Chance of live birth in women with recurrent pregnancy loss referred to a French assisted reproductive technology center

Abstract

Recurrent pregnancy loss (RPL) is a multifactorial condition, with over 50% of cases remaining unexplained. The absence of therapeutic consensus raises questions regarding referral for assisted reproductive technology (ART). To evaluate live birth rates and predictors of success among women with RPL referred to a tertiary ART center. We conducted a retrospective cohort study. Women aged 18–42 years with ≥ 3 pregnancy losses before 14 weeks’ gestation, referred to the ART center of Amiens-Picardie University Hospital (2014–2022) were included. The primary outcome was achieving a live birth during follow-up. Independent predictors were identified using stepwise logistic regression. Among the 85 women with RPL included (median age 29.6 [8.6] years), 49/85 (57.6%) had no underlying infertility issues, and 36/85 (42.3%) had associated infertility issues. Most women were nulliparous (50/85, 58.8%), and had a median of 3 [1] previous miscarriages. Overall, 64/85 (75.3%) achieved at least one live birth: 33/64 (52%) spontaneously and 31/64 (48%) via ART, with median times to conception of 13.6 [10.5] and 14.2 [10.6] months, respectively. ART use was more frequent among infertile women (≥1 IVF/ICSI cycle: 26/36, 72.2% vs. 17/49, 34.7%; p = 0.001), leading to a higher proportion of medically-assisted conceptions in this group (20/24, 83.3% vs. 11/40, 27.5%; p < 0.001). Diminished ovarian reserve and a higher number of previous miscarriages were independently associated with lower live birth rates (aOR 0.26 [0.08–0.89] and 0.76 [0.53–0.96], respectively). Approximately three-quarters of women with RPL achieved a live birth, most after spontaneous conception. ART should be reserved for couples with confirmed infertility or when another underlying cause clearly justifies intervention. The majority of women with a history of RPL will achieve a live birth, many after spontaneous conception. Comprehensive evaluation should include diagnostic testing, lifestyle optimization, psychological support and reassurance. ART should be reserved for couples with confirmed infertility issues.