Causes of infertility - problem in carrying a pregnancy

About 1-2% of all women experience habitual miscarriages. These are three or more spontaneous miscarriages in a row that occur by the twelfth week of pregnancy. The pregnancy itself is unproblematic.

What tests to perform after a miscarriage?

Multiple pregnancy losses are an indication for diagnostic tests for the most common causes of miscarriages. The woman undergoes immunological diagnostics (tests for anticardiolipin antibodies, characteristic of hypercoagulability syndrome; antinuclear antibodies, appearing in the course of autoimmune disorders such as lupus, sarcoidosis, scleroderma; homocysteine measurement - its excess interferes with the process of implantation of the embryo in the uterus), genetic diagnostics (karyotype test, also carried out on the partner; test to detect factor V and II mutations, associated with coagulation disorders; MTHFR mutations) and tests to detect infectious factors, for example, carriage of chlamydia, ureaplasma or active zoonoses. The patient's partner undergoes MSOME semen testing and SCD (sperm DNA fragmentation test). In addition, the presence of infectious agents is checked.

If the results of the tests performed are normal, but the patient does not become pregnant, the couple may benefit from a more complex immunological diagnosis, including testing of NK cell activity, assessment of lymphokine levels, CD4 and CD8 lymphocyte subpopulations, and HLA tissue compatibility antigens. It is worth realising, however, that even after abnormalities are detected and treatment is undertaken (partner lymphocyte vaccines, immunosuppressive drugs, intralipid, immunoglobulin infusions, routine use of low-molecular-weight heparins, etc.), patients are not assured of improvement. Indeed, the efficacy of these methods has not been conclusively proven and for this reason they are not used in InviMed infertility clinics.

Difficulty in maintaining a pregnancy is an indication for an in vitro fertilisation procedure at a later stage of treatment with pre-implantation diagnosis of embryos (PGS). Embryos are screened before transfer to the uterus for genetic abnormalities that may prevent their normal development and subsequently lead to spontaneous abortion. Only normal and promising embryos are placed in the uterine cavity. In vitro with PGS achieves pregnancy in about 68% cases after a single transfer, but in about 55% couples embryos for transfer cannot be found due to the presence of genetic abnormalities.