Recurrent Pregnancy Loss

How can one overcome recurrent pregnancy loss? 

Pregnancy loss is a distressing experience. It is especially devastating when the losses are repetitive. Loss of pregnancy is physically and emotionally challenging. Until recently, there was little a couple could do if they suffered from so called ‘unexplained recurrent pregnancy loss’. Research, however, has provided information on the causes of the heretofore unexplained pregnancy losses, resulting in availability of treatment that enables women to carry their pregnancies to term.

Q. What are the causes of implantation failure?

An embryo may not implant because there is something wrong with the embryo itself. There may be something in the uterine environment that does not allow a normal embryo to implant. It could also be a combination of these factors.

Q.How can one determine whether there is a problem within an egg?

Problems within eggs can manifest clinically as diminished ovarian reserve or premature ovarian failure. Diagnostic tests useful for identifying individuals at greater risk for diminished ovarian reserve or premature ovarian failure include

  1. Hormonal analysis for Follicle Stimulating Hormone [FSH],
  2. Estradiol and Inhibin
  3. Antiovarian antibodies [AOA]
  4. How can one determine whether there are problems within sperms?

Problems within the sperm that are not diagnosed by the standard parameters of semen analysis can be detected through sperm function tests, sperm DNA integrity assay [SDla], and Y chromosome microdeletion assay.

Q.How can one determine anatomical problems within the uterus ?

Problems within the environment in which the embryo implants and fetus grows have been classified as anatomic , hormonal and immunologic.
Anatomic abnormalities of the uterus can be diagnosed by :-

  1. Hysterosonography [ultrasound evaluation of the uterus after fluid is injected] or
  2. Hysterosalpingography [X-ray with instillation of dye into the uterus and fallopian tubes]
  3. Hysteroscopy [telescopic evaluation of the uterine cavity]
  4. How can we determine problems of the hormonal response of the uterus?

The hormonal response of the uterus can be diagnosed with the aid of ultrasound.

  1. Transvaginal ultrasound examination of the lining of the uterus around the time of ovulation.
  2. Color Doppler flow studies to evaluate blood flow to the lining of the uterus.
  3. How can the immunologic factors causing implantation failure be diagnosed ?
  4. Antiphospholipid Antibody [APA] Panel – Antiphospholipid antibodies have shown to kill pre-implantation embryos. They also interfere with angiogenesis
  5. Antinuclear antibody [ANA] panel – Antinuclear antibodies have also been shown to be embryotoxic.
  6. Antithyoid Antibody [ATA] Panel :- Antithyroid antibodies have no direct effect on preimplantation embryos, but are a marker of activated T cells in the lining of the uterus.
  7. Reproductive Immunophenotype [RIP] measures circulating levels of NK cells. Elevated NK killing activity [greater than 10%] has been associated with implantation failure.
  8. Natural Killer Cell Activity [NKa] assay – measures killing activity with NK cells. Elevated NK killing activity [greater than 10%] has been associated with implantation failure.
  9. Embryotoxicity Assay [ ETA] measures circulating substances that kill preimplantation embryo.
  10. Immunoglobulin [Ig] panel – Elevated levels of immunoglobulin particularly immunoglobulin M, have been associated with implantation failure. Also the immunoglobulin panel will detect deficiencies in IgA which can be a contra indication to the use of IVIg if anti IgA antibodies are present.