Repeated abortion or habitual abortion

It is also known as recurrent pregnancy loss.

Regarding epidemiology, it should be noted that the incidence of clinical abortion in the general population is 12-15%. The incidence of recurrent miscarriage is not entirely determined accurately by conceptual differences (two or three previous miscarriages), but it is accepted that it affects 1-5% of women.

Embrion Embarazo

It is important to know the risk of recurrent miscarriage when counseling couples with pregnancy loss.

*Couples with a single miscarriage do not require specific assessment, however, if your specialist doctor provides adequate and detailed information, as well as emotional support for future pregnancies and your immediate well-being, this will help substantially.

  • After 2 abortions the possibility of a third abortion is 25%-30%

  • After 3 abortions the possibility rises to 35-45%

  • After 4 abortions it is greater than 50%

  • Over time it has been considered to start the study when the couple had had three abortions, but currently we prefer to start the studies after a second abortion since the possibility of a third abortion is 25%, much higher than expected by mere chance (0.3%)

Among the causes associated with recurrent pregnancy loss are the following factors:

  • Chromosomal

  • Genetical

  • Anatomical

  • Endocrine

  • Immunological

  • Infectious

  • Social habits

ADN Fertilidad DNA

The five most frequent factors were listed first. It is very valuable when making a diagnosis of recurrent miscarriage to make patients understand that there are initial basic studies and other more sophisticated ones that lead us to rule out these factors and/or assess their significance in this problem.

Most importantly, studies for repeat miscarriage are disaggregated and done systematically.

We can enumerate the studies for diagnosis below, concisely mentioning each one of them.

  • Seminal Study (Sperm FISH): With this test we perform in a seminal sample by means of labeling with fluorescent probes, the typing of chromosomes X, Y, 13, 18, and 21 in spermatozoa, and thus know the numerical alterations of the spermatozoa. sperm.

  • DNA-Saliva study: This study allows us to assess specific alterations (mutations) in specific factors involved in blood coagulation.

  • Repeat Abortion Studies: Specifically, it is to search for Antiphospholipid Antibodies, lupus cells and lupus Anticoagulant that intervene or favor the formation of small microthrombi at the level of small blood vessels.

  • Hyperthyroidism and/or Hyperprolactinemia: These alterations in the pituitary secretion of TSH and PRL favor or increase the risk of spontaneous abortion.

  • Hysterosonography: Study with guided ultrasound of the endometrial cavity to rule out uterine pathology. Among the most frequent anatomical problems are polyps, fibroids or Müllerian defects (uterine septa).

  • Hysteroscopy: It is the visualization of the uterine cavity by means of an optic fiber through the vagina.

  • Preimplantation Genetic Diagnosis: The study of one cell or two cells of the zygote on day 3 of development and/or of the trophectoderm in the blastocyst (day 5 of development) for determination of 9 to 11 pairs of chromosomes and/or mapping of the chromosomes. 23 pairs of chromosomes before their transfer respectively.

General considerations.

Do not forget that close to 50% of the patients that we study with recurrent abortion will have the aforementioned studies normal. So we must have some principles to consider:

  • Do not start treatment until the diagnostic studies have been completed.

  • Do not forget frequent check-ups once the pregnancy is achieved, as well as emotional support during the pregnancy.

  • Progesterone administration (some studies in meta-analyses) have shown a beneficial effect in treatment groups.

  • Early Amniocentesis will be performed according to genetic advice.

  • If we suspect cervical insufficiency, the indication for cerclage at week 12 to 14 should be a priority.

Actuando de acuerdo en estos principios terapéuticos generales y los expuestos por cada causa potencialmente tratable, las expectativas de conseguir un hijo vivo en la mujer con aborto de repetición supera el 75%.

Nuestra recomendación finalmente es:

  • Acudir a un especialista en Reproducción Asistida después de 2 pérdidas gestacionales.

  • Tener presente que el diagnóstico de pérdida gestacional no siempre se encuentra una causa específica.

  • Los tratamientos de Reproducción Asistida de baja o alta complejidad individualizando el caso, nos lleva a un bebé en casa en más del 75% de las pacientes que lograr un nuevo embarazo.

  • Es menester hacer uso de la tecnología y los estudios previos para así mejorar el pronóstico del embarazo a término.

“Repeated miscarriages are one of the most complicated diagnoses, but we have the experience to help you achieve a successful pregnancy and delivery”

Dr. Arturo Valdés
Dr. Arturo Valdés
Reproductive Medicine and Gynecological Endocrinology
View Profile