Results
Thirteen women with recurrent CHI participated in the study. These women
had carried 54 pregnancies themselves (51 singleton, 3
dichorionic-diamniotic). These pregnancies resulted in high rates of
adverse perinatal outcomes (Table). Of the 9 babies born alive, 2 died
in the neonatal period (2/9, 22%), meaning only 7/54 pregnancies (13%)
resulted in surviving children. In 8/54 (15%) pregnancies, the mother
received antenatal immunosuppression including one or more of
prednisolone, hydroxychloroquine, tacrolimus and intravenous
immunoglobulin.
Following attempts to carry a pregnancy themselves, all 13 women
underwent IVF using their own oocytes and their partner’s sperm followed
by embryo transfer into a surrogate mother. This led to 17 successful
surrogate conceptions (12 singleton, 5 dichorionic-diamniotic), of which
15/17 (88%) ended in term or near-term live birth. The two remaining
pregnancies ended in first-trimester miscarriage, one due to confirmed
fetal trisomy 21 and the other with no identified cause. There were two
failed embryo transfers. None of the surrogate mothers received
immunosuppression.
There was no recurrent CHI detected in any of the completed surrogate
pregnancies, although most placentas (13/17) were not tested due to a
good pregnancy outcome.
One of the patients included in this cohort had a late miscarriage and
two early miscarriages due to CHI before undergoing IVF and gestational
surrogacy. This led to two successful surrogate pregnancies. The first
of these was described in the cited article by Reus et
al.,5 but the second has not been reported until now,
hence her inclusion in this cohort.
The parents of the fetus with trisomy 21 subsequently underwent further
IVF using donor oocytes and had healthy dichorionic-diamniotic twins
delivered at 36 weeks’ gestation by a surrogate mother.
The INTERGROWTH-21st birthweight centile calculator is
available from: http://intergrowth21.ndog.ox.ac.uk/en/ManualEntry