Will IVF help with recurrent miscarriage?
Pregnancy loss is a sad event in the life of a woman. The problem is multilevel, affecting to varying degrees physical and to a large extent psychological health. Also this event can become a serious unplanned crisis in family relationships. This article aims to comprehensively answer women’s questions about miscarriage: about causes of multiple miscarriages, treatment for recurrent miscarriage, prospects of pregnancy after multiple miscarriages and whether IVF will help after a recurrent miscarriage.
Loss of pregnancy: causes, treatment and prognosis
To understand the scale of the problem, here are statistics: from 15 to 20 percent of diagnosed pregnancies end in spontaneous termination. That is about one in five. These figures refer to pregnancies that the woman was aware of (from a test or medical examination). The data does not include interruptions that occurred at a time when the woman was not yet aware of her situation. In this case, the symptoms of fetal loss are often mistaken for abundant menstrual days in combination with their delay.
In this way, pregnancy loss is not a rare phenomenon. And depending on the gestational age and reasons, it requires a different approach and has different predictions. Therefore, it is important to understand the classification: according to WHO, interruptions from conception to 22 weeks mean spontaneous abortion (miscarriage), after 22 weeks it is premature birth. Here is a more detailed classification:
- Early miscarriages before 12 weeks of gestation.
- Late miscarriages between 12 and 22 weeks of gestation.
- Premature birth (interruption of gestation between 22 and 37 weeks).
Of 15-20% of terminated pregnancies, about 75-80% are early miscarriages caused by fetal chromosomal abnormalities that are most often fatal. That is, most of the spontaneous abortions are a natural mechanism for the removal of non-viable fetuses. That does not negate the need for examination and, if necessary, treatment of identified pathologies. In the future, a woman will be able to carry pregnancy and give birth to a healthy child.
With satisfactory medical examination results recurrent pregnancy loss at an early stage requires more attention. Multiple failed pregnancy (from 3 or more cases) is called “recurrent failed pregnancy”.
Important! According to statistics, the risk of recurrent miscarriage after the first miscarriage is 13-17%, that is, the risk generally corresponds to the frequency of miscarriage in the population. After two spontaneous abortions, the risk of recurrent pregnancy loss increases by more than 2 times – up to 36-38%. In the case of several consecutive stillbirths (primary recurrent failed pregnancy) after the third spontaneous abortion, the probability recurrent miscarriage reaches 40-45%.
Causes of multiple miscarriages in early pregnancy
Among causes of multiple miscarriages in early pregnancy the main place is occupied by a chromosomal problem connected with the genes of the parents. Expectant mom and dad need genetic consultation. Tell the specialist family history: cases of recurrent miscarriages in relatives, hereditary diseases, oncology, etc. Maybe in your case with recurrent miscarriage, IVF will help to become parents. If genetic pathologies are sex-linked, then the creation and implantation of an embryo of a certain sex will help to carry pregnancy without problems.
Other reasons of multiple miscarriages in early pregnancy:
In the structure of endocrine factors associated with recurrent failed pregnancy, defective luteal phase (NLF), hyperandrogenism, and thyroid pathology predominate. Proportion of endocrine factors among reasons for recurrent miscarriage is 8-20%.
Statistics: in women with NLF recurrent pregnancy loss very often happens at 7-9 weeks of gestation. With hyperandrogenism, if the pregnancy is not terminated in the first trimester, 40% of women have a high risk of isthmic-cervical insufficiency (ICN), and at 24-26 and 28-32 weeks – severe placental insufficiency, impaired fetal development, sometimes leading to the loss of a child. In the pathology of the thyroid gland, the association of autoimmune thyroiditis with recurrent loss of pregnancy has been proven in several randomized trials.
Infectious factors that provoke recurrent pregnancy loss include mainly STIs (gonorrhea, ureaplasmosis, chlamydia), as well as enteroviruses, cytomegaloviruses, herpes simplex virus. Ascending infections can lead to preterm labor.
Statistics: with an infectious factor in 52.5% of women cause of recurrent pregnancy loss became a viral-bacterial flora. In 20% of cases, a monoinfection was diagnosed, in the rest – several infections. Anembryonia was often combined with myco- and ureaplasmas (42.8%), gonococci (33.3%), chlamydia (23.8%). In 60–70% endometritis could be one of causes of multiple miscarriages, and in 87% the cause of frequent miscarriages was associated with the persistence of opportunistic microflora in the endometrium.
Immunological causes of recurrent pregnancy loss represent the mother’s immune response against fetal antigens against the background of alloimmune disorders. Histocompatibility of parents, decreased production of alloantibodies to paternal leukocytes, increased content of cytotoxic cells in the endometrium are typical immunological causes of multiple miscarriages.
Thrombophilia also become causes of multiple miscarriages in early pregnancy (antiphospholipid syndrome in 27-42% of cases of recurrent miscarriage).
Statistics: Another common cause of multiple miscarriages is sensitization to progesterone – the emergence of autoantibodies to it can occur after previous reproductive losses or taking progesterone preparations. In the group of patients taking progesterone preparations, the emergence of autoantibodies that provoke multiple miscarriage, was recorded in 76.9% of observations.
Anatomical causes of recurrent miscarriage:
- Congenital anomalies in the development of the uterus (intrauterine septum; bicornuate, unicornuate, double uterus);
- Acquired anatomical defects (intrauterine synechia, uterine fibroids);
- ICI (organic and functional).
In the group of patients with recurrent failed pregnancy, the frequency of congenital anomalies of the uterus reaches 10-15%. Such pathologies, together with concomitant ICI, become cause of frequent miscarriages in the second trimester of pregnancy.
Important: Congenital anomalies in the development of the uterus are often accompanied by disorders of the ovarian-menstrual cycle. Telling about this problem to a doctor increases the chances of their timely diagnosis and treatment.
Intrauterine synechiae are formed in most cases as a result of surgical interventions (abortions, diagnostic curettage) or due to endometritis. They can become causes of multiple miscarriages, and in case of severity in combination with scars of the basal layer lead to persistent infertility.
Current prediction of pregnancy after recurrent miscarriage against the background of uterine fibroids depends on the location and parameters of the nodes. Large intermuscular and submucosal nodules or uterine fibroids in combination with endometriosis have an unfavorable prognosis and often become causes of frequent miscarriages.
Cause of multiple miscarriages in the second trimester of pregnancy often becomes ICI. This pathology accounts for 40% of cases, it occurs in every third case of premature birth. There are two types of ICI: organic and functional.
Organic or secondary, post-traumatic ICI occurs after curettage, traumatic childbirth, vaginal delivery operations. The reasons for the functional are not exactly established. Often it develops in women with hyperandrogenism, as well as in patients with genital infantilism and malformations of the uterus. ICI is expressed in shortening, softening and opening of the isthmus and cervix. In 40% of cases, the condition is associated with hyperandrogenism.
If all of the above causes of recurrent pregnancy loss are excluded – the etiology of failed pregnancy is idiopathic (unspecified). In this way, recurrent miscarriage treatment should begin with a complete and comprehensive examination.
The encouraging news is that pregnancy after recurrent miscarriage is possible in the vast majority of women with proper treatment. Even healthy pregnancy after multiple miscarriages can occur. Spontaneous abortions more than three times occur in only 1% of cases and are also surmountable
It is recommended to plan pregnancy after recurrent miscarriage not only after the examination and therapy of the identified pathologies, but also after a ususal analysis of the lifestyle. Poor working conditions, night shifts, bad habits, adverse radiation conditions can also weaken the body and provoke miscarriage. The likelihood of successful conception and delivery also tends to decrease with maternal age.
Recurrent miscarriage: will IVF help?
When the next pregnancy after multiple miscarriages ends in spontaneous abortion, many women begin to seek information: Will IVF help with recurrent miscarriage?. The answer is yes, but only in the case of a genetic factor.
IVF for recurrent miscarriage is effective in the case when its cause is in the chromosomal pathologies of the embryo. Multiple cases of embryo formation with genetic pathologies indicate the need for pre-implantation genetic diagnosis. And as a result – in vitro fertilization.
Embryologists carefully select healthy germ cells of future parents, create many embryos, and examine their chromosome set. Embryos without pathologies, the most promising in terms of implantation, are selected for transfer. This is the logic of turning to IVF for recurrent miscarriage.
However, this does not guarantee that developmental anomalies are completely excluded. In the process of development of the embryo, the formation of its organs and systems, disturbances can also occur and, as a result, serious diseases that can lead to miscarriage at a later date. That is why IVF and recurrent miscarriage also occur in the practice of reproductive specialists.
IVF and recurrent failed pregnancy: what if again?
Studies show that the risk of miscarriage with IVF and natural conception is the same. The same factors that are described in the first part of this article lead to the termination of a pregnancy achieved with the help of IVF. However, the age of the mother plays an important role. The sooner a woman who has problems with achieving pregnancy and / or gestating, turns to reproductive specialists, the higher the chances of implanting even an absolutely healthy embryo. Nevertheless, it cannot be argued that the cause of chromosomal abnormalities in the fetus is associated solely with the age of the mother.
Studies have shown that young women under 35 with a history of two or more pregnancy losses more often than women with one spontaneous abortion (52 vs. 28%, respectively) have chromosomal abnormalities of the embryos. This can be explained by a genetic predisposition to disturbances in the processes of oocyte division, which manifests itself regardless of the woman’s age and leads to a high frequency of embryonic chromosomal pathologies.
Based on research data, Feskov Human Reproduction recommends PGD and IVF in cases of recurrent failed pregnancy. This will help increase the chance of a successful pregnancy by creating a healthy embryo. And the control of pregnancy by our doctors will serve as an additional guarantee that everything will be fine.