Etiology of recurrent pregnancy loss in women over the age of 35 years.
OBJECTIVE
To determine the rate of embryonic chromosomal abnormalities, thrombophilias, and uterine anomalies in women over the age of 35 years with recurrent pregnancy loss (RPL).


METHODS
Retrospective cohort study.


METHODS
Academic reproductive endocrinology and infertility clinic.


METHODS
Women>or=35 years old with >or=3 first trimester miscarriages.


METHODS
None.


METHODS
Age, number of prior losses, cytogenetic testing of the products of conception (POC), uterine cavity evaluation, parental karyotype, TSH, and antiphospholipd antibody (APA) and thrombophilia testing. Aneuploidy in the POC in women with RPL was compared with sporadic miscarriages (<or=2 losses) in women>or=35 years.


RESULTS
Among 43 RPL patients, there were 50 miscarriages in which cytogenetic analysis was performed. In the RPL group, the incidence of chromosomal abnormalities in the POC was 78% (39 out of 50) compared with a 70% incidence (98 out of 140) in the sporadic losses. Thrombophilia results in the RPL patients were normal in 38 patients, four patients had APA syndrome, and one had protein C deficiency. Forty out of 43 had normal uterine cavities. Both TSH and parental karyotypes were normal in all of the patients tested. When the evaluation of RPL included karyotype of the POC, only 18% remained without explanation. However, without fetal cytogenetics, 80% of miscarriages would have been unexplained.


CONCLUSIONS
In older patients with RPL, fetal chromosomal abnormalities are responsible for the majority of miscarriages. Other causes were present in only 20% of cases.
Marquard
Kerri
K
Washington University School of Medicine, St. Louis, Missouri.
Westphal
Lynn M
LM
Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Palo Alto, California.
Milki
Amin A
AA
Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Palo Alto, California.
Lathi
Ruth B
RB
Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Palo Alto, California. Electronic address: rlathi@stanford.edu.
D000026:Abortion, Habitual / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000782:Aneuploidy; D002869:Chromosome Aberrations / Q000706:statistics & numerical data; D015331:Cohort Studies; D020964:Embryo Loss / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008423:Maternal Age; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D014599:Uterus / Q000002:abnormalities