Q. How to over come recurrent pregnancy loss ?
Pregnancy loss is a distressful experience. It is especially devastating when the losses are repetitive. Loss of pregnancy is physically and emotionally challenging ordeal. Until recently there was little a couple could do if they suffered from so called unexplained recurrent pregnancy loss. Research however provided information on the causes of the hereto fore unexplained pregnancy losses resulting in availability of treatment that enables women to carry their pregnancies to term.
Q. What are causes of implantation failure ?
An embryo may not implant because there is something wrong with the embryo itself that it cannot implant, or there is something in the uterine environment that does not allow a normal embryo to implant or a combination of these factors.
Q. How can we determine the problems with the egg ?
Problems with in the egg can manifest clinically as diminished ovarian reserve or premature ovarian failure. Diagnostic tests useful for identifying individuals at greater risk for diminished ovarian reserve or premature ovarian failure include :-
– Hormonal analysis for Follicle Stimulating Hormone [FSH], Estradiol and Inhibin.
– Antiovarian antibodies [AOA].
Q. How can we determine the problems within sperms ?
Problems within the sperm not diagnosed by the standard parameters of semen analysis can be detected by :-
– Sperm function tests.
– Sperm DNA integrity assay [SDla].
– Y chromosome microdeletion assay.
Q. How can we determine the anatomic problems within the uterus ?
Problems With the Uterine Environment – Problems within the environment in which the embryo implants and fetus grows have been classified as anatomic , hormonal and immunologic.
Anatomic abnormalities of the uterus can be diagnosed by :-
– Hysterosonography [ultrasound evaluation of the uterus after fluid is injected] or
– Hysterosalpingography [X-ray with instillation of dye into the uterus and fallopian tubes].
– Hysteroscopy [telescopic evaluation of the uterine cavity].
Q. How can we determine problems of hormonal response of uterus ?
Hormonal response of the uterus can be diagnosed with the aid of ultrasound.
Transvaginal ultrasound examination of the lining of the uterus around the time of ovulation.
Color Doppler flow studies to evaluate blood flow to the lining of the uterus.
Q. How can the immunologic factors causing implantation failure be diagnosed ?
- Antiphospholipid Antibody [APA] Panel – Antiphospholipid antibodies have shown to kill pre-implantation embryos. They also interfere with angiogenesis.
- Antinuclear antibody [ANA] panel – Antinuclear antibodies have also been shown to be embryotoxic.
- Antithyoid Antibody [ATA] Panel – Antithyroid antibodies have no direct effect on preimplantation embryos, but are a marker of activated T cells in the lining of the uterus.
- Reproductive Immunophenotype [RIP] – measures circulating levels of NK cells. Elevated NK killing activity [greater than 10%] has been associated with implantation failure.
- Natural Killer Cell Activity [NKa] assay – measures killing activity with NK cells. Elevated NK killing activity [greater than 10%] has been associated with implantation failure.
- Embryotoxicity Assay [ ETA] – measures circulating substances that kill preimplantation embryo.
Immunoglobulin [Ig] panel – Elevated levels of immunoglobulin particularly immunoglobulin M, have been associated with implantation failure. Also the immunoglobulin panel will detect deficiencies in IgA which can be a contraindication to the use of IVIg if anti IgA antibodies are present.
- Thrombophilila Panel – Included in the thrombophilia panel is the gene for Plasminogen Activator Inhibitor[PAI] which can detect the most common cause of defective fibrinolysis contributed by an increase in plasminogen activator inhibitor [PAI 1] concentrations.
- Cytokine Panel – Proteins or cytokines that are produced by immunologic cells within the lining of the uterus.