Primary versus secondary recurrent pregnancy losses: Clinical findings and live birth rate after comprehensive work‐up and personalized management
Chiara Tersigni, Marianna Onori, Giuliana Beneduce, Fabio Sannino, Rita Franco, Andrea Busnelli, Chiara Granieri, Domenico Milardi, Alfredo Pontecorvi, Antonio Lanzone, Giovanni Scambia, Nicoletta Di SimoneAbstract
Introduction
Recurrent pregnancy loss (RPL), defined as two or more consecutive pregnancy losses before 24 weeks of gestation, affects up to 1%–2% of couples. Aim of this retrospective cohort study was to report the main causes and pregnancy outcomes of a cohort of women with RPL and the efficacy of a personalized work‐up and treatment in terms of live birth rate.
Material and Methods
Women with primary (pRPL) and secondary (sRPL) RPL underwent a complete work‐up and personalized therapeutic management. Data related to clinical findings and subsequent pregnancy outcomes were collected. A retrospective comparison between clinical findings and pregnancy outcomes of pRPL versus sRPL was performed by Mann–Whitney U or Chi‐square test.
Results
Main findings after diagnostic work‐up in pRPL (n = 157) versus sRPL (n = 138) couples were hormonal and metabolic factors (75% vs. 90%, p < 0.01), autoimmunity (52% vs. 59%, p = 0.2), acquired uterine/endometrial factors (43% vs. 34%, p = 0.2), vaginal and/or cervical infections (19% vs. 49%; p < 0.0001), congenital Mullerian anomalies (15% vs. 9%; p = 0.1), inherited thrombophilias (13% vs. 21%; p = 0.1), female karyotype abnormalities (2% vs. 2%; p = 0.9), sperm infections (27% vs. 22%; p = 0.1), abnormal semen analysis (17% vs. 14%; p = 0.1), male karyotype abnormalities (2% vs. 0%; p = 0.1). Higher pregnancy and fetal loss rate was observed in pRPL compared with sRPL (85% vs. 56%, p < 0.0001and 9% vs. 0%, p < 0.01, respectively). Higher live birth rate was found in pRLP versus sRPL women (76% vs. 56%, p < 0.001). Increased live birth rate was observed among pRPL women aged <40 years (OR 2.76; CI 1.36–5.64, p < 0.01) and/or with an AMH >1 ng/mL (OR 3.96; CI 1.34–12.52, p < 0.05). Among sRPL women, the age < 40 years was significantly associated to higher live birth rate (OR 3.23; 1.55–6.94, p < 0.01).
Conclusions
RPL is a heterogeneous multifactorial syndrome. A customized management can lead to a good pregnancy outcome in more than a half of cases. Age <40 and AMH >1 ng/mL are the major positive predictors of live birth rate in RPL women.