Toward more accurate prediction of future pregnancy outcome in couples with unexplained recurrent pregnancy loss: taking both partners into account

Predicting the chance of subsequent ongoing pregnancy in couples with recurrent pregnancy loss becomes more accurate when characteristics of both partners are included in a prediction model but remains challenging.

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VOLUME 117, ISSUE 1, P144-152

Authors:

Nadia A. du Fossé, M.Sc., Marie-Louise P. van der Hoorn, Ph.D., Rozemarijn de Koning, B.Sc., Annemarie G.M.G.J. Mulders, Ph.D., Jan M.M. van Lith, Ph.D., Saskia le Cessie, Ph.D., Eileen E.L.O. Lashley, Ph.D.

Abstract:

Objective

To identify, besides maternal age and the number of previous pregnancy losses, additional characteristics of couples with unexplained recurrent pregnancy loss (RPL) that improve the prediction of an ongoing pregnancy.


Design

Hospital-based cohort study in couples who visited specialized RPL units of two academic centers between 2012 and 2020.


Setting

Two academic centers in the Netherlands.


Patients

Clinical data from 526 couples with unexplained RPL were used in this study.


Intervention(s)

None.


Main Outcome Measures

The final model to estimate the chance of a subsequent ongoing pregnancy was determined using a backward selection process and internally validated using bootstrapping. Model performance was assessed in terms of calibration and discrimination (area under the receiver operating characteristic curve).


Results

Subsequent ongoing pregnancy was achieved in 345 of 526 couples (66%). The number of previous pregnancy losses, maternal age, paternal age, maternal body mass index, paternal body mass index, maternal smoking status, and previous in vitro fertilization/intracytoplasmic sperm injection treatment were predictive of the outcome. The optimism-corrected area under the receiver operating characteristic curve was 0.63 compared with 0.57 when using only the number of previous pregnancy losses and maternal age.


Conclusions

The identification of additional predictors of a subsequent ongoing pregnancy after RPL, including male characteristics, is significant for both clinicians and couples with RPL. At the same time, we showed that the predictive ability of the current model is still limited and more research is warranted to develop a model that can be used in clinical practice.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.