The correlation between ANA and pregnancy loss and their impact on IVF/ICSI-ET pregnancy outcomes in patients with recurrent pregnancy loss

Abstract The relationship between antinuclear antibodies (ANA) and recurrent pregnancy loss (RPL) or single pregnancy loss (PL) is unclear. In this retrospective study, patients first seen at the hospital between January 2016 and December 2022 and who underwent two ANA tests within 4-6 weeks were included. After exclusion of confounding factors, patients were divided into the non-PL, single-PL or RPL group according to previous number of PLs, and the correlation between PL and ANA was analysed. The first embryo transfer (ET) after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) without immunological treatment was selected in the RPL group, and patients were classified into the ANA-negative subgroup or ANA1:80 subgroup according to ANA titre. The effect of ANA on pregnancy outcomes in the RPL patients after IVF/ICSI-ET was further analysed. The results of multivariate unordered logistic regression showed that when the non-PL group was used as the reference, ANA positivity was an independent risk factor for RPL (P=0.023) but not for single PL (P=0.654). When the single-PL group was used as the reference, ANA positivity was an independent risk factor for RPL (P=0.022). There was no significant difference in ANA titre among the three groups of ANA-positive patients (P=0.106). Multivariate logistic regression analysis revealed that the early PL rate of the ANA1:80 subgroup was significantly higher than that of the ANA-negative subgroup (P=0.039), and the total PL rate of the ANA1:80 subgroup was significantly higher than that of the ANA-negative subgroup (P=0.033). The results showed that ANA positivity may be related to RPL occurrence, but there was no significant correlation between ANA positivity and single PL. ANA positivity (titre 1:80) is associated with PL occurrence in RPL patients after transplantation, and the correlation is reflected mainly in the first trimester. RPL patients should be screened for ANA and receive treatment.