Recurrent unexplained Losses -How to proceed ?

 

Honestly speaking even after many tests aiming at etiological diagnosis many a case of such recurrent pregnancy loss-sadly no aetiology can’t be ascertained (about 50%) However following tests may be offered to the couple.
In the woman:-

1) Acqd Thrombophilia,(Level 1+evidence),

 2) Inherited Thrombophilia(Level 2+). 3) Anatomic defects of Uterus( Level ¾).

 4) Infective cause (level -3),

5) Endocrine Disorders (Level-3) .including PCOS and Low Ov reserve ; 6) Chromosomal aberration of Developing Embryo (level 4)

7) Environmental Pollutants.

8) Psychological cause is considered one of the imp. -TLC concept”-Psych-Neuro-Endocrinology “ in continuation of Preg. As few hrarsh words from mother in Law may hurt her and be an etiologic factor

9) Impaired expression of HLA antigens.

10) Hcst.(homocysteine).
• B) Causes in the Male: - Chromosomal Defects / Deletion disorders in genes, 2) Pollutants & Drug abuse-Life style disorders-Smoking etc.
•  For male factor defect : Cryofreezing-Selection of best embryo/ Delayed transfer –PGS may of help

C)  Combined defect in both partners: -

 1. History:- What to ask for : family tree –Pedigree tracing : Geneticist opinion of –both partners ,Smoking, Alcohol intake, & other Addictions , Environmental pollutants including Workplace toxins, Regular ingestion of teratogens for some systemic diseases including drugs for depression & Psychiatric diseases Diabetes mellitus, Hypothyroidism, etc.. , Abnormal sperm morphology, Food habits,

 

 

 An aberrant immune response – either auto- or alloimmune – has been postulated to underlie some cases of ‘unexplained’ infertility, in vitro fertilisation (IVF) failure and recurrent miscarriage. Despite a paucity of evidence, a variety of immune tests and treatments for reproductive failure have been introduced into clinical practice.

 Sadly, in some cases the etiology even if diagnosed are not always modifiable-!! Such unfortunate causes of preg loss are genetic, emotional, endocrinological, anatomic (partly modifiable) most importantly, immunologic causes !!