Background: The aetiology of recurrent pregnancy loss (RPL) is varied and ranges from genetic abnormalities, autoimmune, uterine structural abnormalities, thrombophilic disorders, endocrinologic dysfunction, infective to idiopathic factors. Reproductive immunology may provide an area of opportunity in treatment of idiopathic cases. Research has indicated that any amount of HLA compatibility among spouses leads to immunological perturbations leading to higher RPL rates. These disturbances in alloimmune parameters are found to be significantly reduced after a successful immunotherapy with paternal lymphocytes immunotherapy (LIT) among couples who share HLA. Aim: To analyze the role of alloimmune factors in couples who are considered unexplained RPL by testing HLA sharing between the partners and to determine the effect of lymphocyte immunotherapy (LIT) on live birth rate in couples with HLA sharing. Methods: This retrospective observational study was conducted in a single tertiary center in Bangalore for a duration of three years. Couples who satisfied the inclusion and exclusion criteria were selected and HLA sharing between the partners was tested. Couples with HLA sharing received LIT before and during pregnancy. The pregnancy and live birth rates were calculated and compared with couples with HLA sharing who did not receive LIT. Results: Out of the 199 couples who were screened for HLA sharing among partners, 146 couples had different degrees of HLA sharing. 81 couples received LIT and 32 did not opt for LIT and were taken as control group. The pregnancy and live birth rates were significantly higher in the LIT group compared to control group (77.7% vs 40.6%, p-0.0001, OR 5.1, 95% CI 2.10-11.4 and 56.7% vs 21.8%, p-0.0002, OR 4.6, 95% CI 2.13-13.8 respectively). Miscarriage rates were similar between the two groups. Conclusion: Partner lymphocyte immunotherapy is a novel treatment option in improving the pregnancy outcomes among women with unexplained RPL and HLA sharing among partners.
Background: Chromosomal rearrangements play an important role in infertility. Carriers of chromosomal rearrangements have a lower chance of producing normal or balanced gametes due to abnormal segregation of chromosomes at meiosis, which leads to recurrent spontaneous abortions and infertility. Preimplantation genetic testing for structural chromosome rearrangements (PGT-SR) is offered to couples who have balanced chromosomal rearrangements in order to select embryos with a balanced karyotype prior to implantation, thereby increasing the chances of pregnancy. The purpose of the current study was to assess the outcomes of PGT-SR in patients carrying various balanced chromosomal rearrangements and to assess their clinical pregnancy outcome after in vitro fertilization (IVF). Methods: In this study, infertile couples with balanced chromosomal abnormalities undergoing PGT-SR were retrospectively analyzed at a single fertility center from January 2016 to December 2019. Results: PGT-SR was performed on 87 embryos from 22 couples in whom one partner carried a balanced translocation or an inversion. Fifty-seven (65.5%) of these embryos had unbalanced or sporadic aneuploidies, 30 (34.5%) embryos were normal or chromosomally balanced, which were then transferred in 18 couples. A higher rate of unbalanced translocations in comparison to sporadic aneuploidies was observed in couples with reciprocal translocation. The live birth rate per embryo transfer was found to be 66.6% (12/18). Conclusion: PGT-SR is a useful tool in selecting normal or balanced embryos for transfer in IVF, which could lead to a pregnancy by reducing the chance of miscarriages due to chromosome aneuploidy in couples with balanced chromosomal rearrangements.
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