Fertility issues and pregnancy outcomes in Turner syndrome

Objective: To study fertility issues and pregnancy outcomes in Turner syndrome (TS). Design: Retrospective cohort study. Setting: Not applicable. Patient(s): One hundred fifty-six TS patients, median age 32 years, 23 mosaic 45,X/46,XX, 45,X/47,XXX, 45,X/46,XX/47,XXX. Intervention(s): None. Main Outcome Measure(s): Fertility choices, spontaneous pregnancy, and oocyte donation (OD) outcomes. Conditions associated with aortic dissection and poor pregnancy outcomes at preconception were considered. Pregnancy -related aortic dimension changes and the long-term impact of pregnancy on TS -related comorbidities were assessed. Results(s): In all, 13.5% had spontaneous pregnancies, resulting in a pregnancy with live birth in 18 patients (37 newborns); 16% considered OD, one adopted, and one underwent fertility preservation. Spontaneous pregnancy predictive factors were a karyotype with a second or third cell line with more than one X and spontaneous menarche. In all, 47.6% had miscarriages, two experienced preeclampsia, and two had gestational diabetes. One daughter was diag- nosed with TS in adulthood. Seven of 14 who attempted OD had a pregnancy with live birth; two of seven had gestational diabetes; 64.3% attempting OD had risk factors associated with poor pregnancy outcomes, including four who had double embryo transfer. Cardiac status at preconception was evaluated in 12 of 25 women who had a pregnancy. The aortic diameters during pregnancy increased. The aortic growth at sinuses was 0.51 ? 0.71 mm/year and at ascending aorta 0.67 ? 0.67 mm/year, reaching a signi ficant difference at sinuses compared with the growth in nulliparous TS. Among women who had a pregnancy, none experienced aortic dissection during and in the years after pregnancy. Conclusion(s): This study highlights the importance of a TS -dedicated multidisciplinary management of pregnancy, before and during pregnancy and in the postpartum period. (Fertil Steril (R) 2020;114:144-54. (C) 2020 by American Society for Reproductive Medicine.)