PROBLEM We aimed to investigate the main causes of recurrent miscarriage (RM) in patients with losses after spontaneous gestation (SG) and after in vitro fertilization (IVF). METHOD OF STUDY A prospective case-control study was conducted. The eligible patients were women who had experienced two or more consecutive abortions after <12 weeks' gestation, two consecutive losses after SG, or two consecutive losses after IVF. All patients were subjected to the following evaluations: karyotyping of the aborted material, alloimmune and autoimmune marker testing, and acquired and hereditary thrombophilia marker testing. RESULTS In total, 58 patients were eligible: 32 patients with RM after SG and 26 patients with RM after IVF. The factors associated with RM were genetic (29%), immune (14%), thrombophilic (21%), and thrombophilic and immune (24%), and only 12% of the cases were idiopathic. Comparing the two study groups (SG and IVF), all studied factors were similar, except for a higher ANA positivity observed in the SG group (SG 30.4% vs IVF 5.3%, OR 8.6 (CI 1.1-21.1, P .048). CONCLUSION Our study identified the possibly factors associated with recurrent miscarriage in 86% of the cases, and these factors appear to be similar in patients with recurrent miscarriage after spontaneous gestation and IVF. This study demonstrates that IVF with PGT-A with euploid embryo transfer could reduce abortions by up to 29%, but other factors need to be investigated even in patients undergoing in vitro fertilization.

中文翻译：

---

自发妊娠和体外受精后反复流产的原因。

问题我们旨在调查自然流产（SG）和体外受精（IVF）后丢失的患者反复流产（RM）的主要原因。研究方法进行了一项前瞻性病例对照研究。符合条件的患者是那些在小于12周的妊娠后经历了两次或更多次连续流产，在SG后连续两次流产或在IVF后连续两次流产的妇女。所有患者均接受以下评估：流产材料的核型分析，同种免疫和自身免疫标记物测试，以及获得性和遗传性血友病标记物测试。结果总共有58例患者合格：SG后32例RM，IVF后26例RM。与RM相关的因素包括遗传（29％），免疫（14％），血栓形成性（21％）以及血栓形成性和免疫性（24％），只有12％的病例是特发性的。比较两个研究组（SG和IVF），所有研究因素相似，除了在SG组中观察到较高的ANA阳性（SG 30.4％vs IVF 5.3％或8.6（CI 1.1-21.1，P .048）。结论我们的研究确定了86％的病例中反复流产的可能因素，这些因素在自然妊娠和IVF后复发流产的患者中相似，该研究表明IVF与PGT-A结合整倍体胚胎移植可以最多可将流产降低29％，但即使在体外受精的患者中，也需要研究其他因素。4％vs IVF 5.3％或8.6（CI 1.1-21.1，P .048）。结论我们的研究确定了86％的病例中反复流产的可能因素，这些因素在自然妊娠和IVF后复发流产的患者中似乎相似。这项研究表明，IVF与PGT-A结合整倍体胚胎移植可以减少多达29％的流产，但是即使在进行体外受精的患者中也需要研究其他因素。4％vs IVF 5.3％或8.6（CI 1.1-21.1，P .048）。结论我们的研究确定了86％的病例中反复流产的可能因素，这些因素在自然妊娠和IVF后复发流产的患者中似乎相似。这项研究表明，IVF与PGT-A结合整倍体胚胎移植可以减少多达29％的流产，但是即使在进行体外受精的患者中也需要研究其他因素。