When a patient has suffered two or more miscarriages, if the problem has not been diagnosed and treated, the chances of recurrence are high and increase in direct proportion to the number of previous miscarriages.
Some of us know, and others can imagine, the excitement of a positive pregnancy test. But now, I ask you to think about how people who have had two or more miscarriages experience this moment… The hope of having a child is confronted with the possibility of a new failure, what uncertainty and anxiety!
Thanks to assisted reproduction, progress has been made in the knowledge of the causes of miscarriage, which are little known to the gynaecologist who does not specialise in this subject. In many cases infertility, implantation failure and miscarriage are due to the same problem. They must therefore be studied and treated in a similar way.
On our website you can read about the causes, diagnosis and treatment of patients with repeated miscarriages.
The most frequent cause of recurrent miscarriage are chromosomal abnormalities of the embryo, approximately 50% of the cases. Secondly, acquired thrombophilias (antiphospholipid syndrome) and hereditary thrombophilias, approximately 20%. In the remaining 30% of cases we do not know the diagnosis.
I mean that these two are the only causes for which scientific evidence has been demonstrated. For all the others, NO.
We have to acknowledge what we don’t know and study and research to move forward. Infertility is a new science, but it is science.
I am concerned about what is happening in my speciality with the management of recurrent miscarriages and embryo implantation failures in IVF. Since we still do not know many things, it has become trendy to prescribe all kinds of unscientific diagnostic tests and empirical treatments (“based on one’s own experience and observation without having implied a logical assumption or deduction and without any scientific demonstration”) worthy of shamanism. I am referring to studies such as the natural killer cells, anti-paternal antibodies, KIR, HLA, uterine surgeries without a real indication, etc.
I expressed my concern about this issue at the last congress of the Spanish Society of Gynaecology and Obstetrics (SEGO). Here you can watch the video:
*Remember that you can watch the video subtitled in English thanks to the You Tube tools.
Since, without doing anything, there is a chance that the next pregnancy will go well, any treatment can appear to be successful: this feeds the doctor’s ego. In addition, we are under pressure from the pharmaceutical industry and from patients who have read everything on the internet or who have received these proposals in other clinics.
I give you the example of Vitamin D: suddenly everyone has low Vitamin D and it is the cause of all pathologies. And that is not true! Infertility is a disease and it needs diagnosis, prognosis, proper treatment and humility to admit what we don’t know.
PregnancyLoss: In the case of a miscarriage, we can already determine a possible genetic cause with just a blood test.
As I have explained above, the most common cause of miscarriage is chromosomal abnormalities in the embryo. A blood test of the patient now allows us to determine the karyotype of the non-evolving embryo within 4 days.
As soon as the embryo is implanted, embryonic DNA is found in the mother, so the analysis can be carried out following any miscarriage, even with only a week’s delay.
This is a great advance because when this study is carried out on the abortion remains, by means of curettage or chorion biopsy, there are many failures when it comes to obtaining the result and, in addition, the sample may have been contaminated with DNA from the mother.
At Institut Marquès we obtain the blood sample in our own clinic to carry out the “PregnancyLoss” analysis.