Do things differently
Many women who have suffered recurrent miscarriage and IVF failure have not been given clear reasons why this has happened but are persuaded to keep repeating the same unsuccessful process. With their fertile time often running out, it is important for them to consider other options. It is essential to look at what else can be done to help improve women’s chances and support them through a very stressful process and not just see it as a numbers game and persisting with the same one-size-fits-all treatments.
Spontaneous Abortions and Biochemical pregnancies
Miscarriage, also known as spontaneous abortion or pregnancy loss, is the natural death of an embryo or fetus before the 23rd week of gestation after visibility by ultrasound. These miscarriages are classified as clinical miscarriages.
Biochemical pregnancy is the death of embryos after implantation in the uterus before visibility by ultrasound but secretion of pregnancy hormone (BETA hcg) has taken place and was able to be detected in the mother’s blood stream. These miscarriages are classified as preclinical miscarriages and may account for 50-75% of all miscarriages.
In fact, between 50% and 60% of all first-time pregnancies are thought to end in miscarriage - a large majority of which can be attributed to biochemical pregnancies. An accurate number is hard to determine because most women who experience a biochemical pregnancy never even realize they are pregnant unless they are trying to conceive and testing regularly and early.
Many biochemical pregnancies are discovered today that would otherwise have gone undetected due to the ultra sensitive pregnancy tests on the market, which make it easier to get a positive result 3 or 4 days before a woman’s period is due. Additionally, it has been established that as many as 25% of pregnancies fail even before the woman has any subjective indication that she is pregnant, that is, before she misses her menstrual period or has symptoms of pregnancy .
Data on miscarriages are not complete, as many occur outside of hospital, and consequently, are not recorded. A woman who has had a previous miscarriage has a 25% chance of having another (only a slightly elevated risk than for someone who has not had a previous miscarriage).
Immune mediated miscarriages
Initially, recurrent spontaneous abortions (miscarriages) were considered to be due either to chromosomal aberrations of the fetus that are incompatible with its development or to maternal causes as uterine anatomical abnormalities, hormonal or metabolic disturbances, hereditary thrombophilia, and infectious agents. When all the above causes of miscarriages were excluded, the miscarriages were characterized as “unexplained miscarriages”. During the last 25 years, it has become clear that a large percentage of unexplained RSA may be due to immunological causes. About 50% of pre-clinically lost embryos and 95% of those clinically lost in women with RSA have a normal karyotype and most of these losses may be of immune etiology. Immune-mediated abortions are characterized by either autoimmune or of alloimmune disturbances. In autoimmune abortions, the development of the placenta and the embryo is affected by maternal autoantibodies and autoreactive cells, which target decidual and trophoblastic molecules. In alloimmune abortions, the maternal immune system reacts against the embryo and damages trophoblast through allogeneic, rejection-type reactions. Clinically, both of them represent a broad immunological imbalance that leads to pregnancy loss.
