PMID- 38171035
OWN - NLM
STAT- MEDLINE
DCOM- 20240122
LR  - 20240202
IS  - 1872-7603 (Electronic)
IS  - 0165-0378 (Linking)
VI  - 161
DP  - 2024 Feb
TI  - Expanding the role of chromosomal microarray analysis in the evaluation of 
      recurrent pregnancy loss.
PG  - 104188
LID - S0165-0378(23)00394-7 [pii]
LID - 10.1016/j.jri.2023.104188 [doi]
AB  - Multiple factors contribute to recurrent pregnancy loss (RPL). This review 
      highlights the latest international guidelines for RPL workup, including 
      immunological testing, by the American Society for Reproductive Medicine (ASRM), 
      the European Society of Human Reproduction and Embryology (ESHRE), and the Royal 
      College of Obstetricians and Gynaecologists (RCOG). These three societies 
      recommend testing for antiphospholipid syndrome. ESHRE and RCOG also recommend 
      thyroid peroxidase antibody testing, whereas ASRM does not. All guidelines advise 
      against testing of natural killer cells, cytokines, antinuclear antibodies, human 
      leukocyte antigen (HLA) compatibility, anti-HLA antibodies, and anti-sperm 
      antibodies. However, when following ASRM, ESHRE or RCOG diagnostic guidelines, 
      over 50% of cases have no identifiable cause. Genetic testing of products of 
      conception (POC) can improve our understanding of unexplained RPL as aneuploidy 
      is a common cause of RPL. Based on studies reporting results from chromosomal 
      microarray analysis (CMA) of POC, we propose a novel algorithm for RPL 
      evaluation. The algorithm involves following evidence-based societal guidelines 
      (published by ASRM, ESHRE, or RCOG), excluding parental karyotyping, in 
      combination with CMA testing of miscarriage tissue. When utilizing this new 
      evaluation algorithm, the number of unexplained cases of RPL decreases from over 
      50% to less than 10%. As a result, most patients are provided an explanation for 
      their loss and healthcare costs are potentially reduced. Patients with an 
      otherwise negative workup with euploid POC, are classified as "truly unexplained 
      RPL". These patients are excellent candidates for enrollment in randomized, 
      controlled trials examining novel immunological testing and treatment protocols.
CI  - Copyright (c) 2024 Elsevier B.V. All rights reserved.
FAU - Eliwa, Jasmine
AU  - Eliwa J
AD  - Division of Obstetrics and Gynecology, University of Tennessee Health Sciences 
      Center-Memphis, Memphis, TN, USA.
FAU - Papas, Ralph S
AU  - Papas RS
AD  - Infertility Division, Obstetrics & Gynecology Department, St George Hospital - 
      University Medical Center - University of Balamand, Beirut, Lebanon.
FAU - Kutteh, William H
AU  - Kutteh WH
AD  - Division of Obstetrics and Gynecology, University of Tennessee Health Sciences 
      Center-Memphis, Memphis, TN, USA; Recurrent Pregnancy Loss Center, Fertility 
      Associates of Memphis, Memphis, TN, USA. Electronic address: wkutteh50@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20231228
PL  - Ireland
TA  - J Reprod Immunol
JT  - Journal of reproductive immunology
JID - 8001906
RN  - 0 (Antibodies, Antinuclear)
SB  - IM
MH  - Pregnancy
MH  - Female
MH  - Humans
MH  - *Abortion, Habitual/diagnosis/genetics
MH  - Aneuploidy
MH  - Microarray Analysis
MH  - *Antiphospholipid Syndrome/complications
MH  - Antibodies, Antinuclear
OTO - NOTNLM
OT  - Chromosomal microarray
OT  - Immunotherapy
OT  - Recurrent pregnancy loss evaluation
OT  - Reproductive immunology
OT  - Society guidelines
COIS- Declaration of Competing Interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this article..
EDAT- 2024/01/04 01:18
MHDA- 2024/01/22 06:43
CRDT- 2024/01/03 18:00
PHST- 2023/09/30 00:00 [received]
PHST- 2023/11/18 00:00 [revised]
PHST- 2023/12/22 00:00 [accepted]
PHST- 2024/01/22 06:43 [medline]
PHST- 2024/01/04 01:18 [pubmed]
PHST- 2024/01/03 18:00 [entrez]
AID - S0165-0378(23)00394-7 [pii]
AID - 10.1016/j.jri.2023.104188 [doi]
PST - ppublish
SO  - J Reprod Immunol. 2024 Feb;161:104188. doi: 10.1016/j.jri.2023.104188. Epub 2023 
      Dec 28.