Comparison of the pregnancy outcomes of natural conception with PGD in RPL carriers
Few studies have comparied the pregnancy outcomes after choosing between NC/EM (natural conception/expectant management) and PGD for RPL carriers, because randomized control trials are unavailable. We systemically searched the literature as much as possible for the available evidence on pregnancy outcomes to describe this question and only 2 nonrandomized comparative studies comparing the pregnancy outcomes after PGD with those after NC in our study (Table 5). Savanie reported that 74% of RPL carriers with NC and 38.5% of those with PGD had a live birth, although the period of follow-up was significantly longer in the NC group (p=0.016)[19]. Shinichiro reported 37-63% on the first trial, 65-83% cumulatively with NC and 27-54% with PGD had at least a live birth[18]. The meta-analysis showed no significant difference in the accumulated LBR (Figure 3a; two studies; odds ratio (OR): 1.82; 95% CI: 0.38–8.71; I2 =71%; p=0.45) but a higher miscarriage rate (Figure 3b; two studies; odds ratio (OR): 5.75; 95% CI: 2.57–12.86; I2 =45%; p<0.0001) when comparing NC with PGD in RPL carriers.