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What Causes Recurrent Miscarriages?
Question: hi doctor my wife recently had 3rd recurrent miscarriage in last 3 yrs. 1st & 2nd time it was anembryonic preganancy & there was no heart beat detected. it was this 3rd time that the heart beat was detected & pregnancy went upto 14 weeks without any complaints. when we went for the nt scan we found the heart beat was gone & the doctor advised her to take pills & expel out the foetus the foetus has now been sent for kayotyping. also previously all tests were done on both me & my wife all tests came out to be negative. now we dont know on how to proceed further. Also this time we had conducted the foertal karyotyping which came out to be normal as well. We would like to since there was chromosomal abnormalities involved do we still need to explore the option for IVF with PGS or should we undergo any other treatment or precautions to be taken before trying again.
Brief Answer:
CMA ANALYSIS is next step before IVF consideration + PGID.
Detailed Answer:
Hello,
Thanks for the query to hcm for an opinion,
Firstly i am really sorry for your loss. I have gone through all your reports attached and considering the karyotyping studies of all couple and foetus and blood studies of your wife, all are normal. The semen analysis is also fairly normal with decreased normal forms though count is fine.
But if the pregnancy survived till 14 weeks and then had a missed abortion, then likelihood are generally thrombophilias ( which have been ruled out ) and the other are congenital metabolic disorders or familial chromosomal abnormalities in form of familial diseases or syndromes.
The next best thing for you would be to get a chromosomal micro-array test for both of you as a couple and genetic counselling to establish any possible familial chromosomal disorders running in family or mosaicism pattern established after fertilisation which is incompatible to life.( In that case foetal tissue CMA would have bene helpful).
However , previous 2 anembryonic gestations and 1 missed abortion now doesn't really call for investigations for recurrent pregnancy losses as first 2 gestations didn't have a foetal pole and the reason is always idiopathic. Ideally you should try naturally for another child after 3 months as you both are fit medically. CMA analysis is an over precaution but at this point of time IVF is still not indicated because IVF can assist in conception but cannot remove any genetic abnormalities unless PRE-GENETIC IMPLANTATION DIAGNOSIS is done on embryos before embryo transfer. So that too shall need a CMA analysis before IVF.
You may consider CMA first and if normal then can try naturally for a cycle or two as in your case fertilisation and pregnancy is not an issue but sustenance of pregnancy is a concern.
Regards
CMA ANALYSIS is next step before IVF consideration + PGID.
Detailed Answer:
Hello,
Thanks for the query to hcm for an opinion,
Firstly i am really sorry for your loss. I have gone through all your reports attached and considering the karyotyping studies of all couple and foetus and blood studies of your wife, all are normal. The semen analysis is also fairly normal with decreased normal forms though count is fine.
But if the pregnancy survived till 14 weeks and then had a missed abortion, then likelihood are generally thrombophilias ( which have been ruled out ) and the other are congenital metabolic disorders or familial chromosomal abnormalities in form of familial diseases or syndromes.
The next best thing for you would be to get a chromosomal micro-array test for both of you as a couple and genetic counselling to establish any possible familial chromosomal disorders running in family or mosaicism pattern established after fertilisation which is incompatible to life.( In that case foetal tissue CMA would have bene helpful).
However , previous 2 anembryonic gestations and 1 missed abortion now doesn't really call for investigations for recurrent pregnancy losses as first 2 gestations didn't have a foetal pole and the reason is always idiopathic. Ideally you should try naturally for another child after 3 months as you both are fit medically. CMA analysis is an over precaution but at this point of time IVF is still not indicated because IVF can assist in conception but cannot remove any genetic abnormalities unless PRE-GENETIC IMPLANTATION DIAGNOSIS is done on embryos before embryo transfer. So that too shall need a CMA analysis before IVF.
You may consider CMA first and if normal then can try naturally for a cycle or two as in your case fertilisation and pregnancy is not an issue but sustenance of pregnancy is a concern.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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