Embryo Transfer Failure Research Articles

Endometrial CD138 Count Appears to be a Negative Prognostic Indicator for Patients Who Have Experienced Previous Embryo Transfer Failure

(Abstracted from Fertil Steril 2019;112:1103–1111) Chronic endometriosis (CE) is a chronic infectious disease that is often misdiagnosed due to its vague symptomatic severity, lack of typical clinical or ultrasounds symptoms, and requirement for histopathologic diagnosis. Evidence has shown that CE may be associated with various subgroups of reproductive failure.

Efficacy of intrauterine perfusion of peripheral blood mononuclear cells (PBMC) for infertile women before embryo transfer: meta-analysis

This meta-analysis was intended to evaluate the effects of intrauterine perfusion of peripheral blood mononuclear cells (PBMC) on the pregnancy outcomes including clinical pregnancy rates, embryo implantation rates, live birth rates and miscarriage rates of infertile women who were undergoing in vitro fertilisation (IVF) treatment. By searching Pubmed, Embase database, five articles meeting the inclusion criteria were included, and 1173 women were enrolled (intrauterine PBMC group: n = 514; NO-PBMC group: n = 659). For the entire IVF/ICSI population and one or two embryo transfer failure patients, there was no significant difference in endometrial thickness, embryo implantation rates, live birth rates, and miscarriage rates between the PBMC group and NO-PBMC group. Although the clinical pregnancy rates of the PBMC group were higher than that of the NO-PBMC group, the confidence interval was close to the line of unity. As for the patients with three or more implantation failures, the clinical pregnancy rates, embryo implantation rates and live birth rates were much higher in the PBMC group than that of the NO-PBMC group. In summary, current evidence suggests that intrauterine perfusion of PBMC can significantly improve pregnancy outcomes in patients who have three or more implantation failures. Impact statement What is already known on this subject? An increasing number of studies have shown that immune cells play an important role in embryo transfer. There is no reliable evidence to confirm the clinical efficacy of intrauterine perfusion of PBMC. What do the results of this study add? The current evidence suggests that intrauterine perfusion of PBMC can significantly improve pregnancy outcomes in patients who have three or more implantation failures. What are the implications of these findings for clinical practice and/or further research? To the best of our knowledge, this meta-analysis is the first to evaluate the effect of intrauterine perfusion of PBMC on pregnancy outcomes before embryo transfer. Our study indicated that intrauterine perfusion of PBMC significantly increased clinical pregnancy rates, embryo implantation rates, and live birth rates in patients who failed more than three implants.

Endometrial CD138 count appears to be a negative prognostic indicator for patients who have experienced previous embryo transfer failure

To explore the predictive value of endometrial CD138 expression in the natural cycle preceding frozen embryo transfer in patients with normal endometrial dating and histopathologic features, who previously failed the transfer of two high-quality fresh embryos. Retrospective analysis. University-affiliated hospital. Women with normal endometrial dating and histopathologic features who previously failed the transfer of two high-quality fresh embryos, and who then underwent an endometrial scratching operation preceding a natural cycle. Paraffin-embedded endometrial samples cut into sections for immunohistochemistry staining of CD138 (syndecan-1) expression, then clinical information for these patients reviewed and analyzed. Clinical rates of pregnancy and implantation. A total of 141 women met the inclusion criteria. Of these patients, about 31.2% (44 of 141) were positive for CD138 expression, with CD138 counts ranging from 0 to 33. Receiver operating characteristic (ROC) curves were analyzed to determine whether the number of cells expressing CD138 (CD138+ cells) predicted a successful pregnancy. The areas under the ROC curves based on CD138+ cell density and CD138+ cell count were 0.660 and 0.658, respectively. The clinical pregnancy and embryo implantation rates in patients not expressing CD138 (80.04% and 64.9%, respectively) were statistically significantly higher than rates in CD138+ patients (52.7% and 46.8%, respectively). In addition, the higher the number of cells expressing CD138, the worse the outcome of the pregnancy. Finally, clinical data showed that free pelvic fluid on the day of endometrial sampling (identified using transvaginal ultrasound) might be a risk factor for CD138 expression. Endometrial CD138+ count might be a valuable marker predicting pregnancy outcomes after frozen embryo transfer in patients with normal endometrial dating and histopathologic features who previously failed the transfer of two high-quality fresh embryos.

Measuring Immune Tolerance to Predict Miscarriage or Failed Embryo Transfer

Measuring Immune Tolerance to Predict Miscarriage or Failed Embryo Transfer

Poor ovarian response is associated with serum vitamin D levels and pro-inflammatory immune responses in women undergoing in-vitro fertilization

Poor ovarian response (POR11POR, poor ovarian response) limits the success of infertility treatment modality. In this study, we aim to investigate if POR is associated with serum 25(OH) vitamin D (VD22VD, vitamin D) levels and pro-inflammatory immune responses in infertile women with a history of in-vitro fertilization and embryo transfer failures. A retrospective cross-sectional study included 157 women with IVF failures. Study patients were divided into four groups based on serum 25(OH)VD level and ovarian responses during the most recent IVF cycle; low VD (LVD33LVD, low vitamin D) with POR, LVD with normal ovarian response (NOR44NOR, normal ovarian response), normal VD (NVD55NVD, normal vitamin D) with POR, and NVD with NOR. Serum 25(OH)VD level, cellular- and auto-immunity, and metabolic parameters, including homocysteine and plasminogen activator inhibitor-1 were investigated. Peripheral blood CD56+ NK cell levels (%) and NK cytotoxicity were significantly higher in POR-LVD when compared to the other groups (P < 0.05, respectively). CD19 + B and CD19+/5+ B-1 cell levels were significantly higher in women with POR-LVD as compared with those of NOR-LVD and POR-NVD (P < 0.05, respectively). TNF-α/IL-10 producing Th1/Th2 cell ratio of POR-LVD was significantly higher than those of POR-NVD and NOR-NVD (P < 0.05 respectively). Peripheral blood homocysteine level of POR-LVD was significantly higher than those of NOR-LVD and POR-NVD (P < 0.05 respectively). We conclude that assessment of cellular and autoimmune abnormalities and metabolic factors, such as homocysteine should be considered in women with POR and LVD. VD and folic acid supplementation may be explored further as a possible therapeutic option for POR with immune and metabolic etiologies.

Management of recurrent implantation failure by gonadotropin-releasing hormone agonist and aromatase inhibitor suppression, in women without evidence of endometriosis

Endometriosis is common among those with infertility, although many cases go undiagnosed. This study was performed to determine whether empiric treatment with two months of depo-leuprolide 3.75 mg monthly (dep-GnRH-ag) and letrozole 5 mg daily improves pregnancy outcomes in patients with at least two unexplained failed embryo transfers (ETs) but without a previous diagnosis of endometriosis. A retrospective cohort study was performed with subjects who failed at least two good quality ET. The study excluded women with a known history of endometriosis or ovarian cysts (possible endometriomas). Subjects (N = 38) were treated with dep-GnRH-ag and letrozole pre-cycle. Matched women (N = 37) who did not receive either pretreatment served as a control group. Data were compared by non-paired T-tests and multivariate logistic regression to control for confounding effects. Demographic data, hormonal profiles, and ovarian reserve parameters were similar between the two groups. The treated group had failed more embryo transfers (3.5 ± 1.7 vs. 2.0 ± 1.3, p = .01) than the controls. When adjusting for the number of MII oocytes collected, number of blastocysts developed and number of blastocysts transferred, there were more pregnancies (24/38 vs. 11/37, p = .02) and ongoing pregnancies (18/38 vs. 9/37, p = .03) in the treated group. Patients with multiple unexplained failed ET may have undiagnosed endometriosis and may benefit from pretreatment with dep-GnRH-ag and letrozole. These results would benefit from being subjected to a randomized prospective study.

Preimplantation genetic testing for aneuploidy is cost-effective, shortens treatment time, and reduces the risk of failed embryo transfer and clinical miscarriage

To determine if preimplantation genetic testing for aneuploidy (PGT-A) is cost-effective for patients undergoing invitro fertilization (IVF). Decision analytic model comparing costs and clinical outcomes of two strategies: IVF with and without PGT-A. Genetics laboratory. Women ≤ 42years of age undergoing IVF. Decision analytic model applied to the above patient population utilizing a combination of actual clinical data and assumptions from the literature regarding the outcomes of IVF with and without PGT-A. The primary outcome was cumulative IVF-related costs to achieve a live birth or exhaust the embryo cohort from a single oocyte retrieval. The secondary outcomes were time from retrieval to the embryo transfer resulting in live birth or completion of treatment, cumulative live birth rate, failed embryo transfers, and clinical losses. 8,998 patients from 74 IVF centers were included. For patients with greater than one embryo, the cost differential favored the use of PGT-A, ranging from $931-2411 and depending upon number of embryos screened. As expected, the cumulative live birth rate was equivalent for both groups once all embryos were exhausted. However, PGT-A reduced time in treatment by up to four months. In addition, patients undergoing PGT-A experienced fewer failed embryo transfers and clinical miscarriages. For patients with > 1 embryo, IVF with PGT-A reduces healthcare costs, shortens treatment time, and reduces the risk of failed embryo transfer and clinical miscarriage when compared to IVF alone.

In vitro fertilization: Louise Brown, four decades after her birth

Forty years ago, Patrick Steptoe, Robert Edwards, and Jean Purdy achieved the first human birth through in vitro fertilization (IVF). IVF is one of the transformative technologies of the 20th century, designed to help human conception, and involves four aspects: 1. Acquisition of a sufficient number of mitotic and cytoplasmically mature oocyte. 2. In vitro fertlization of these mature oocytes; 3. Embryo culture before implantation; 4. Embryo transfer within the maternal womb. The story of the collaboration of Steptoe and Edwards was full of disappointment and failure, reaching a successful conclusion with the birth of a girl named Louise Brown, after 102 failed embryo transfers. Due to this success, Robert Edwards, in 2010, received the Nobel Prize in Physiology or Medicine for the development of IVF plus embryo transfer (IVF / ET). His work resulted in the birth of the first «test tuve baby» in July 1978. Now, more than four million babies have born using IVF / ET, and a medical speciallity called Biology of Reproduction has been created, which is responsible of the assisted fertilization.

Endometrial scratch injury for women with one or more previous failed embryo transfers: a systematic review and meta-analysis of randomized controlled trials

To investigate endometrial scratch injury (ESI) as an intervention to improve IVF outcome in women with a history of ET failure. Systematic review and meta-analysis. Not applicable. Infertile women undergoing IVF after one or more failed ET. We included all randomized controlled trials of women undergoing IVF after one or more failed ET, where the intervention group received ESI and controls received placebo or no intervention. Pooled results were expressed as relative risk (RR) with a 95% confidence interval (95% CI). The review protocol was registered in PROSPERO before starting the data extraction (CRD42017082777). Live birth rate (LBR), clinical pregnancy rate (PR), multiple PR, miscarriage rate, ectopic pregnancy (EP) PR. Ten studies were included (1,468 participants). The intervention group showed higher LBR (RR 1.38, 95% CI 1.05-1.80) and clinical PR (RR 1.34, 95% CI 1.07-1.67) in comparison to controls, without difference in terms of multiple PR, miscarriage rate, and EP PR. Double luteal ESI with pipelle was associated with the greatest effect on LBR (RR 1.54, 95% CI 1.10-2.16) and clinical PR (RR 1.30, 95% CI 1.03-1.65). The ESI was beneficial for patients with two or more previous ET failure, but not for women with a single previous failed ET. No effect was found in women undergoing frozen-thawed ET cycles. The ESI may improve IVF success in patients with two or more previous ET failures undergoing fresh ET. The ESI timing and technique seem to play a crucial role in determining its effect on embryo implantation.

A comparison of pre-treatment with and without GnRH-agonist or letrozole in women with 2 failed embryo transfers undergoing a frozen cycle and no evidence of endometriosis

A comparison of pre-treatment with and without GnRH-agonist or letrozole in women with 2 failed embryo transfers undergoing a frozen cycle and no evidence of endometriosis

Patentability of time-lapse monitoring has nothing to do with human dignity: A response to Alain Pottage.

In December 2017, Alain Pottage published an article denying the patentability of a technique called Time-Lapse Monitoring (TLM). His argument was that this procedure, like all other embryo selection procedures, fails to respect human dignity. Here, we argue that this statement is mistaken because assisted reproductive technologies (ART) require a scarce resource, namely a woman's uterus in the right physiological condition. Therefore, embryo selection using TLM is entirely appropriate, as it is not possible to guarantee that all of them will have access to the environment they need to develop. Hence, the use of techniques designed to maximize the number of live births and minimize the suffering of women who undergo failed embryo transfers is a moral obligation.

P94: The comparison of Chinese medicine of tonifying kidney and activating blood and cyclosporine on treatment of the failure of recurrent embryo transfer

American Journal of Reproductive ImmunologyVolume 80, Issue S1 p. 97-97 ABSTRACTS P94: The comparison of Chinese medicine of tonifying kidney and activating blood and cyclosporine on treatment of the failure of recurrent embryo transfer First published: 26 June 2018 https://doi.org/10.1111/aji.93_12984Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume80, IssueS1Special Issue: American-Sino Joint Meeting of Reproductive Immunology (ASRI-CSI 2018), June 28-1 July, 2018 Shanghai, ChinaJune 2018Pages 97-97 RelatedInformation

Curative effect of assisted reproduction technology by Traditional Chinese Medicine multi-channel interventional therapy on 95 cases of in vitro fertilization and embryo transfer failure

ObjectiveTo evaluate the curative effect of Traditional Chinese Medicine (TCM) multi-channel interventional therapy on women with Assisted Reproductive Technology (ART) failure, to compare the curative effect of the dual therapy and triple therapy on women with ART Failure, and to choose the best TCM interventional therapeutic plan. MethodsThe 95 cases with ART Failure from West China second University Hospital of Sichuan University meeting the inclusion criteria were randomly divided into three groups:dual therapy group (31 cases), triple therapy group (33 cases) and control group (31 cases). According to the intervene treatment of in vitro Fertilization and Embryo Transfer (IVF-ET) long cycle scheme, the control group wait naturally for 3 months before IVF-ET. The dual therapy group take TCM prescription E of cultivating emotion and assisting reproduction and auricular acupoint therapy for 3 months before IVF-ET, then Western Medicine treatment progestin supporting as well as auricular application and Antai Recipe after IVF-ET transplantation. The triple therapy group take TCM prescription E of cultivated emotion and assisted reproduction, auricular acupoint therapy and retention enema of TCM, and combination treatment the same as dual therapy group after transplantation. The natural pregnancy number, the period condition of secondary IVF-ET and the improvement of the kidney deficiency, liver depression and blood stasis syndrome among those three groups were compared. ResultsIt was showed from analysis in 95 cases with ART failure that the number of natural pregnancy was as followings: 3 patients from the dual therapy group, 10 patients from the triple therapy group, and no patient from the control group. The comparison among three groups have statistical significance (P < 0.05). The treatment group is superior to the control group, while the triple therapy is superior to the dual therapy. The comparison of the condition of the fertility rate, clinical pregnancy rate, biochemical pregnancy rate and early abortion rate during the period of secondary IVF-ET between pre-therapy and post-treatment of both the dual therapy group and the triple therapy group have statistical significance (P < 0.05). The comparison of the improvement of the kidney deficiency, liver depression and blood stasis syndrome between pre-therapy and post-treatment of both the dual therapy group and the triple therapy group have statistical significance (P < 0.05). The comparison between three groups after treatment have statistical significance (P < 0.05). ConclusionTCM multi-channel interventional therapy can increase the natural pregnancy rate of patients with ART Failure (the triple therapy is superior to the dual therapy); it can increase the fertility rate, clinical pregnancy rate, and decrease the early abortion rate during the period of secondary IVF-ET; it can improve syndromes of kidney deficiency, liver depression and blood stasis.

The role of pathology in endometrial scratch specimens and the relationship to the outcome of subsequent embryo transfer

The role of endometrial scratch (injury) in women with previous failed embryo transfers is controversial. The most recent (2015) Cochrane meta-analysis does favor scratch therapy as being helpful. The mechanism of this benefit is unknown. This study was performed to evaluate the role of endometrial pathology in the scratch specimen on subsequent outcomes. Few studies have evaluated the pathology of endometrial scratch specimens

The effect of warm needling pretreatment for endometrial receptivity of frozen embryo transfer

To explore the effect of warming needling pretreatment for endometrial receptivity before frozen-thawed embryo transfer (FET). Fifty-six repeatedly embryo transfer (ET) failure patients with ultrasound showing follicular phase endometrium of C type, hysteroscopy examination presenting endometritis were randomly assigned into an observation group (25 cases) and a control group (31 cases). The patients in the observation group three months before ET were treated with antibiotics in the menstrual period, warming needle (once a day) at Zhongwan (CV 12), Tianshu (ST 25), Guanyuan (CV 4), Zhongji (CV 3), Zigong (EX-CA 1), Liangqiu (ST 34), Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39) after menstruation until the ovulation stopped, and oral administration of progesterone was applied after ovulation. The patients in the control group three months before ET were treated with antibiotics in the menstrual period, and oral administration of progesterone was applied after ovulation. Continuous three menstrual periods were carried out for the both groups. The changes of endometrial thickness, type and endometrial blood flow and the outcome of FET were observed. Endometrial morphology and blood flow were improved after treatment in the two groups (all P<0.01), with better results in the observation group (both P<0.01). The embryo transplantation rate and pregnancy rate in the observation group were higher than those in the control group (both P<0.01), and the early abortion rate decreased (P<0.01). Warm needling may improve endometrial receptivity, embryo transplantation rate and pregnancy rate and decrease early abortion rate by regulating endometrial morphology and blood flow.

Correlated study on psychological elasticity and coping mode of patients with embryo transplantation failure

Objective To Investigate the correlation between psychological elasticity and coping mode in patients with embryo transplantation failure in hospital, and provide scientific theoretical basis for targeted intervention measures. Methods Totally 225 patients with embryo transplantation failure were selected by random sampling as the research object, and cross-sectional study was used to collect their basic demographic information. Connor-Davidson resilience scale(CD-RISC) and medical coping modes questionnaire (MCMQ) were used to evaluate their psychological elasticity and medical coping mode. Results The average score of psychological elasticity of patients with embro transplantation failure was (66.79±14.27) points and the score of coping mode was (44.77±5.61) points. Psychological elasticity was compared among races, causes of infertility, education backgrounds, times of embryo transplantation failure, types of infertility, and the causes of hospitalization, the differences were statistically significant (P<0.05). The total score of psychological elasticity in an patient with embryo transplantation failure was significantly correlated to the total score of coping mode (r=0.377, P<0.01). All the dimentions were significantly related (P<0.01) except optimism and avoidance. Conclusions The psychological elasticity and coping are correlated in patients with embryo transfer failure. In order to increase the patients′ psychological elasticity and help them establish the effective coping, medical personnel should know the patients′ psychological elasticity level clearly and intervene with targets measures. Key words: Resilience, psychological; Infertility; Embryo transplantation; Coping mode

Promoting the use of elective single embryo transfer in clinical practice.

BackgroundThe transfer of multiple embryos after in vitro fertilization (IVF) increases the risk of twins and higher-order births. Multiple births are associated with significant health risks and maternal and neonatal complications, as well as physical, emotional, and financial stresses that can strain families and increase the incidence of depression and anxiety disorders in parents. Elective single embryo transfer (eSET) is among the most effective methods to reduce the risk of multiple births with IVF.Main bodyCurrent societal guidelines recommend eSET for patients <35 years of age with a good prognosis, yet even this approach is not widely applied. Many patients and clinicians have been reluctant to adopt eSET due to studies reporting higher live birth rates with the transfer of two or more embryos rather than eSET. Additional barriers to eSET include risk of treatment dropout after embryo transfer failure, patient preference for twins, a lack of knowledge about the risks and complications associated with multiple births, and the high costs of multiple IVF cycles. This review provides a comprehensive summary of strategies to increase the rate of eSET, including personalized counseling, access to educational information regarding the risks of multiple pregnancies and births, financial incentives, and tools to help predict the chances of IVF success. The use of comprehensive chromosomal screening to improve embryo selection has been shown to improve eSET outcomes and may increase acceptance of eSET.ConclusionseSET is an effective method for reducing multiple pregnancies resulting from IVF. Although several factors may impede the adoption of eSET, there are a number of strategies and tools that may encourage the more widespread adoption of eSET in clinical practice.

Efficacy of hyaluronan-rich transfer medium on implantation and pregnancy rates in fresh and frozen-thawed blastocyst transfers in Korean women with previous implantation failure.

ObjectiveTo evaluate the effect of hyaluronan-rich transfer medium on pregnancy and implantation rates in fresh and frozen-thawed embryo transfers in Korean women with previous implantation failure.MethodsThis retrospective study included 283 blastocyst transfers in patients with previous embryo transfer failure at a private fertility clinic. In the study group (n=88), blastocyst transfers were performed using an hyaluronan-rich transfer medium prior to transfer, whereas blastocyst transfers without any treatment served as controls (n=195). According to the type of transfer (fresh elective or frozen-thawed), all the blastocyst transfers were divided into two study and two control groups.ResultsThe patient's mean age, serum anti-Müllerian hormone level, causes of infertility, embryo quality, and the number of transferred embryos were comparable between the study and control groups. There were no significant differences in clinical pregnancy rate (45.5% vs. 43.1%), implantation rate (28.9% vs. 28.8%), and clinical abortion rate (10.0% vs. 8.3%) between the two groups, and these findings were not changed after subgroup analysis according to the type of transfer.ConclusionThe use of hyaluronan-rich transfer medium in the blastocyst transfer does not appear to have any significant effect on the implantation and pregnancy rates in patients with previous implantation failure.

Effect of adding human chorionic gonadotropin to frozen thawed embryo transfer cycles with history of thin endometrium

Embryo implantation process is a complex phenomenon and depends on fetal and maternal factors interaction. Endometrial thickness is needed for successful implantation. We designed this study in order to assess adding human chorionic gonadotropin (HCG) to the conventional protocol in endometrial preparation in women with thin endometrium and a history of in vitro fertilization-embryo transfer (IVF-ET) failure. The non-randomized clinical trial study (quasi experimental design) was performed on 28 patients. Participants were women who were candidate for frozen-thawed (ET) and had two previous failed ET cycles because of thin endometrial. HCG was administrated (150 IU, intramuscular) from the 8th day of cycle and when endometrial thickness reached at least 7mm HCG was discontinued and frozen thawed ET was done. Totally 28 patients were included. The mean ± SD age of participants was 30.39±4.7. The mean of endometrium thickness before and after HCG were 5.07±0.43 and 7.85±0.52, respectively p<0.001. Also, there were five clinically and chemically pregnant women. The findings of the study suggested that adding HCG to the conventional preparation method was an effective protocol and significantly improved endometrial thickness and pregnancy outcomes in women with previous embryo transfer failure because of thin endometrium.

Incorporation of comprehensive chromosome screening (CCS) in IVF care is associated with faster resumption of care after failed embryo transfer

Time away from fertility treatment after a pregnancy loss can have a negative impact on overall success rates. Treatment paradigms which minimize loss rates and decrease time to resumed treatment are thus optimal. This data seeks to determine if utilization of CCS impacts time to resumption of treatment after an embryo transfer fails to result in a delivery. Retrospective cohort study at a single, academic center. All first fresh or frozen embryo transfer cycles from 2010 to 2014 were evaluated. All cycles which had an embryo transfer which did not result in a delivery were included for analysis. Time away from treatment was designated by calculating the number of days between the embryo transfer and the date of next treatment cycle start. Patients were compared overall and then analyzed depending upon whether CCS was part of their treatment strategy. Student t-test and chi square were utilized where appropriate. During the study timeframe there were 1763 individual patients who met inclusion criteria. The average number of days away from treatment was 88.2 (9-700). There were 1504 patients who did not have CCS and 259 who did have CCS. Patient in the non-CCS group required a D&C in 10.8% of cases while those in the CCS group required a D&C in 7.0% of cases (p=0.106). The average time away from treatment for the group without CCS was 90.2±1.95 days and with CCS was 76.3±4.69 days (p<0.006). Time away from fertility treatment when an embryo transfer does not result in a delivery can significantly impact overall success rates. Data about time away from treatment after pregnancy loss can be helpful in patient counseling and setting expectations. The overall average time to next treatment nearly 3 months. When CCS is incorporated into the treatment paradigm, the time away from treatment after a loss is decreased. It is possible that a priori knowledge of ploidy status allows for patients and their care team to process the implications of pregnancy loss more quickly and allows swifter return to care.