Miscarriage
Sporadic miscarriages
Miscarriage, the death or malformation of a pregnancy or the loss of a potentially viable pregnancy, is the most common serious complication of pregnancy. In young women, nearly one in seven pregnancies ends in miscarriage, and this frequency increases with a woman's age: In women over 40, a miscarriage is expected in almost one in three pregnancies. By far the most common cause of miscarriage is a sporadic chromosomal abnormality in the underlying egg cell. The woman's body usually detects this abnormality early in the pregnancy and terminates the pregnancy. A chromosomal abnormality in the pregnancy tissue can generally be detected through genetic testing. The most frequent result of such testing—the detection of a sporadic chromosomal abnormality—usually means that the risk of miscarriage in subsequent pregnancies is not significantly increased—that is, it corresponds to the risk associated with age.
Single or recurrent (habitual) miscarriages
You become pregnant but are unable to carry the pregnancy to term? Did the pregnancy end (missed abortion)? Or did you experience bleeding and the pregnancy end? Was an embryo visible on ultrasound before the miscarriage? Was a heartbeat detected? Have you possibly experienced multiple miscarriages? Is the course of each miscarriage similar, or did the pregnancies differ? Was the tissue examined microscopically and/or genetically? Have any further investigations been conducted to determine the possible causes of the miscarriages? Are there any treatment options available for a future pregnancy?
For many years, I have been intensively involved with the diverse causes of single and recurrent miscarriages. I have counseled and supported numerous couples experiencing miscarriages, and I understand the suffering and uncertainty that often pervade the lives of affected couples. The first crucial step is to determine whether it is a case of one or more sporadic miscarriages. While these cases are extremely distressing, there is no concrete risk of recurrence. In these instances, the focus is primarily on providing support and reducing stress. Medical treatment, which may have significant side effects, is unnecessary and could even pose unnecessary risks (and/or costs). Alternatively, is there an underlying medical problem? In this case, a high risk of further miscarriages must be anticipated. Without effective diagnostics and knowledge of the underlying causes, subsequent pregnancies often have little chance of a successful birth and only exacerbate the suffering. Here, it is of paramount importance to be aware of the available therapeutic options and to utilize them effectively.
I would be happy to offer you my extensive experience to assess your specific situation, all previous pregnancies and all available findings in the context of an online consultation. We can calmly discuss all open questions regarding the purpose and potential consequences of existing or additional examinations. It is particularly important to discuss all possible treatment options with regard to a future pregnancy and to weigh them in your best interest.
Systematic causes of Recurrence
The situation is quite different with so-called systemic causes of miscarriage: anatomical abnormalities (fibroids, adhesions in the uterus, congenital uterine malformations) can be the cause of recurrent miscarriages. In these cases, a significantly increased risk of miscarriage must also be expected in subsequent pregnancies. Other causes can be infectious, hormonal, or immunological in nature, and in many of these cases, miscarriages also occur repeatedly in subsequent pregnancies. Accordingly, it is of paramount importance to identify these causes of miscarriage and to utilize targeted treatment strategies for a future pregnancy. For example, in untreated antiphospholipid syndrome (APS), recurrent miscarriages are to be expected in approximately 80 to 90%, and it appears to be of utmost importance to identify this problem by means of appropriate blood tests before a further pregnancy, especially since a relatively simple, well-tolerated drug therapy can significantly reduce the probability of miscarriage to approximately 15 to 20%.
M2 haplotype of the Annexin A5 gene (M2/ANXA5)
Annexin A5 is an important protective factor that prevents blood clotting and keeps it fluid on the surface of the placenta. People with the genetic variant M2 have significantly reduced protective activity of Annexin A5, and at the LMU Fertility Center, we were able to show that women with multiple miscarriages are more likely to carry this M2 haplotype. Furthermore, we were able to demonstrate that the M2 haplotype is also significantly more common in the partners of women with multiple miscarriages. This suggests that we may have identified a relatively frequent paternal cause of miscarriages. We now also have initial indications of an effective treatment option for subsequent pregnancies for affected couples. I would be happy to discuss the details with you in a consultation. A detailed online appointment is available.
Anti-trophoblast antibodies
An important immunological cause of miscarriages, which I investigated intensively during my fellowships at the Center for Reproduction and Transplantation Immunology (Indianapolis, USA), is the formation of antibodies against the tissue of the placenta (trophoblast). We were able to demonstrate that some women recognize the placental tissue, which is inherited half from the father, as foreign and therefore produce antibodies against it – so-called anti-trophoblast antibodies (ATAK). These antibodies attack the placenta and inhibit the production of the pregnancy hormone (hCG), thus explaining why these women repeatedly experience miscarriages. In subsequent work at the LMU Fertility Center, we were able to establish a standardized detection method for ATAK and demonstrate that ATAK are detectable in 17% in women after miscarriages and in 34% in women with three or more miscarriages.
Treatment options for the detection of anti-trophoblast antibodies (ATAK): At the LMU Fertility Center, we have now established a promising treatment option for ATAK-positive miscarriage patients. In these patients, we have been able to significantly reduce the likelihood of miscarriages in subsequent pregnancies through regular lipid infusions, and almost all of these patients went on to give birth to healthy children. If you have any questions about the detection of anti-trophoblast antibodies or about treatment with lipid infusions, I am happy to answer them. a detailed and personal online appointment is available.
Other possible causes – sense and nonsense of therapy options
Women with miscarriages frequently exhibit abnormalities in blood clotting, and it is suspected that increased blood clotting may impair the blood supply to the early pregnancy, thus hindering growth and normal development. However, therapeutic approaches in these cases—especially the administration of aspirin and/or heparin—are controversial. In fact, a large German study, in which our LMU Fertility Center played a key role, found no discernible benefit from this intervention.
Even differentiated immunological and infectious disease examinations of the uterine lining—the detection of NK cells and the detection of so-called chronic endometritis (CE)—appear, despite initial optimism, to be largely irrelevant for explaining recurrent miscarriages or for selecting a therapy for subsequent pregnancies. In fact, current results show that the pregnancy prognosis for CE-positive patients appears to be most favorable without antibiotic therapy.
There is a virtually endless number of possible diagnostic and therapeutic options for recurrent miscarriages – and unfortunately, these are not always advisable. It is also essential to be informed about potential risks and side effects. In any case, it is recommended to remain skeptical, especially regarding "new" interventions that are not yet sufficiently proven. In any event, the effort, costs, and, above all, the potential risks and side effects for mother and child should always be considered in light of the scientific evidence of actual, demonstrable effectiveness. If you are unsure about the benefits or drawbacks of complex or invasive diagnostic interventions, I would be happy to provide you with an independent second opinion. available as part of a personal online appointment.