What is the efficacy of In Vitro Fertilization (IVF) in a 34-year-old female with a history of recurrent spontaneous abortions?

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IVF Efficacy in a 34-Year-Old Woman with Recurrent Pregnancy Loss

IVF with preimplantation genetic testing for aneuploidy (PGT-A) significantly improves live birth rates in women with recurrent pregnancy loss, with adjusted odds ratios of 1.31-1.45 for women aged 34-37 years compared to IVF without PGT-A. 1

Evidence for IVF with PGT-A in Recurrent Pregnancy Loss

The most robust evidence comes from a large SART-CORS database study analyzing 12,631 frozen embryo transfer cycles in women with recurrent pregnancy loss (defined as ≥3 losses). 1 For women in the 35-37 age bracket (which includes your 34-year-old patient), IVF-FET with PGT-A demonstrated an adjusted odds ratio of 1.45 (95% CI: 1.21-1.75) for live birth compared to IVF without PGT-A. 1

Key Outcome Data by Age Group

  • For ages <35 years: Live birth OR 1.31 (95% CI: 1.12-1.52) with PGT-A versus without 1
  • For ages 35-37 years: Live birth OR 1.45 (95% CI: 1.21-1.75) with PGT-A versus without 1
  • Clinical pregnancy rates showed similar improvements, with OR 1.26 for age <35 and 1.37 for ages 35-37 1

Mechanism of Benefit

Chromosomal abnormalities are significantly elevated in preimplantation embryos from women with recurrent miscarriage, particularly affecting chromosome 13. 2 This explains why PGT-A provides substantial benefit—it allows selection of euploid embryos, thereby reducing the baseline miscarriage rate to 14-16% across all maternal ages. 3

A prospective study demonstrated that PGT-A reduced spontaneous abortion rates from an expected 35.9% to 12.8% in patients with more than two previous losses. 3 The benefit was consistent regardless of fertility status, with fertile patients achieving 37% delivery rates and infertile patients achieving 34% delivery rates. 3

Underlying Causes to Consider

Before proceeding with IVF, comprehensive evaluation should identify treatable causes:

  • Genetic factors: 29% of recurrent miscarriage cases show genetic causes 4
  • Thrombophilic factors: 21% isolated, 24% combined with immune factors 4
  • Immune factors: 14% isolated 4
  • Idiopathic: Only 12% of cases remain unexplained after thorough workup 4

Important caveat: Even with PGT-A selecting euploid embryos, this addresses only the 29% of cases due to genetic factors. 4 The remaining 71% of cases require evaluation for immune, thrombophilic, endocrine, and anatomical factors. 5, 6

Recommended Evaluation Prior to IVF

Your 34-year-old patient should undergo:

  • Parental karyotyping (both partners) 6
  • Antiphospholipid antibody testing (lupus anticoagulant, anticardiolipin, anti-β2 glycoprotein I) 5
  • Thrombophilia screening if family history of VTE (Factor V Leiden, Prothrombin G20210A) 6
  • Uterine cavity assessment via transvaginal ultrasound and sonohysterography 5
  • Thyroid function testing (TSH, free T4) 5
  • Assessment for PCOS and ovarian reserve (AMH, antral follicle count) 5, 6
  • Male partner evaluation including karyotype and consideration of sperm DNA fragmentation testing 6

Clinical Algorithm

For a 34-year-old woman with recurrent pregnancy loss:

  1. Complete diagnostic workup as outlined above to identify treatable causes 5, 6

  2. If genetic mutations in NLRP7 or KHDC3L genes are identified (recurrent molar pregnancies), consider ovum donation rather than conventional IVF 5, 6

  3. For idiopathic or chromosomal causes: Proceed with IVF-FET with PGT-A 1

    • Expected live birth improvement: 31-45% higher odds compared to IVF without PGT-A 1
    • Reduces miscarriage rate to baseline 14-16% 3

  4. If thrombophilia identified: Women with homozygous Factor V Leiden or Prothrombin G20210A with positive family history for VTE should receive prophylactic or intermediate-dose LMWH during pregnancy 6

  5. Optimize modifiable factors: Thyroid function, glycemic control, avoid smoking/alcohol, maintain healthy BMI 5, 6

Expected Outcomes

Based on the highest quality evidence, a 34-year-old woman with recurrent pregnancy loss undergoing IVF with PGT-A can expect:

  • Clinical pregnancy rate improvement of 26-37% compared to IVF without PGT-A 1
  • Live birth rate improvement of 31-45% compared to IVF without PGT-A 1
  • Reduction in spontaneous abortion rate from expected 34-36% to approximately 14% 3
  • Overall delivery rate of approximately 34-37% per transfer cycle 3

Critical Pitfall to Avoid

Do not assume IVF with PGT-A alone will solve all recurrent pregnancy loss. While it addresses chromosomal abnormalities (29% of cases), it does not address immune, thrombophilic, anatomical, or endocrine causes that account for the majority of cases. 4 A comprehensive workup and treatment of identified factors is essential for optimal outcomes. 5, 6

References

4
Research

Causes of recurrent miscarriage after spontaneous pregnancy and after in vitro fertilization.

American journal of reproductive immunology (New York, N.Y. : 1989), 2020

5
Guideline

Management of Recurrent Pregnancy Loss

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

6
Guideline

Genetic and Anatomical Factors in Recurrent Pregnancy Loss

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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