Study and diagnosis of infertility or repeated miscarriage.
What do we understand by ‘infertility’?
We speak of infertility when a couple easily succeeds in becoming pregnant, but where the pregnancy is repeatedly interrupted before the fetus becomes viable.
When should infertility testing begin?
Having a miscarriage during the first trimester is not an indication that this will happen again, although it is important to examine the products of conception.
We consider that infertility testing should begin after two miscarriages.
What are the causes of repeated miscarriages?
In a high percentage of cases no conclusion is drawn after testing. However, we do know that there are some specific causes associated with repeated miscarriages:
- Chromosomal abnormalities in the embryo.
- An alteration of the chromosome number in one of the parents which is transmitted to the embryos.
- Malformation of the uterine cavity that prevents the successful implantation of the embryo.
- The presence of autoantibodies that block the implantation process.
- An alteration in coagulation.
- Hormonal disorders.
- Infections.
- Immunological problems…
A multidisciplinary approach by a team trained in this type of pathology is particularly important.
What tests need to be done?
Basic testing is aimed at ruling out pathologies that are clearly associated with miscarriages.
- Karyotypes (testing of the chromosomes in the blood), in both the woman and the man.
- Thrombophilia testing in the woman – checking for abnormalities in blood coagulation, both acquired and inherited.
- Antiphospholipid antibodies.
- An examination of the uterine cavity, either by hysterosalpingography, magnetic resonance … Although the most effective test is 3D ultrasound.
- Hormonal tests to rule out thyroid disorders.
- Testing of the ovarian reserve and semen analysis.
Fortunately, most of the abnormalities that may be diagnosed through these tests are treatable. In cases where they are not, having an understanding of the situation clinic allows us to give advice to the couple with regard to more specific tests, and different therapeutic alternatives.
Careful monitoring during the first trimester of pregnancy and treatment with progesterone are very important. And in the case of another miscarriage, a products of conception test is strongly advised.