A taboo subject: Recurrent abortion

A taboo subject: Recurrent miscarriages 

The doctor’s view 


A taboo subject that is not often talked about in society. It is not widely known that up to a quarter of all pregnancies end in miscarriages. Women are logically reluctant to share their personal experience of abortion. Abortion is defined as the termination of pregnancy before the fetus is viable. That is, by the 24th week of gestation. What are the causes of miscarriage and how are men involved? This is what you will find out in an interview with the head doctor of the Prague Fertility Centre, MUDr. Lucie Švabíková.

What are the possible causes of miscarriage?
The most common reasons for miscarriage are genetic causes, which can be congenital and already present in the genetic information of each partner, but also de novo” - newly-emerged. These usually come hand in hand with the increasing age of the woman, which increases the risk of miscarriage exponentially from the age of 33. Another reason may be immunological causes. A woman’s body in early pregnancy must be immunologically prepared to accept an embryo that is partly foreign to her body. (Half is from the partner). This is a complex process of immunotolerance, but it can be disrupted. Here it is necessary to undergo an immunological examination and a specific treatment plan.

Can a miscarriage be caused by another medical complication?

Abortion can also be caused by a poorly treated endocrinological disease (e.g. reduced or increased thyroid function, decompensated diabetes, hyperprolactinaemia) or by one of the most common hormonal disorders, polycystic ovary syndrome (PCOS). In this disease, which may affect up to 20 % of women in the population, the cause of the higher risk of abortion is not entirely clear.

What should I do if I have been diagnosed with one of these diseases?
In such cases, interdisciplinary cooperation with an endocrinologist, an obesitologist or another specialist is essential. There is a common perception in society that assisted reproductive technology (IVF) clinics focus only on artificial insemination. This is only partially true; we also focus on the reproductive health of the couple.

What to look out for next?
In a woman’s personal and gynaecological history, it is first of all necessary to find out the risk factors. These are age, weight or untreated diseases mentioned above. The presence of congenital genetic defects in the family also has an influence. These may cause, for example, increased blood clotting or certain cancers. As an example, a BRCA gene mutation is a serious predisposition to breast or ovarian cancer.

Pregnancy is not just a women’s issue. What do men mean in this context?
For men, experts take into account, in particular, the examination of the spermogram. A personal history of previous operations — for example, on the testicles or prostate — is also important. Other diseases and the specific medication the man is taking also have a significant influence. I am thinking of medications for hypertension, cholesterol, and others.

Can women with recurrent miscarriages be helped?

For a genetic cause of miscarriage, a couple genetic consultation and blood test is certainly in order, from which genetic information in both partners can be examined (called karyotype). Even if both partners are healthy, they may be carriers of a particular genetic problem, which may then manifest itself in the incipient pregnancy.

How are genetic tests performed? 
During the examination, the geneticist indicates the so-called preimplantation diagnostics in the embryo. A genetic examination of several cells taken from the embryo takes place. This confirms or rules out possible genetic causes of the miscarriage. Only genetically healthy, so-called euploid embryos are used for possible IVF treatment. If an immunological factor is suspected, it is necessary to work with a reproductive immunologist to tailor treatment to each couple.

What should we not forget?
The treatment of patients who want to become pregnant should always be individual and comprehensive. It is not just about trying to induce ovulation. It is also necessary to adjust weight and lifestyle habits.