Comparison of the etiological results and live birth rates
between 55 carriers and 229 non-carriers
Because it is difficult to achieve the complete the pregnancy results
from thousands of patients from 2008 to 2018, 428 RM couples with normal
chromosomes who came to our outpatient department in the whole year of
2018 were selected and followed up for 2 years. They completed all
etiological screenings and 229 of them were pregnant in the follow-up
period as in the figure 1. Comparison of 55 carriers and 229
non-carriers showed that female carriers were younger at the time of
consultation, while other clinical characteristics and combined
pathological factors were not statistically different in Table 1. The
outcome after the pregnancy, namely the live birth rate (LBR), was also
not statistical different (p=0.87). Among the 55 carriers, 51 carriers
with primary recurrent miscarriage (no previous live birth history), and
4 were secondary recurrent miscarriages. 6 females were diagnosed with
polycystic ovary syndrome (PCOS, according to the Rotterdam
criteria[13]), and 3 females were diagnosed with decreased ovarian
reserve (DOR, according to the hormonal markers and ultrasound
parameters[14]). To further analyze of other etiological screening
results in the 55 carriers, 8 cases (14.6%) were positive for infection
factors (including male or female genital tract Mycoplasma and Chlamydia
infection), 2 cases (3.64%) were with abnormal uterine anatomical
structure, 14 cases (25.5%) were with imbalance of peripheral blood
lymphocyte subsets, 9 cases (16.4%) were with endocrine disorders
(including ovarian hormone abnormalities, thyroid hormone abnormalities
and hyperprolactinemia), 7 cases (12.7%) were with nutritional element
deficiency (including folic acid and vitamin B12). Among the combined
autoimmune antibodies, 13 cases (23.64%) were positive for
anti-phospholipid antibodies, and 9 cases (16.4%) were positive for
connective tissue antibodies. During the follow-up period 40 in 55
pregnant RM carriers gave birth to healthy babies in the way of natural
conception or intrauterine insemination without IVF/PGD, the live birth
rate (LBR) in the carriers (72.7%) was similar to that in the
non-carriers (71.2%). It could be seen that, apart from age, the
above-mentioned combined pathological factors and the final LBR was not
statistically different between carriers and non-carriers in the Table
1. The results were still consistent after using binary logistic
analysis to adjust the age factor.
Table 2 showed the details of every patient number, the age of the
female, the karyotypes of the female and the male, the number of
miscarriages and the outcome of pregnancy of 55 carriers. 40 of 55
carriers gave birth to healthy newborns at the end with the LBR of
72.73%. Among the 40 cases, 7 cases were numerical abnormalities (LBR
of 87.5%) and 33 cases were structural abnormalities (LBR of 70.21%).
The structural abnormalities included 14 cases with balanced ectopic
(LBR of 60.87%), 17 cases with inverted position (LBR of 80.95%), and
2 cases with Robertsonian translocations (LBR of 66.67%). As shown in
Figure 4, there was no statistical difference in the LBR in the four
types of chromosomal abnormalities (p=0.35).
Among the 55 pregnant couples, 34 were female and 21 were male carriers.
In the Table 3 we analyzed the women’s age, number of miscarriages,
distribution of karyotype abnormalities and the total LBR in female and
male carriers respectively. There was no statistical difference in all
items and showed gender of carrier had no effect on the pregnancy
outcome (p=0.428).
In order to rule out the influence of other etiological factors on the
pregnancy outcomes, we analyzed the female age, the number of abortions,
infection factors, anatomical uterine abnormalities, autoimmune
antibodies positive rate, blocking antibody deficiency, peripheral blood
lymphocyte subset disorders, endocrine disorders and nutritional
elements deficiency between 40 carriers with live birth and 15 carriers
with miscarriage again in the Table 4. All the differences in above
items between the two groups were not statistically significant and no
one showed huge influence to alter pregnant outcomes.