Re-abortion of pregnancy
Publication date: 28.01.2020
Repeated abortion (repeated reproductive loss, habitual interruption, RPL syndrome) is a very urgent problem. Its prevalence in the general population is 1-2%, and half of this percentage is inexplicable, since the causes are many.
Repeated abortion is diagnosed in the first trimester of pregnancy, it develops in 15-25% of pregnancies. According to anamnestic data, 5% of women have 2, and 1% have 3 or more clinically confirmed abortions. According to available data, the main reasons for the usual termination of pregnancy are: acquired and congenital thrombophilia, hormonal-metabolic disorders, infections, autoimmune disorders, sperm quality, lifestyle, psychogenic factors.
Sporadic loss develops before 10 weeks of gestation, sporadically interrupted pregnancies are mainly due to chromosomal abnormalities (trisomy, monosomy, polyploidy). In the diagnosis of conventional abortion, it is recommended to determine the sex karyotype of the couple in order to diagnose balanced structural and chromosomal abnormalities.
AGE OF THE WOMAN
The age of a woman is very important in the development of repeated reproductive losses. A female embryo of any age is at risk of aneuploidy (a change in the number of chromosomes). Its risk is known to increase with maternal age. If the mother’s age is up to 35 years – 30%, up to 42 years – 85%. There are a number of violations that can be eliminated with timely diagnosis. With a cytogenetic disorder, the problem can be solved only with the help of assisted reproductive technologies (in vitro fertilization) and preimplantation genetic screening. Almost half of the embryos obtained as a result of in vitro fertilization have chromosomal aneuploidy, and this number increases with increasing maternal age.
Almost half of the embryos resulting from the cycle have chromosomal aneuploidy. At the same time, this number increases with the age of the mother. Aneuploidy leads to unsuccessful implantation, and if implanted successfully, it can lead to premature termination of pregnancy – spontaneous abortion. Such a pregnancy can also end in childbirth, although the child may have physical and mental developmental disorders, the most common of which is aneuploidy – Down’s syndrome.
PREIMPLANTATION GENETIC SCREENING
The normal number of chromosomes of the embryo is important for the successful course of pregnancy, the traditional method of selection of the embryo is a visual assessment of the shape and structure of the embryo (morphology). With this method, the number of chromosomes of the embryo is not determined.
Preimplantation genetic screening allows you to select and transfer only one embryo instead of several, with a normal chromosome set. At the same time, we laugh at the complications associated with multiple pregnancies. Preimplantation genetic screening is an important part of in vitro fertilization, as it increases the chances of successful implantation and reduces the risk of miscarriage, the probability of pregnancy increases by 2.5 times, and in the case of advanced age of the mother, the probability of implantation decreases. 2.3 times higher, 1.7 times more likely to become pregnant Women with habitual abortion/recurrent reproductive loss are 1.6 times more likely to become pregnant with male infertility.
SEMEN ANEUPLOIDY TEST
1. Determines the genetic factor of male factor infertility
2. Quantitative change of chromosomes
3. Allows identification of males with a low reproductive chance.
4. Provides personalized patient management prior to in vitro fertilization.
5. In vitro fertilization, transfer an embryo with a normal chromosome set and, accordingly, reduce the risk of abortion.
Antiphospholipid syndrome (acquired thrombophilia) is one of the main causes of recurrent miscarriage. 15% of common abortions occur for this reason. Very often, antiphospholipid syndrome is associated with the development of preterm labor, as well as malformations of the uterus.
Even in the case of a normal abortion that developed in the first trimester, doctors recommend assessing the anatomical features of the uterus … magnetic resonance imaging, 3D ultrasound are recommended for diagnosis. In the case of a uterine septum, hysteroscopic resection may be partially successful.
Congenital thrombophilia (leidin factor 5, mutation of the prothrombin gene, mutation of the MTHFR gene …) can be called one of the causes of RNP. Both the patient’s history (venous thromboembolism) and a severe hereditary history should be taken into account.
Maternal endocrine dysfunction -. Thyroid dysfunction, uncorrected diabetes mellitus, hyperprolactinemia are also an important factor in the development of repeated reproductive losses. According to one study, the fertility rate in the case of treatment of hormonal dysfunction is 85.7%, and without treatment – 52.4%. The role of other types of hormonal dysfunction in the development of GDR has not been fully confirmed.
Late implantation can be considered as a cause of delayed pregnancy, and a shortened luteal phase is also somewhat associated with a risk factor for delayed pregnancy, although identifying a suspected incomplete luteal phase is problematic.
At present, it is possible to examine the endometrial aspirate in the genetic laboratory, where we are given information about the reception of the endometrium and the favorable period for implantation (reception test). This study allows personalization of patient care.
SEXUALLY TRANSMITTED DISEASES
The infectious factor, in particular sexually transmitted infections, is very often diagnosed with repeated reproductive losses in women. There are no studies indicating that chronic endometritis is the cause of unsuccessful in vitro fertilization, and can also be considered as a cause of recurrent pregnancy loss. There are tests that examine endometrial aspirate. It allows both to identify chronic endometritis and to identify an imbalance in the microflora of the endometrium.