Spontaneous pregnancies in patients with at least one failed IVF cycle after the management of autoimmune disorders, hereditary thrombophilia, and methylation disorders.

Atakan Tanacan,Mehmet Sinan Beksac

doi:10.5935/1518-0557.20190034

Abstract

Objective:This study aimed to describe the impact on achieving spontaneous pregnancy of treating patients with at least one failed in-vitro fertilization (IVF) cycle for autoimmune disorders, hereditary thrombophilia, and methylation disorders.Methods: Fifty-three patients who met the enrollment criteria seen between January 2007 and October 2017 were included in this retrospective cohort study. The patients were retrospectively assessed for the presence of hereditary thrombophilia, methylenetetrahydrofolate reductase (MTHFR) polymorphisms, serum vitamin B12/folate/homocysteine levels, and autoimmune antibody positivity. The required data were extracted from the institutional patient database. Statistical analyses were performed on Statistical Package for the Social Sciences (SPSS.22®). The Kolmogorov-Smirnov test was used to evaluate the distribution of the data, and since the data did not following a normal distribution, proportions and median (minimum-maximum) values were used.Results:The 53 patients included in the study had singleton pregnancies. The distribution of autoantibodies was as follows: thyroid peroxidase (n=17); antithyroglobulin (n=11); double-stranded DNA (n=4); antinuclear (n=8); anti-smooth muscle (n=1); and anticardiolipin IgG and IgM (n=1). Autoimmune diseases included Hashimoto's thyroiditis (n=23); SLE (n=7); Behcet's disease (n=1); Sjogren's syndrome (n=1); ulcerative colitis (n=1); and anti-phospholipid antibody syndrome (n=1). Ten patients had heterozygous Factor V Leiden thrombophilia; two had homozygous Factor 5 Leiden thrombophilia; and three had the prothrombin 20210A heterozygous mutation. Twenty-eight patients were positive for autoantibodies and hereditary thrombophilia and/or MTHFR polymorphisms.Conclusions:Evaluation and management of hereditary thrombophilia, MTHFR gene polymorphisms, and/or autoimmune conditions may be beneficial for patients with unexplained infertility.

Highlights

Infertility is defined as a couple's inability to achieve pregnancy after abstaining from contraceptive methods for 12 months
In the absence of an explainable cause after comprehensive examination, couples are diagnosed with unexplained infertility (UI)
This study aimed to describe the impact on achieving spontaneous pregnancy of treating patients with at least one failed in-vitro fertilization (IVF) cycle for autoimmune disorders, hereditary thrombophilia, and methylation disorders

Summary

Introduction

Infertility is defined as a couple's inability to achieve pregnancy after abstaining from contraceptive methods for 12 months. The prevalence of primary infertility - a term coined to categorize couples unable to achieve their first pregnancy - is approximately 1.9% (Mascarenhas et al, 2012). The time interval accepted for women aged 35 years or older is six months (Practice Committee of American Society for Reproductive Medicine, 2013). In the absence of an explainable cause after comprehensive examination, couples are diagnosed with unexplained infertility (UI). Comprehensive examination is expected to reveal the following: 1) regular ovulation, 2) tubal patency, 3) a normal uterine cavity, 4) normal semen analysis results, and 5) an adequate ovarian oocyte reserve (Practice Committee of American Society for Reproductive Medicine, 2013). Lifestyle changes, timed intercourse, and intrauterine insemination (IUI) with gonadotropin stimulation or in vitro fertilization (IVF) are different treatment options for UI (Nandi et al, 2017; Quaas & Dokras, 2008)

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