Results
Thirteen women with recurrent CHI participated in the study. These women had carried 54 pregnancies themselves (51 singleton, 3 dichorionic-diamniotic). These pregnancies resulted in high rates of adverse perinatal outcomes (Table). Of the 9 babies born alive, 2 died in the neonatal period (2/9, 22%), meaning only 7/54 pregnancies (13%) resulted in surviving children. In 8/54 (15%) pregnancies, the mother received antenatal immunosuppression including one or more of prednisolone, hydroxychloroquine, tacrolimus and intravenous immunoglobulin.
Following attempts to carry a pregnancy themselves, all 13 women underwent IVF using their own oocytes and their partner’s sperm followed by embryo transfer into a surrogate mother. This led to 17 successful surrogate conceptions (12 singleton, 5 dichorionic-diamniotic), of which 15/17 (88%) ended in term or near-term live birth. The two remaining pregnancies ended in first-trimester miscarriage, one due to confirmed fetal trisomy 21 and the other with no identified cause. There were two failed embryo transfers. None of the surrogate mothers received immunosuppression.
There was no recurrent CHI detected in any of the completed surrogate pregnancies, although most placentas (13/17) were not tested due to a good pregnancy outcome.
One of the patients included in this cohort had a late miscarriage and two early miscarriages due to CHI before undergoing IVF and gestational surrogacy. This led to two successful surrogate pregnancies. The first of these was described in the cited article by Reus et al.,5 but the second has not been reported until now, hence her inclusion in this cohort.
The parents of the fetus with trisomy 21 subsequently underwent further IVF using donor oocytes and had healthy dichorionic-diamniotic twins delivered at 36 weeks’ gestation by a surrogate mother.
The INTERGROWTH-21st birthweight centile calculator is available from: http://intergrowth21.ndog.ox.ac.uk/en/ManualEntry