Repeated abortions are recurring gestational losses that affect five percent of women of childbearing age, being one of the causes of infertility.
The reasons why repeat abortions occur can be very varied, so it is important to perform the relevant medical tests that determine what is happening and what treatment to follow to avoid it. We tell you in detail in this article.
What do we call recurrent abortions?
The Spanish Fertility Society lists recurrent abortions as the loss of three or more consecutive gestations before 20 weeks, with a fetus less than 500 grams in weight. However, there is no clear consensus on its definition and some experts point out that the losses should not be "consecutive" to talk about repeat abortions.
However, for the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine, it would suffice with two or more consecutive failed pregnancies confirmed by ultrasound to talk about recurrent abortions.
The spontaneous abortion supposes a hard emotional blow for the woman, but in the case of recurrent abortions the pain increases even more if possibleFor hopes and illusion are renewed again and again with each new pregnancy, but so is sadness, anger and fear with each new loss.
According to experts, when the woman has already suffered a miscarriage the chances of going through the same thing again are around 15 percent, a percentage that increases to 25 or 30 percent if two or more previous abortions have already been had, or even up to 60 percent in cases of women over 40 years.
Why do repeat abortions occur?
Around 40-50 percent of the time no cause is found to justify repeat abortions, but on other occasions it does seem to be and according to studies it could be due to the following:
Genetic abnormalities
Genetic and chromosomal abnormalities are responsible for 50 percent of gestational losses, also being the most common cause of recurrent abortions.
The factors behind this type of anomalies are:
Maternal age is usually the most common factor, since how old is the mother worse will be the quantity and quality of your oocytes.
Chromosomal alterations of one of the two parents, or alterations in the quality of the sperm of man.
The abortions caused by genetic causes usually occur early, in week seven or eight of gestation, sometimes even before the woman has confirmed her pregnancy.
If medical tests reveal that this is the cause of recurrent abortions, experts advise resorting to fertility techniques with preimplantation genetic diagnosis, or if the situation requires it to opt for the donation of eggs or semen.
Anatomical alterations of the uterus
According to some experts, up to 15 percent of recurrent abortions would occur due to malformations of the uterus, mainly due to a septal uterus, which is the anomaly whereby the uterine cavity is divided into two parts by a central septum.
Also the fibroids, polyps, fibroids and adhesions in the scar tissue could cause repetitive gestational losses. vary the morphology of the uterus and interfere with the implantation or growth of the fetus.
Another uterine factor that could cause recurrent abortions is cervical insufficiency, which occurs when the cervix is unable to support pregnancy, opening prematurely and causing loss.
If it is revealed that any of these causes abortion, doctors may advise resorting to surgery or cerclage, in case of cervical insufficiency, to correct the problem.
Thrombophilias
Thrombophilia problems, whether inherited (the most frequent are the mutation of Factor V of Leiden and prothrombin) or acquired (the most frequent is the antiphospholipid syndrome), occur between three and four percent of the time causing alterations in coagulation of maternal blood that prevent the formation of the placenta or the development of the fetus.
In the case of diagnosing any thrombophilia that may be difficult to carry the pregnancy to term, medical treatment is usually acetylsalicylic acid and injections of low molecular weight heparin.
Immunological causes (not related to antiphospholipid syndrome)
Immune problems arise due to alterations in the mother's immune system that cause an abnormal response during pregnancy attacking the fetus when considering that it is a foreign body. This is caused by the effect of cells called Natural Killer (NK), a type of lymphocyte responsible for the immune defense of our body.
Medical treatment in the case of determining that the NKs are responsible for embryonic implantation failures or repeat abortions, will depend on the characteristics of the patient and the associated pathology.
Endocrine causes
According to the Spanish Fertility Society there are little scientific evidence that relates endocrine pathologies to repeat abortions, since:
Diabetes mellitus and clinically controlled thyroid disorders are not a risk factor.
The relationship between polycystic ovarian synovium (PCOS) and repeat abortions is casual.
The inability of the ovary to produce progesterone (a very important hormone for the maintenance of pregnancy) and high levels of prolactin are not the cause of repeated abortions.
However, the most likely endocrine cause today would be the insulin resistance, which has been associated with a higher abortion rate in women with insulin-resistant PCOS undergoing ovulation induction, compared to non-insulin-resistant.
When to start a study?
Experts agree that the ideal would be to start a study when two abortions have occurred, since the probability of having an abortion again is similar after three abortions (24-30 percent versus 30-33 percent).
Anyway, and according to the Spanish Fertility Society, it would be reasonable to individualize each case, considering the age of the woman, the circumstances surrounding the gestational losses, personal and family history and the couple's anxiety.
The study must be carried out by specialized professionals, and although there are many tests that must be performed to find out the cause of recurrent abortions, the most common are usually:
Karyotypes of man and woman, to find out if there is any structural alteration in one of the chromosomes that predisposes to abortion.
Imaging tests in women, such as hysterosalpingography, ultrasound or hysteroscopy. This is intended to see the uterine anatomy and rule out the presence of malformations, myomas or uterus of low receptivity.
Tests in man such as FISH or sperm DNA fragmentation tests.
Hormonal analysis of women, to determine the level of prolactin, progesterone and thyroid gland function.
Study of thrombophilias and autoimmune diseases.
Once the cause has been determined, and according to its type and severity, it may be necessary to put yourself in the hands of a multidisciplinary team (endocrine, gynecologist, hematologist, andrologist, psychologist ...) who will recommend the best treatment to follow in each case.
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