Repeated miscarriages are one of the main reasons why Patients come to our Fertility clinic and consult our experts. Approximately 20-25% of all pregnancies end in a spontaneous miscarriage. When we talk about spontaneous miscarriages we mean those who happen before the 20th week of the pregnancy.
Although doctors disagree on a precise definition, a repeated miscarriage is usually defined as the loss of three or more pregnancies before the 20th week. On the other hand, it also means that they do not have to take place one after the other. Thus, the birth of a living newborn baby does not exclude the possibility of further miscarriages, or the possibility of suffering from further miscarriages in between miscarriages. The experts also disagree on the number of miscarriages, above which a precise study is necessary.
In IVF-Spain, we believe that the patient should be spared this painful loss, and therefore we believe it is necessary to carry out studies to detect the problem early or to avoid its recurrence, and therefore additional pain.
What types of miscarriages are there?
Most miscarriages happen before the 12th week of pregnancy, in the first trimester. They can be sorted according to the time of miscarriage:
– Biochemical miscarriage before the amniotic sac is made visible with ultrasound.
– Premature miscarriage if it happens before the 10th week of pregnancy.
– Late miscarriage if the abortion takes place between 11-20 weeks
– Premature delivery if the loss occurs after the 20th week.
What are the reasons for repeated miscarriages?
When a Patient has gone through two miscarriages, the probability that it will happen a third time is about 24-30%, but after a third time it is even higher: 30-33%. There are two types of causes that lead to repeated miscarriages: the known and the unknown.
The most known causes are:
Those who are related to the genetics of the Embryo, like for example the changes in the karyotype of the parents and chromosomal changes due to the age of the mother and/or sperm related illnesses. More and more studies relate the age of the father over 45 and the decreasing sperm quality.
Immunological or coagulation disorders in the expectant mother, such as antiphospholipid syndrome, are one of the main causes of miscarriages of known origin.
Infections in the 1st trimester, such as the cytomegalovirus, toxoplasmosis or rubella can also be a trigger for abortion.
Other easily identifiable causes of miscarriage can be uterine malformations, cervical incompetence or even the presence of fibroids in the uterine cavity.
As for the unknown causes, we know that a large percentage of cases of repeated miscarriages do not reveal a cause.
How can repeated miscarriages be avoided?
In order to avoid repeated miscarriages, different tests need to be done and factors to be taken into account:
We will first examine the parents’ blood karyotypes. Sometimes PGT-SR (Preimplantation Genetic Testing for Structural Diseases) can be carried out to provide preimplantation genetic diagnosis to rule out structural changes. Some of these chromosomal abnormalities affect the viability of the embryo, resulting in non-implantation or abortion, and others would lead to diseases in the future baby.
We can also perform the PGT-A genetic test before implantation. Using a non-invasive biopsy on the embryo, we perform a genetic study to detect aneuploidies associated with advanced maternal age and/or pathological sperm. In this way, we can select the embryos with the greatest capacity for implantation and achieve a viable pregnancy.
Serologies at the beginning and before treatment are also necessary to exclude pathologies already mentioned in this article, such as rubella, cytomegalovirus and toxoplasmosis.
We will carry out a study using ultrasound or hysterosalpingography (HSG) – a test that assesses the shape of the uterus and checks if the fallopian tubes are permeable – to rule out uterine malformations and/or fibroids.
It is also important to carry out a study of thrombophilia or blood clotting disorders, as they tend to form clots or thrombi.
Another great ally against recurrent abortions is the ER Map Endometrial Receptivity Test. The ER Map test allows us to analyse the sensitivity of the endometrium in order to choose the best day to carry out the embryo transfer. Recent studies show that the condition of the endometrium is almost as important as the quality of the embryo for implantation.
Other risk factors
There are other factors that can threaten the development of a pregnancy by increasing the rate of abortions and complications during pregnancy. One example is maternal obesity, associated pathologies such as arterial hypertension or diabetes, but also multiple pregnancies. This is why, in IVF Spain, we have the technology and experience to transfer a single embryo without compromising our success rates.
On the other hand, we are often asked by patients about causes such as quality of life and stress, and although the studies are inconclusive, it seems that these lifestyles have a direct influence on pregnancy loss. For this reason, we recommend that you live as physically and mentally healthy a life as possible in the first few weeks, especially after the transfer and after confirmation of the implantation and the pregnancy.
The personalisation of each process
At IVF-Spain we believe that our ability to give a reproductive response to each patient arises from the individualisation of each process. That is why we do not believe in master formulas and we believe in offering the patient a treatment plan that meets his needs.