Treatment for Recurrent Pregnancy Loss

The heartbreak of going through fertility treatments only to miscarry before the embryo implants can keep a couple in a constant state of tension and disappointment. Hopes are built and dashed in a short period, over and over again, as the efforts to conceive a pregnancy seem to elude some couples. The stress of infertility can be worse than many other medical problems and discouragement can cause a couple to give up.

Reasons for Failure of the Embryo to Implant

There are two basic reasons for the failure of an embryo to implant - one could be a problem with the embryo itself that makes it impossible for it to implant and the other a problem with the uterine environment that causes implantation failure. In the case of a problem with the embryo, the most common abnormality found in pre-implantation embryos is abnormal chromosomes, a fact that genetic diagnosis suggests occurs in 30% to 90% of in vitro fertilized eggs, depending upon maternal age. Additionally, about 75% of normal pre-implantation embryos fail to implant, with abnormal genes or abnormal DNA being contributors to the loss.

Uterine Problems

Uterine difficulties are classified as anatomic, hormonal and immunologic. Anatomic abnormalities are the presence of lesions, growths, tumors, scarring or adhesions that act like an IUD, preventing implantation. Fibroids, endometriosis, and uterine synechia are all conditions that are known to cause this type of situation within the uterus.

In order for the uterus to be environmentally friendly to the embryo there must be positive responses of estrogen and progesterone, the hormones necessary for the uterus to be receptive. Recurrent failure of the embryo to implant has been linked to mutations in some of the genes that are encoded for the progesterone receptor.

A successful implantation means that both the uterus and the embryo have to be receptive to the process. The uterus is made receptive through the interaction between the embryo and the mother that is communicated through proteins called cytokines that are secreted by the cells of the uterine lining, including immune cells. The period of time before implantation is the time when the uterine lining should stimulate an adhesion system that holds the embryo to the uterus. If the immune cells don't send the right signals via secretion of cytokines to the embryo, or if the cells don't respond to the embryo's signals, then implantation does not happen.

Establishing the Correct Treatment

It is important to establish the right diagnosis for the pre-implantation loss in order to treat the couple properly. A wide variety of tests are made on the egg, the sperm, and the uterus to determine where the problems lie. It is a long process and one that takes a lot of time to determine the cause of the consistent loss.

If the Problem is the Embryo...

Treatment is dependent upon the cause, of course. If the cause rests within the embryo itself, then treatment options include donor sperm, egg or embryo or pre-implantation genetic diagnosis.

When the Problem is the Uterine Environment

If the problem lies within the uterine environment, the treatments vary with the cause. Anatomic abnormalities are surgically dealt with using a number of different methods from laparoscopic surgery to laser surgery. Hormonal therapy is commonly used with most assisted reproductive techniques. After thorough testing, hormone injections are given to raise the level of hormones necessary for conception or implantation.

When the pre-implantation problem is caused by immunologic issues, immunotherapy is applied to the situation. These therapies include intravenous immunoglobulin (IVIg), which is the only medication that has been shown to be effective in treating implantation failure. Its success rate for women with a history of previous implantation failure is 50% for successful implantation and the live birth rate is 70%.

Intralipid, a soy oil extract administered intravenously may be effective in stimulating the immune system to remove danger signals that can lead to pregnancy loss. It is a 20% intravenous fat emulsion that is commonly used to provide fat and calories for patients that require nutrition. It is inexpensive and is not a blood product.