Recurrent miscarriages / IVF failures

Couples facing one of these situations, reasonably ask what the underlying cause is!
Unfortunately, for a large percentage ( up to 50%), there is no specific cause.

However, you must take into account the following:

The 60 to 70% loss of pregnancies occur due to abnormal embryos, whose genetic material is not normal.

Although eggs and sperm contribute equally to the genetic material of the embryo, the embryo quality has mainly to do with the age and quality of eggs in proportion of 90%, with only 10% being attributed to sperm.

For this reason, it is more difficult for a pregnancy to evolve in older women or those with menopausal changes or poor ovarian function.
When a woman miscarries, it is preferable to subject the fetus to karyotyping (genetic identification), instead of performing histological analyzes culture and PCR products of abortion. In this case, if the fetus is found pathological, for example, with syndrome of Down, it explains the loss of pregnancy while avoiding and conducting extensive and accurate controls.

The karyotype of peripheral blood for the pair is placed in these cases:

In 20-30% of cases the failure-unsuccessful implantation and evolution of embryos may be due to pathology of the uterus such as:

Congenital anomalies (diaphragmatic mainly bicornuate uterus and rarely or unicorn mainly related to obstetrical problems).

Acquired pathology such as:

  • Fibroids (especially those occupying the uterine cavity part-submucosal), and fewer ???endotoichomatika, which must be ≥ 3m. and at a distance ≤ 5mm. of the endometrium.
  • Polyps endometrium.
  • Adhesions endometrial cavity.
  • Inflammatory lesions of the endometrium.
  • Destruction of the functional layer of the endometrium due to previous curettage as a vacation pregnancy and abortions.

The ultrasound, the 3D yperichotografia the HyCoSy (postscript), hysterosalpingography, hysteroscopy, endometrial biopsy culture and PCR for Chlamydia, mycoplasma and ureaplasma as for viral infections (eg, CMV and HSV), play an important role diagnosis and treatment of the underlying disease.

10-20% of losses due to various reasons that include:

  • Metabolic Diseases (curve glucose and thyroid tests).
  • Autoimmune diseases (control ANA, AGA, ASMA, anti-DNA and LA).
  • Antifosfolopidiko syndrome * (control antibody against phosphatide, serine & kardiolipidion).
  • Thrombophilia* (thrombophilia genetic testing and peripheral blood).
  • Immunological causes ** (Antipater antibodies,Toxic lymphocytes (NK cells)).

Although the global community dissociates views on involvement in these causes miscarriages or failed IVF treatment, even greater differences in treatment or not treatment with:

  • Vaccinations lymphocyte
  • Administering antiviral drugs eg Valtrex
  • Intravenous immunoglobulins.

All therapeutic interventions are intended to modify the immune system and the acceptance of the fetal-s of the endometrium with subsequent proper development of the placenta.

  • Genetic damage (if not done karyotype pair, this should be done after 2 or more miscarriages-failures IVF.
  • Check uterus (endometrium) for infections by PCR (molecular technique) has been proposed, since the vaginal or cervical cultures may not show a potential microbial or viral infection.
  • Check semen viral infections by PCR for viruses CMV, EBV & HSV.
  • Control sperm FISH for genetic damage to chromosomes X, Y, 13, 15, 18 and 21, have a place in severe cases patients oligo-teratozoospermia, failure and unexplained disturbances divisional capacity and embryo quality, especially when the image ova is good and the ovarian function expected for the age of the patient.
  • PGS (preimplantation control) embryo biopsy on the third or fifth day (blastocyst) of life and transport of genetically healthy embryos.

Until now, this technique was carried out by FISH in a cell and have several disadvantages such as:

  • Failure diagnosis in 10-20%
  • Failure of blastocyst development in fetuses
  • Diagnosis only of ordinary genetic lesions (X, Y 13.18, 21 and 22)
  • Diagnosing abnormalities will correct themselves'''' thus excluding healthy embryos for transfer &
  • Cellular mosaicism without clinical significance.

However, these restrictions seem to disappear from the new technique of array-CGH
(Comparative genomic hydridization = comparative genomic hybridization), which is screening-diagnosis of all genomic material and 23 chromosomes.
This technique, however, is new, and thus it takes time before the effective and clinically useful application.

* These two conditions associated with increased blood coagulation and create small thrombus at the site of implantation of the embryo reducing in this way the good blood supply and therefore stopping the progression of pregnancy.
The treatment of said pathology is a low molecular weight heparin and aspirin.

** The author's opinion is that we should exclude all other causes in order to be accepted any diagnostic or therapeutic immune intervention.