Time to next pregnancy in spontaneous pregnancies versus treatment cycles in patients with recurrent pregnancy loss

Abstract

ObjectiveTo report time to pregnancy (TTP) in patients with recurrent pregnancy loss (RPL) and the impact of fertility treatments in this population.DesignProspective cohort study of patients seen in a RPL clinic from 2009 to 2012.Materials and MethodsAfter an initial evaluation, RPL patients without a history of infertility were encouraged to attempt spontaneous conception for 6 months prior to initiating infertility treatment. Patients requesting fertility treatment for any indication were offered a range of treatment options (ovarian stimulation, intrauterine insemination and IVF). A small subset of the fertile RPL cohort requested to proceed immediately to pre-implantation genetic screening (PGS). A total of 172 patients completed the evaluation and were followed for at least 4 months in our center. Of the 172 patients, 144 had a pregnancy documented by an ultrasound in our office, corresponding to an 84% pregnancy rate (PR). Of the 144 pregnancies, 90 were conceived spontaneously and 54 occurred after infertility treatment. Within the treatment group, there were 10 fertile RPL patients that underwent PGS.ResultsTabled 1SpontaneousAll treatmentsPGSAge34.736.2*Statistically significant for p<0.05.37.6*Statistically significant for p<0.05.Gravida3.93.73.9Previous miscarriages2.82.52.6BMI23.723.622.7TTP for first 2 pregnancies2.84.6*Statistically significant for p<0.05.2.6Prior use of treatment4%24%*Statistically significant for p<0.05.20%TTP4.53.8*Statistically significant for p<0.05.4.0PR at 6 months74%81%100%* Statistically significant for p<0.05. Open table in a new tab ConclusionFor patients with RPL, the mean interval between initial evaluation and TTP is 4 months. Those patients wishing to avoid fertility treatments can be reassured that 74% of RPL patients conceived spontaneously within 6 months and there appeared to be no decrease in TTP with the elective use of PGS. ObjectiveTo report time to pregnancy (TTP) in patients with recurrent pregnancy loss (RPL) and the impact of fertility treatments in this population. To report time to pregnancy (TTP) in patients with recurrent pregnancy loss (RPL) and the impact of fertility treatments in this population. DesignProspective cohort study of patients seen in a RPL clinic from 2009 to 2012. Prospective cohort study of patients seen in a RPL clinic from 2009 to 2012. Materials and MethodsAfter an initial evaluation, RPL patients without a history of infertility were encouraged to attempt spontaneous conception for 6 months prior to initiating infertility treatment. Patients requesting fertility treatment for any indication were offered a range of treatment options (ovarian stimulation, intrauterine insemination and IVF). A small subset of the fertile RPL cohort requested to proceed immediately to pre-implantation genetic screening (PGS). A total of 172 patients completed the evaluation and were followed for at least 4 months in our center. Of the 172 patients, 144 had a pregnancy documented by an ultrasound in our office, corresponding to an 84% pregnancy rate (PR). Of the 144 pregnancies, 90 were conceived spontaneously and 54 occurred after infertility treatment. Within the treatment group, there were 10 fertile RPL patients that underwent PGS. After an initial evaluation, RPL patients without a history of infertility were encouraged to attempt spontaneous conception for 6 months prior to initiating infertility treatment. Patients requesting fertility treatment for any indication were offered a range of treatment options (ovarian stimulation, intrauterine insemination and IVF). A small subset of the fertile RPL cohort requested to proceed immediately to pre-implantation genetic screening (PGS). A total of 172 patients completed the evaluation and were followed for at least 4 months in our center. Of the 172 patients, 144 had a pregnancy documented by an ultrasound in our office, corresponding to an 84% pregnancy rate (PR). Of the 144 pregnancies, 90 were conceived spontaneously and 54 occurred after infertility treatment. Within the treatment group, there were 10 fertile RPL patients that underwent PGS. ResultsTabled 1SpontaneousAll treatmentsPGSAge34.736.2*Statistically significant for p<0.05.37.6*Statistically significant for p<0.05.Gravida3.93.73.9Previous miscarriages2.82.52.6BMI23.723.622.7TTP for first 2 pregnancies2.84.6*Statistically significant for p<0.05.2.6Prior use of treatment4%24%*Statistically significant for p<0.05.20%TTP4.53.8*Statistically significant for p<0.05.4.0PR at 6 months74%81%100%* Statistically significant for p<0.05. Open table in a new tab ConclusionFor patients with RPL, the mean interval between initial evaluation and TTP is 4 months. Those patients wishing to avoid fertility treatments can be reassured that 74% of RPL patients conceived spontaneously within 6 months and there appeared to be no decrease in TTP with the elective use of PGS. For patients with RPL, the mean interval between initial evaluation and TTP is 4 months. Those patients wishing to avoid fertility treatments can be reassured that 74% of RPL patients conceived spontaneously within 6 months and there appeared to be no decrease in TTP with the elective use of PGS.