Implantation failure and repeated miscarriages: What's new?

In many cases, infertility and embryo implantation failure in IVF treatment and miscarriage are due to the same problem. They must therefore be studied and treated in a similar way.

Dr. Marisa López-Teijón, Director of Institut Marquès expresses in her blog her concern about the management of repeated miscarriages and embryo implantation failures in IVF cycles. “Since we still do not know many things, it has become trendy to prescribe all kinds of unscientific diagnostic tests and empirical treatments (“based on one’s own experience and observation without having implied a logical assumption or deduction and without any scientific demonstration”) worthy of shamanism. I am referring to studies such as the natural killer cells, anti-paternal antibodies, KIR, HLA, uterine surgeries without a real indication, etc.” 

What we know

Thanks to Assisted Reproduction, progress has been made in understanding the causes of miscarriage and implantation failure.

When a patient has had two or more miscarriages, if the problem has not been diagnosed and treated, the chances of a recurrence are high and increase in direct proportion to the number of previous miscarriages.

The most frequent cause of recurrent miscarriage is chromosomal abnormalities of the embryo, approximately 50% of the cases. Secondly, acquired thrombophilias (antiphospholipid syndrome) and hereditary thrombophilias, approximately 20%. These two are the only causes for which scientific evidence has been demonstrated. 

What we don't know

In 30% of cases of miscarriage or implantation failure, there is no clear diagnosis: "We have to acknowledge what we don't know and study and research in order to move forward. Infertility is a new science, but it is science," says Dr Marisa López-Teijón, winner of the National Prize for Medicine and Doctor of the Year in Assisted Reproduction.  "Given that, without doing anything, there is a chance that the next pregnancy will go well, any treatment may seem to be successful: this feeds the doctor's ego. In addition, we are under pressure from the pharmaceutical industry and from patients who have read about everything on the internet or who have received these proposals in other clinics. Infertility is a disease and needs diagnosis, prognosis, adequate treatment and humility to admit what we don't know," adds Dr López-Teijón.

For more information:

Recurrent miscarriages: causes, diagnosis and treatment

Treating Recurrent Miscarriages: Science or Shamanism?