The definition of recurrent pregnancy loss (RPL) is 3 or more successive pregnancy losses. At Astra, RPL affects a significant proportion of our presenting patient population. We usually do not wait for the 3rd loss to initiate investigations to identify the reason for the repeated losses. To try and identify the cause of RPL, genetic testing, advanced sperm testing, evaluation for clotting, hormonal, and immune disorders is performed. Screening for uterine anomalies and pathology like fibroids or adenomyosis is mandatory. Testing and genetic analysis of the products of conception also offers valuable information during comprehensive investigative workup. Finding the root cause for recurrent loss is pivotal to offering meaningful and effective treatment. Nevertheless, despite extensive testing, no cause is found in up to half the cases.
Generally speaking, the treatment of RPL is the treatment of the underlying cause, if identified. If no cause can be found, offering IVF with Pre-Implantation Genetic screening (PGS) i.e. testing the embryos before transferring them into the uterus is usually offered as a potential practical solution. Selecting the genetically sound embryo and placing it in the well-prepared uterus may offer the best chances for a viable pregnancy in these challenging cases.
Immunotherapy for Recurrent Implantation Failure/ Recurrent Pregnancy Loss
One of the missed diagnoses for recurrent implantation failure and recurrent early pregnancy loss is an underlying female immune system disorder that targets the embryo perceiving it as a foreign invader.Unfortunately, some individuals have an overactive immune system that recognizes the embryo as a foreign entity and destroys it, resulting in recurrent failed implantation or RPL. While this concept of an overactive immune system is widely accepted in the medical community, the method for diagnosis and management of these disorders is controversial. As a result, investigations and treatments should be considered experimental at this point. Among these controversial empiric therapies are intralipids or IVIG infusions, immune modifiers like Humira, and related drugs like steroids and blood thinners.