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Moving Beyond Unexplained Recurrent Pregnancy Loss: Are We Still Missing the Genetic Diagnosis in SOGC Guidelines?
Elias M Dahdouh1, Camille Sylvestre2, Jacques Balayla3
1ART Center, department of Obstetrics-Gynecology, CHU Sainte-Justine, Université de Montréal, Montreal, Canada.
Abstract:
The recently published SOGC guideline on recurrent pregnancy loss (RPL) provides a rigorous, evidence-based framework for investigation and management. However, emerging evidence suggests that contemporary genetic technologies are under-integrated. Advances in chromosome microarray analysis (CMA) and next-generation sequencing (NGS) demonstrate that fetal aneuploidy accounts for a substantial proportion of RPL, even after two losses. Systematic genetic testing of products of conception could significantly reduce the proportion of "unexplained" RPL, refine prognosis, and guide individualized management. Conditional use of preimplantation genetic testing (PGT), including PGT-A for aneuploidy and PGT-SR for structural rearrangements, in selected patients may further improve patient-centred outcomes.
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