects identified by hysterosalpingogram or hysteroscopy), endocrinologic (TSH, prolactin, midluteal progesterone, fasting insulin and glucose), immunologic (LAC, anticardiolipin and antiphosphatidyl serine antibodies), thrombophilic, (protein C, protein S, antithrombin, activated protein C resistance or Factor V Leiden, and homocysteine or MTHFR), microbiologic (cervical cultures for chlamydia, mycoplasma and ureaplasma), and social factors (self-reporting of tobacco, ethanol, and illicit drug use). Patients were categorized by the type and number of pregnancy losses. Primary RPL was characterized as two (P2) or more (P3) consecutive losses with the same partner without carrying a fetus to viability, and secondary RPL was categorized as two (S2) or more (S3) consecutive losses following at least one viable pregnancy with the same partner. ResultsResults from 1018 patients were used in the analysis. Most women included in this study had primary RPL (66%) and had experienced three or more losses (60%). Approximately 75% of patients had one or more abnormalities. One abnormality was present in 38% of patients while 36% of women with RPL had two or more abnormal findings. Patients with three or more losses were no more likely to have abnormal findings than patients with only two losses. Patients with secondary RPL were no more likely to have abnormal findings than those with primary RPL. Results from 1018 patients were used in the analysis. Most women included in this study had primary RPL (66%) and had experienced three or more losses (60%). Approximately 75% of patients had one or more abnormalities. One abnormality was present in 38% of patients while 36% of women with RPL had two or more abnormal findings. Patients with three or more losses were no more likely to have abnormal findings than patients with only two losses. Patients with secondary RPL were no more likely to have abnormal findings than those with primary RPL. ConclusionEvaluation of women with 2 or more consecutive pregnancy losses is recommended, whether or not their losses are primary or secondary. An evaluation of all etiologies is advised because more than one-third of patients will have multiple abnormalities. If a full evaluation is performed, an etiology can be found in over 70% of the patients. When no cause is found, supportive care is recommended. Evaluation of women with 2 or more consecutive pregnancy losses is recommended, whether or not their losses are primary or secondary. An evaluation of all etiologies is advised because more than one-third of patients will have multiple abnormalities. If a full evaluation is performed, an etiology can be found in over 70% of the patients. When no cause is found, supportive care is recommended.