Implantation care pathway and miscarriage clinic:
At least half of all (spontaneous) conceptions or pregnancies end prematurely. In most cases because there is no implantation after fertilisation, so there is no (incipient) pregnancy.
If the fertilised egg implants in the uterus, your body starts to produce pregnancy hormones, which allows you to establish that you are pregnant.
Even after this point, a pregnancy may end prematurely.
- If development stops very quickly, this is called a ‘biochemical pregnancy loss’. Your body produces pregnancy hormones, which shows up in your bloodwork, but the ultrasound does not confirm your pregnancy.
- We only use the medical term ‘clinical pregnancy loss’ when an ultrasound confirmed a pregnancy that does not evolve in a normal way.
Generally, we consider clinical pregnancy loss to be a natural selection mechanism, as it is usually caused by a developmental defect of the foetus, often because of chromosome abnormalities. Although this experience is distressing for the prospective parent(s), clinical pregnancy loss occurs more frequently than usually thought and more often at an older age. With age, the quality of eggs decreases and the risk of genetic (chromosomal) abnormalities in the embryo increases.
Recurrent pregnancy loss is said to occur when two or more pregnancies end prematurely. Five percent of all pregnant women experience two pregnancy losses, and two percent face even clinical pregnancy loss three times.
There often is no single cause for (recurrent) pregnancy loss. Perhaps several factors play a role simultaneously, both in the embryo and in the mother’s body.
If you have already had several pregnancies that did not progress, we will closely monitor you and your next pregnancy with a team of experts, with more frequent ultrasound scans, blood tests and, if necessary, tests on the foetus.
You can be included in this care pathway if you identify with one of the groups below:
- Patients in whom an IVF or ICSI treatment does not result in pregnancy despite the repeated transfer of a quality embryo (repeated implantation failure);
- Patients in whom an insemination or IVF/ICSI treatment repeatedly ended in pregnancy loss after a positive pregnancy test (recurrent);
- Spontaneously pregnant women who have had two or more consecutive pregnancy losses (recurrent).
Since in many cases recurrent pregnancy loss cannot be attributed to a single cause, the suggested approach may vary from patient to patient.
How do we proceed?
- Identify and treat risk factors;
- Clinical follow-up of your situation (and possible pregnancy);
- Offer psychological support;
- Conduct scientific research.
From diagnosis to treatment: a roadmap
Your first fertility clinic appointment
- Given up-to-date information, including on lifestyle changes that could potentially have a positive effect on your pregnancy outcomes;
- Prescribed additional examinations; and
- If possible (if the root cause of your problem has been identified) treatment.
You may be eligible to participate in a study. These may not directly benefit your treatment at this time, but you will be contributing to research into recurrent pregnancy loss. This may result in a better approach or even a cure for this problem in the future.
This is why this care pathway provides psychological support for prospective parents who require it. At Brussels IVF, we have psychologists with knowledge of our various pathways who are happy to provide you with very targeted support. We look at how to cope with loss in addition to dealing with all the feelings that you may experience during a subsequent pregnancy.
What are the possible options?
- A comprehensive medical history that focuses on your own history as well as your family context.
- We take a closer look at your previous (interrupted) pregnancies to determine at which point the pregnancy ended (whether it was a biochemical pregnancy loss or a clinical pregnancy loss);
- A vaginal ultrasound may be performed, supplemented by a hysteroscopy and an endometrial biopsy;
- A blood test may be scheduled to check your thyroid (in case of weight problems or PCOS), clotting factors and antibodies;
- We may choose to perform karyotyping (chromosome mapping) for you and your partner.
- We can also request a semen sample to check for risk factors for recurrent pregnancy loss (DNA fragmentation).
Unfortunately, we are unable to pinpoint a clear or unambiguous cause for repeated pregnancy loss in most prospective parents. We thus remain fully committed to research to expand our knowledge and the possible solutions for patients.
Start of treatment
- Preventive care: a healthy lifestyle avoiding risk factors such as smoking and alcohol consumption. Your hormone levels are also checked in case of e.g., diabetes or thyroid dysfunction.
- If your uterus has an abnormality, this can sometimes be fixed with a therapeutic hysteroscopy (surgical procedure).
- If you suffer from inflammation or we detect abnormal blood levels, we will prescribe medication if necessary.
- Either partner may have a genetic problem that increases the risk of pregnancy loss. In that case, you have the option of PGT treatment or pre-implantation genetic testing. This involves testing good-quality embryos after IVF-ICSI treatment before transferring them.
- Patients who have no specific genetic risk can also have a PGT-A done.
PGT-A is a screening of the chromosome content of some of the embryo’s cells. Here too, the lab can make a selection, prior to the embryo transfer, based on their morphology (the shape and number of cells), as well as chromosomal (ab)normality. When enough embryos are available for analysis, this technique can thus increase your chances of a pregnancy that progresses and shorten the time to a pregnancy with a good outcome.
Your fertility doctor will always advise you on the added value of a specific technique in your individual case.
Your hormone levels will be checked weekly (with a blood test) after your positive pregnancy test. From the sixth or seventh week of your pregnancy, you will have regular ultrasounds. If the pregnancy does not progress as it should, we try to identify the cause.