Blog post written in collaboration with our partners Embryoclinic.
It’s nice to think about the success stories in recurrent miscarriages cases, but it’s a difficult topic to tackle. It’s very sensitive and requires attention and care on how it’s presented to people. Addressing a non-medical audience is a challenge because patients need useful information more than they need hopeful information.
The definition of recurrent miscarriages is the loss of two or more pregnancies. These cases aren’t rare, and they must be systematically and holistically addressed by a qualified team to better understand and treat them. To see the whole problem is to know where and how to start addressing it. If we add more factors to the recurrent miscarriages, like age, recurrent IVF failure, a diagnosis, high-risk lifestyle, of course the situation can be better explained. So, when talking about miscarriages the whole history of the patient needs to be mentioned – what works for some does not work for everyone.
Reasons for recurrent miscarriages
The main reasons for recurrent miscarriages/IVF failures fall on the female side and on the male side.
On the female side we have:
hormonal reasons (e.g., thyroid or other defects, PCOS,…)
lifestyle issues (e.g., heavy smoking or drinking, high BMI, pollution,…)
On the male side we have semen-related reasons (analysis and culture), genetic reasons and hormonal reasons like on the female side but with different implications and presentations of course, and DNA fragmentation tests and Y microdeletion tests might also need to take place.
The female anatomy is composed by the uterus, the fallopian tubes, and the ovaries. It is of upmost importance to highlight the impact female anatomy can have in recurrent miscarriages. A female anatomical assessment is without question needed when presented with a recurrent miscarriage scenario and should be done in all patients before starting fertility treatment.
Success Story: uterine malformation
A patient in her mid-40s arrived at the clinic with multiples IVF failures and miscarriages. She was diagnosed with uterine malformation. This was addressed with a hysteroscopy. And she ended up having twins. The moral here is that it may be commons practice to do so, but an ultrasound scan isn’t the only way to assess the female anatomy and should not be the only tool used in recurrent failure cases.
Success Story: hydrosalpinx
A patient in her mid/late-40s arrived to the clinic with a case of recurrent miscarriages. She was diagnosed with hydrosalpinx, meaning that fluid had accumulated in her fallopian tubes, which was addressed with laparoscopy and she had two children consecutively. A hysterosalpingogram, or HSG, can show tubal blockages, but most EU and US clinics don’t have it as a standard test before IVF or after miscarriages.
Success Story: Endometrial Adhesion
A patient arrived to the clinic with a past history of miscarriages and has developed endometrial adhesion that were then divided. She got pregnant naturally. Despite why a woman isn’t being able to conceive, the miscarriage itself may cause damages and hinder later attempts. These damages have to be assessed prior future treatment attempts.
After how many miscarriages should a patient give up on IVF treatment?
Sometimes patients have to stop IVF treatment due to their advanced age or financial strains. However, for people to whom these factors don’t apply, first it’s important to run diagnostics on the egg/sperm/embryo, re-do full blood testing, check for blocked tubes, verify the quality of the implantation environment, look for conditions patients’ may have developed – exhaust diagnostics to understand why it hasn’t worked, make sure it’s medically advised to keep trying and be realistic with the chances that patient has. If someone over 40 has had 3-4 miscarriages with their own eggs, perhaps performing IVF with their own eggs after a PGT-A to make sure they are chromosomally normal – euploid – is the way to go, but then, especially if they are in their late-40s, consider donor eggs.
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