Therapeutics · Anti-Infective and Anti-Inflammatory Agents
RRM Academy Synopsis
43 of 54 transfers after loss or failure reached clinical pregnancy
In a look back at 54 embryo transfers after repeated loss or failure, about 8 out of 10 cycles reached clinical pregnancy on one medication protocol. The authors call this encouraging and want randomized trials.
Key Findings
- The 54 cycles had a mean patient age of 35.74 years (range: 24 - 44).
- Clinical pregnancy occurred in 79.62% of cycles (n=43/54).
- Of the 43 clinical pregnancies, 31 (72.09%) lasted at least 8 weeks.
- Of those 31, 23 (74.19%) went on to their estimated date of delivery. Live birth followed in 21 of the 23 (91.30%).
- Clinical pregnancy loss occurred in 14.81% of cycles (n=8/54), and biochemical pregnancy loss in 7.41% (n=4/54).
Interpretation
The source is a conference abstract, so full methods and tables are unavailable. The design is a retrospective cohort: the authors reviewed past records of one treated group, with no comparison group. Every cycle used the patient's own eggs and a single euploid embryo (one with a typical chromosome count). A study like this describes outcomes and cannot show that the protocol caused them. The authors state the study was limited by sample size and design and call for randomized controlled trials. The percentages count cycles.
RRM Context
The abstract says doctors do not fully understand why pregnancy loss and failed transfers repeat. Restorative reproductive medicine begins by asking why, and looks at both partners. The abstract reports outcomes of a medication protocol. It describes no workup for the cause.
Abstract
Objective
While preimplantation genetic testing (PGT) is increasingly being utilized to identify euploid embryos and to improve the likelihood of successful outcomes, many patients still experience recurrent pregnancy loss (RPL) and/or repeated implantation failure (RIF). Patients who experience RPL and/or RIF must cope with physical and emotional distress. Reproductive immunologists often utilize combination medication therapies to treat patients with RPL and RIF, however, these protocols often are not well supported by evidence-based research. This study evaluated the clinical outcomes for RIF and RPL patients who were treated with a specific combination protocol.
Design
Retrospective, cohort study.
Materials and Methods
The study included patients who underwent single, euploid frozen embryo transfers (FET) with the combination medication therapy from 2014 - 2018. The combination medication protocol includes: Vitamin D, Prednisone, Aspirin and a Vitamin-B12/Vitamin B6/ Folate (CBF) complex. Patients with a history of R 2 failed euploid, single embryo transfers (SET), R 3 clinical spontaneous abortions (SAB), or a combination of 2 SABs and 1 failed SET were included in the analysis. Only patients who utilized autologous oocytes were included.
Results
A total of 54 IVF-FET cycles meeting criteria were included. Patient average age was 35.74 years old (range: 24 - 44). Upon review of the cycle outcomes, a total of 79.62% (n=43/54) achieved positive clinical pregnancy rates. Of those who attained a positive clinical pregnancy, 72.09% (n=31/43) reached at least 8 weeks gestation. Of those who passed the 8week gestation period, 74.19% (23/31) reached their estimated date of delivery and 91.30% of those (n=21/23) achieved live birth. A total of 14.81% (n=8/54) cycles resulted in clinical pregnancy loss and 7.41% (n=4/54) resulted in biochemical pregnancy loss. Finally, 20.38% (n=11/54) cycles resulted in negative pregnancy tests.
Conclusions
While the etiology of RPL and RIF are not well understood, our study sought to identify an affordable and minimally invasive alternative treatment regimen. Due to the high levels of anxiety and distress associated with failed euploid embryo transfer cycles and spontaneous abortions, we sought to develop a new viable treatment strategy. Although the study was limited by sample size and design, the results were encouraging and future randomized control trials should be done to provide further support for this combination-medication treatment protocol.
