Specialised Unit for Implantation Failure and Repeated Miscarriage
On some occasions we have good quality embryos but a viable pregnancy is not achieved due to repeated implantation failures. In other cases, pregnancy is achieved but does not progress due to repeated miscarriage.
In order to approach these reproductive problems, our fertility centre has a specialised unit for Implantation Failure and Repeated Miscarriage, where specific tests are applied to diagnose the cause of these complex cases related to unusual pathologies and infertility of an unknown origin.
The study of the causes of repeated miscarriage (RM) is aimed at patients with a loss of two or three consecutive gestations before week 20 of pregnancy, with a foetal weight of 500g or less, personalising each case and considering different factors such as the woman’s age, the circumstances around the early pregnancy loss or personal and family history, among others.
Genetic causes and treatment
The fundamental causes of RM are due to genetic factors and antiphospholipid syndrome. Genetic anomalies and chromosome alterations in the embryo cause 50% of miscarriages. Maternal age is the most common cause of infertility, as the higher the age the lower the quality and quantity of oocytes.
The HLA Vistahermosa Reproduction Unit completes the embryo study with advanced Pre-implantation Genetic Diagnostics, as well as chromosome analysis to enable optimal embryo selection or determine the implantation capacity of the woman to bring the pregnancy to full term.
Pre-implantation Genetic Testing is a set of the latest techniques used to carry out a genetic embryo study before implantation in the maternal uterus, with the objective of selecting those embryos that are free of chromosome alterations.
The male and female karyotypes are used to guess if there are any structural alterations in any of the chromosomes with a predisposition to miscarriage. In men, tests such as FISH are carried out, which allows for visualisation, distinction and study of chromosomes and anomalies which may occur, as well as fragmentation of sperm DNA.
In women, image analysis through hysterosalpingography, ultrasound or hysteroscope is carried out to study the anatomy of the uterus allowing malformations to be ruled out such as the uterine cavity being divided in two parts by a central septum, myomas, polyps, fibromas, adhesions in the scar tissue or cervical insufficiency, which occurs when the neck of the uterus is unable to support the pregnancy, opening prematurely and leading to loss.
Immunological causes and treatment
Another cause of repeated miscarriage is related to alterations in the immunological system of the mother leading to an anomaly response during the pregnancy and and the foetus being attacked as it is considered to be a foreign body.
During gestation, implantation begins in the woman’s body with the growth of a different being from the genetic material from the mother and father. On certain occasions, maternal tolerance can be altered putting the development of the foetus at risk. It is important that a state of tolerance occurs between the mother’s immune systems and the embryo so that the pregnancy develops successfully.
Antiphospholipid syndrome leads to alterations in the maternal blood coagulation which impede the formation of the placenta or the development of the foetus, which demands a multi-disciplinary medical and obstetric approach, as well as a therapeutic intervention based on a combination of acetylsalicylic acid and low weight molecular heparin injections.
Treatment is based on patient characteristics and the associated pathology. The medical solution to these immunological problems causing embryo implantation failure is very complex. The different factors impeding correct implantation must be jointly evaluated on a case by case basis. Our specialised Reproductive Immunology unit studies metabolic, immunological and endocrinological mechanisms which appear in the decisive phase of the pregnancy and later find the appropriate treatment for each couple.
Current medical, biological and technological advances help us to identify the causes of repeated miscarriage and apply the most appropriate treatment to enable our patients achieve their dream of becoming parents.
How to detect immunological problems
Studies that are carried out to try to guess the immunological causes of implantation failures highly depend on the patient’s clinical history, but in general, an immunological study is carried out to study:
- Endometrial defences known as Natural Kills (NK) which help to connect the mother and embryo’s blood vessels.
- Alterations in blood immunoglobulin anti-bodies.
- Cytokines and interleukins that act in the activation of lymphocytes.
- A maternal/ embryo compatibility study through the genotype of the maternal KIR and the paternal HLA-C.
The medical solution to the immunological problems causing embryo implantation failure is very complex. The different factors impeding correct implantation must be jointly evaluated on a case by case basis. Our specialised Reproductive Immunology unit studies metabolic, immunological and endocrinological mechanisms which appear in the decisive phase of the pregnancy and later find the appropriate treatment for each couple.