Habituelle aborte - recurrent miscarriages
A miscarriage is the dying of the embryo or the premature birth of a child before it achieves the ability to survive independently. Miscarriages are a frequent occurrence: about 8% of all pregnancies terminate prematurely. After IVF treatment the miscarriage rate is even higher.
The definition of recurrent miscarriages is applicable after three abortions have occurred in a continuous sequence (defined by the WHO = World Health Organization).
Which examinations are meaningful?
Examination of the uterus
A malformation of the uterus or benign growths (mucous membrane polyps within the uterine cavity) can inhibit the blood circulation of the endometrium and thereby prevent the nidation of the embryos or negatively impact the development of the embryo after successful nidation. With the help of a hysteroscopy, this can be detected and treated. During this examination a camera is inserted into the uterine cavity. In some cases, an additional laparoscopy is necessary.
Genetic abnormalities occur in approximately 3 to 5 % of couples who are experiencing recurrent miscarriages. Most frequently, these are so-called “translocations”, a “transfer” of genetic information within a chromosome pair. This may be present in the woman or in the man and does not result in any health problems. However, after the fusion of egg and sperm cell, this may lead to repeated miscarriages. Although in this case there are no available treatments, it is at least reassuring to find the cause for the miscarriages. Human genetic testing by a specialist can help clarify a couple’s chances of a normal pregnancy and the probability of a renewed miscarriage. If the woman wishes to fall pregnant, a diagnosis (e.g. a trophectoderm biopsy before inserting the embryo) should be considered.
Hormone dysfunctions can be identified in women suffering from recurrent miscarriages, like for example a lack of progesterone in the second half of her cycle. An increased LH value (LH = luteinizing hormone, which triggers ovulation) is also related to miscarriages. This imbalance in the hormonal system can be treated. A hormone assay between day 1 and day 4 of the cycle therefor is part of every miscarriage diagnosis. This not only determines the sex hormones, but also serves to check the thyroid gland function.
Examination of the blood clotting
Changes in the blood clotting can also trigger a miscarriage. This is because the blood circulation of the placenta can be disturbed by the smallest blood clot. A special blood test can examine the function of various blood clotting factors. Women affected by this are advised to take blood thinners during the pregnancy, in order to prevent a further miscarriage.
Searching for special antibodies
Approximately 20% of all women who suffer from the so-called “antiphospholipid syndrome” may suffer from recurrent miscarriages. These women have certain antibodies in their blood that negatively affects the blood clotting, and therefore disrupts the healthy development of the pregnancy. Here the women are also advised to take blood thinner during the pregnancy.
Infections in the female genital tract are less often considered in the case of recurrent miscarriages. In an advanced pregnancy it can however lead to premature contractions and in turn to a premature delivery. A vaginal smear can be taken to diagnose the infection. Treatment is carried out using special antibiotics that can be taken without hesitation during the pregnancy.
A definite cause for recurrent miscarriages can only be found for about 50% of the couples. And not every cause can be treated. This may appear very disappointing, yet still 75% of the affected women sooner or later give birth to a healthy child.