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Recurrent miscarriages, pregnancy, and IVF

Let’s state some interesting facts. Around 15-20% of pregnancies end up in miscarriage, but usually, that doesn’t mean there is any underlying genetic or reproductive issue. It is also estimated that less than 5 out of 100 women will experience 2 miscarriages in a row. Even after two miscarriages, there’s a 65% chance your third pregnancy will end in a live birth. However, about 0.5% of women will experience a third consecutive loss, which might indicate a reproductive problem. Therefore, a full medical examination is recommended after two or more losses, for the couple to understand what and why it is happening and reduce the extra stress that might add up to the equation.

Types of recurrent miscarriages:

The two biggest categories that miscarriages are divided into are early and late.

  • Early: They happen in the first trimester of the pregnancy (up until 13 weeks of it) and usually they occur due to genetic or chromosomal problems of the embryo, with 50-80% of spontaneous losses having abnormal chromosomal numbers. Structural problems of the uterus can also play a role in early miscarriage.
  • Late: They can be the result of uterine abnormalities, autoimmune problems, an incompetent cervix, or premature labor.

Causes of miscarriages:

The most common cause of a miscarriage is the chromosome abnormalities that happen during fertilization. This type of genetic problem happens by chance, and there is not any underlying medical condition that causes it. This type of loss increases with a woman’s age.

Some couples may experience miscarriage because one partner has a chromosome in which a piece is transferred to another chromosome. This is called translocation. People who have a translocation usually don’t detect any symptoms, but some of their eggs or sperm will have abnormal chromosomes. If an embryo gets too much or too little genetic material, it often leads to a miscarriage.

Medical conditions that may result in recurrent miscarriages:

  • Certain congenital problems of the uterus. Although there are many such disorders, one of the most common that has been linked to miscarriage is a septate uterus. In this condition, the uterus is partially divided into two sections by a wall of tissue.
  • Asherman syndrome. This condition causes adhesions and scarring in the uterus.
  • Fibroids and polyps. These are benign (noncancer) growths of the uterus.
  • Antiphospholipid syndrome (APS). This autoimmune disorder that affects blood clotting can cause a variety of medical problems. APS can occur alone or with other autoimmune diseases, such as lupus.
  • Diabetes mellitus. Diabetes, especially if the disease is poorly controlled, can increase the risk of pregnancy loss. Keeping blood sugar levels in the normal range before pregnancy and throughout pregnancy can decrease the risk.
  • Thyroid disease. Problems with the thyroid gland that are not treated can increase the risk of miscarriage. Treating thyroid problems can decrease the risk.
  • PCOS.

Diagnosis of multiple pregnancy loss:

According to the NHS, if a woman had 3 or more miscarriages in a row (recurrent miscarriages), further tests will be used to check for any underlying cause. However, no cause is found in about half of cases.

Usually after a third miscarriage in a row, doctors will suggest proceeding with karyotyping testing. Karyotyping is a type of genetic test that can detect some kinds of chromosomal abnormalities. To perform a karyotype miscarriage test, cells from miscarriage tissue must be grown in the lab. When the cells reach a certain stage, the chromosomes are extracted and stained, and then a microscope is used to identify and count them.

Another testing may involve a pelvic examination, blood tests, or any other physical exams of the woman and the man involved in the conceiving process. 

Treatments available:

In cases of fibroids or septum in the uterus, doctors will suggest surgery to correct the issue. The surgery is aimed at correcting the structure of the uterus so that the fetus has enough space to grow and develop fully. Such surgeries are typically conducted with the help of a hysteroscopy.

In cases of diabetes, thyroid dysfunctions, or other immune system disorders, medication is suggested. 

IVF with PGT-A.

PGT-A (preimplantation genetic testing for aneuploidy) is the process that determines which embryos are chromosomally normal, and it occurs during an IVF cycle. 

To do PGT-A, embryologists remove a cell, or if at a later stage, several cells, from the embryo, which is then tested for any chromosomal abnormalities. The embryo can still develop with fewer cells if the removal of cells is done carefully.

PGT-A is traditionally offered to women over 37, patients who have had several miscarriages or failed IVF cycles, people with a family history of chromosome problems, and men whose sperm may carry abnormal chromosomes. 

PGT-A is now mostly carried out at the blastocyst stage on day five or six. There is no evidence from RCTs that PGT-A carried out at this stage is effective at improving your chances of having a baby for most patients undergoing IVF. It appears possible that reduced availability of embryos for transfer following PGT-A may counter any benefit of embryo selection.

Also, keep in mind that the reduction in the rate of miscarriage does not increase the chances of having a baby. It is likely that, with PGT-A, embryos that express a chromosomal abnormality that could lead to a miscarriage are not selected for embryo transfer. This means that although the patient does not have a miscarriage, she also does not become pregnant because the embryo transfer did not take place.

IVF in Greece.

There are fertility doctors and clinics in Greece with vast experience in the assisted reproduction field, who can perform PGT-A and IVF cycles. The biggest benefit of performing your IVF in our country is the much less cost, the non-existent waiting lists, the good legislation, and the current IVF age limit that is 54 years old for women, one of the biggest age limits worldwide. 

The one thing you should remember from this article, is that having the necessary tests doesn’t mean that you will find the cause of your miscarriages. About half of the couples who have the tests don’t come out with any clear reason for their miscarriages. Although very frustrating, it is also positive news because it means that there is a good chance of the next pregnancy being successful, without any treatment at all. 

And if the cause is identified, there may still be a good chance of having a successful pregnancy. This will depend on what is found and whether there is any treatment to reduce the risk next time.

Experiencing even one miscarriage is painful, even if it is in the 6th week of pregnancy or later. The week you experienced the loss doesn’t lessen the pain you felt, and it is something you should give time to accept. Take your time to mourn your pregnancy loss, keep your loved ones close to you, and when you feel ready try again. 

There are also several communities where you can share your experiences, such as or our FB group “Your fertility journey by MEDIPASS”, a safe space for all those who wish to share their voice.

And if you decide to proceed with a fertility treatment, reach out to us. We are here and we care. And no matter the outcome, we support you. 

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Recurrent miscarriages, pregnancy, and IVF