| Background: Recurrent spontaneous abortion is defined as three or more consecutive spontaneous pregnancy losses. It accounts for 0.4% to 1.0% of the total spontaneous pregnancy losses (15%-20%).The etiological factors are very complicated and diverse. Currently, known factors include: genetic abnormalities, endocrine disorders, infections, immunological factors and uterine anomalies.Objective: To perform an etiological analysis of patients with a history of recurrent spontaneous abortion.Method: The study was carried out from September 2004 to February 2007 at Jilin University (First, second and third clinical hospital). A total of 124 patients with a history of recurrent spontaneous abortion were evaluated. Patients were selected on the following basis: no history of consanguinity and male partner showing no abnormality in physical or laboratory examination. The control group consisted of 30 healthy, fertile female volunteers with proven fertility. Following tests were performed to evaluate the causes: Peripheral blood for karyotype analysis, in serum ACA-IgG, ANA-IgG, EmAb-IgG, AsAb-IgG for immunological studies, hormone profile (FSH, LH, PRL, T, E2 and P) to identify endocrine disorders. For infections, Ureaplasma urealyticum(UU) was cultured and Enzyme immunoassay for Chlamydia trachomatis(CT) from cervical mucus was done. Screening for TORCH (Toxoplasma, Rubella, Cytomegalovirus, Herpes Simplex I & II ) in serum was performed for specific antibody. Various examinations (hysterosalpingogram, hysteroscopy, B-ultrasound, diagnostic laparoscopy) for uterine anomalies were also performed. Statistical analysis was performed using X2 test. P<0.05 was considered to be statistically significant.Result: 1. Of all 124 patients with RSA, chromosome abnormalities were identified in 3.23% (4/124).In tests for infection, positive tests for CT, UU and TORCH were found in 19.35%(24/124). ACA, ANA, EmAb and AsAb were tested positive in 58.87% (73/124). Endocrine disorders were identified in 10.48% (13/124) and uterine anomalies in 2.42% (3/124). In 5.65% (7/124), cause could not be identified. 2. Chromosomal abnormalities were identified in 3.23% (4/124) and the types of chromosomal abnormalities include: 47,XXX; 46,XX,1 (q12+); 46,XX,t (11;22) (q24.1;q12.1); 46,XX, inv (9) (p12q13). 3. Tests for UU and CT were positive in 10.48% (13/124). Among these, UU tested positive in 7.26% (9/124), CT tested positive in 8.87% (11/124) and coinfection of UU and CT in 5.65% (7/124).The percentage of positive tests for UU, CT and (UU + CT) were significantly higher in the study group than that in the control group (P<0.05). In addition, other infections were detected: Cytomegalovirus (+) 4 cases, Rubella (+) 5 cases, Toxoplasma gondii (+) 1 case, and Herpes Simplex (+) 1 case, giving a total percentage of 8.87%(11/124). 4. ACA-IgG tested positive in 36.3% (45/124), ANA-IgG in 8.06% (10/124), EmAb-IgG in 9.68% (12/124) and AsAb-IgG in 4.84% (6/124).This data was significantly higher than that of the control group (P<0.01). 5. Endocrine disorders were found in 10.48% (13/124). The majority had a problem with low FSH level in the mid-follicular phase and a low P level after ovulation. 6. Uterine anomaly was identified in 2.24% (3/124), and all had uterine septa. 7. In 5.65% (7/124) patients, cause could not be identified despite extensive investigation.Discussion: 1. In this study, chromosomal abnormalities are classified as translocation, inversion, trisomy and polyploidy. 2. In this study, the infection rate is significantly higher than in previous literature reports. This discrepancy may be attributed to the selection of patients, sample size, sample collection, data collection, skill of lab technicians etc. In the study group, the positive tests for UU, CT and (UU + CT) were significantly higher than that in control group (P<0.01).Our study demonstrated that infection with CT and UU can result in RSA. In addition, TORCH infection can also lead to RSA to some extent. 3. The percentage of positive tests for ACA-IgG, ANA-IgG, EmAb-IgG, AsAb-IgG in the study group were significantly higher than that in the control group (P<0.01), and among these, ACA-IgG (+) has the highest percentage (36.3%; 45/124). This study demonstrates that immunological factors, especially ACA is closely associated with RSA. 4. In the present study, low FSH in mid-follicular phase, Luteal Phase Defect and low P level after ovulation are common endocrine disorders. As a result, there may be a defect in corpus luteum function causing RSA. 5. Uterine anomaly was identified in 2.24% (3/124), and all had uterine septa. Our detection rate of uterine anomaly was lower than that reported by other studies. This may be attributed to the sample size, operator dependability for diagnosis and other sample collecting methods. 6. In 5.65% (7/124) patients, cause could not be identified despite extensive investigations. With further advancement in medical technologies and research, these unexplained causes are expected to be clearer in near future.Conclusion: Our etiological analysis on recurrent spontaneous abortion also showed diverse causes. These include: 1. Chromosomal abnormality, mainly translocation, inversion and numerical abnormality. 2. Infections especially with UU, CT and TORCH 3. Immunological factors include ANA, EmAb, AsAb and especially ACA. 4. Endocrine disorders include low FSH level in the mid-follicular phase and low P level after ovulation. 5. Uterine anomaly in the form of partial uterine septum. 6. In some cases, cause could not be identified.
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