Reproductive outcomes in recurrent pregnancy loss associated with a parental carrier of a structural chromosome rearrangement

BACKGROUND: Reproductive outcome studies of couples with a history of recurrent pregnancy loss (RPL) associated with a maternal or paternal carrier of a structural chromosome rearrangement are limited. Correlation of carrier status and cytogenetics of miscarriage specimens is critical to estimate subsequent pregnancy outcome. METHODS: Couples found to have a structural chromosome rearrangement were followed prospectively in a tertiary academic centre. Descriptive analysis and subsequent pregnancy outcomes were tabulated and compared to historic controls. RESULTS: In 1893 RPL couples, 51 carriers of a structural chromosome rearrangement were identified (2.7%). Overall, this cohort had a total of 273 documented pregnancies. Prior to evaluation, the mean maternal age at the time of delivery or miscarriage was 29.8 years and the live birth rate was 15%. Following evaluation and treatment of concomitant factors, there were 58 monitored pregnancies, with a live birth rate of 71%. Amniocentesis was performed on 22% of the ongoing pregnancies; all were diploid or balanced structural chromosome rearrangements. Thirty-six per cent of the miscarriages were found to have an unbalanced structural chromosome rearrangement. CONCLUSIONS: Following evaluation and management of RPL, the live birth rate for carriers of a structural chromosome rearrangement is highly encouraging at 71%, without the addition of assisted reproductive technology.