title: Etiology of recurrent pregnancy loss in women over the age of 35 years.
abstract: 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.
authors: Washington University School of Medicine, St. Louis, Missouri.
authors: Kerri
authors: K
authors: Marquard
authors: Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Palo Alto, California.
authors: Lynn M
authors: LM
authors: Westphal
authors: Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Palo Alto, California.
authors: Amin A
authors: AA
authors: Milki
authors: Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Palo Alto, California. Electronic address: rlathi@stanford.edu.
authors: Ruth B
authors: RB
authors: Lathi
mesh_terms: 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