When it comes to reproduction, humans are the poorest performers of all mammals. In fact, we are so inefficient that 75% of fertilized eggs do not produce live births, and 20% of pregnancies end in place, renowned for being lost within 10 weeks of gestation (in Q1). Recurrent pregnancy loss (RPL) pregnancies are defined as two (2) or more. Less than 5% of women experience two (2) consecutive miscarriages, and only 1% experience three or more.Pregnancy loss can be classified according to the stage of pregnancy when the loss occurs: the early loss of pregnancy (Q1) of late pregnancy loss (after the 1st quarter) occult (or hidden not clinically recognized) pregnancy loss occurs before confirmation pregnancy.Early ultrasound fetal loss LossEarly usually occur sporadically (not repetitive). Over 70% of cases the loss is due to irregularities known as numerical chromosomal aneuploidy (where there is more or less than the normal fee of 46 chromosomes). RPL while rarely be attributed to chromosomal causes, in some cases are due to the structure (rather than numerical) chromosomal aberrations (unbalanced translocation). In most cases, RPL s not attributable to chromosomal causes, such as immune dysfunction Implementation (IID). As most of early pregnancy loss induced by chromosomal factors and therefore are not repetitive, having had a miscarriage only the probability of a second place is no bigger than the first. However, once he had 2 losses to the possibility of that happening is third twice (3540%) and after having three (3) loss of the possibility of an increase of 4 about miscarriage 60% The reason for this is that the more miscarriages a woman has, the greater the probability that this is due to nonchromosomal (repetitive) case as follows that if IID.It chromosome analysis (karyotype) of the embryos and products of a miscarriage fetus shows a normal karyotype embryo, then a nonchromosomal factor must be present. In such cases, there is a strong likelihood of miscarriage to be repeated in subsequent pregnancies. Therefore, it makes sense to take steps to remedy the cause rather than waiting for a repeat disaster. This is precisely why we strongly advocate that all specimens karyotyped miscarriage. There are, however, a warning to be taken into consideration. That is, the laboratory performing the karyotype without realizing it could be proof of stem cells rather than conception. That's why you can not safely exclude aneuploidy in cases where the karyotype of the products suggests a normal chromosome (euploid) female embryo / fetus.Late Pregnancy LossLate pregnancy losses occur less frequently (in only 1% of all pregnancies) the loss of early pregnancy. They are most commonly due to anatomical abnormalities of the uterus and / or cervix. The weakness of the neck, cervix, making it unable to act as an effective valve that keeps the pregnancy (ie, cervical incompetence) common cause of pregnancy loss. So are the development (congenital) abnormalities of the uterus (eg, a uterine septum) and uterine fibroids. In some cases, intrauterine growth retardation, abruptio placenta (placenta abruptio), premature rupture of membranes and preterm birth are also causes of the latest loss.Much pregnancy has been made in understanding the mechanisms involved in RPL. There are two (2) general categories: 1. The perturbations of the uterine environment can prevent proper implantation and development. These may include: Inappropriate liningIrregularity uterine thickening in the contour of the uterine cavity (polyps, fibroids in the uterine wall into the uterine scar and adenomyosis) hormonal imbalances (deficiency of progesterone / luteal phase defect). This most often leads to hidden RPL. The poor blood flow to uterine implantation immune dysfunction coating (IID). This is a major cause of RPL and plays a role in 75% of cases in which the preimplantation embryos chromosomally normal implant.Interference no blood supply to the developing embryo. This may occur because of an inherited bleeding disorder known as thrombophilia. 2. Genetic and / or structural chromosomal abnormalities in the embryo of the embryo: genetic abnormalities are rare causes of RPL. Structural chromosome abnormalities occur infrequently (1%). Known as unbalanced translocations that result when part of a chromosome is removed and then merges with another chromosome.Finally, several studies suggest the existence of a father's sperm (derivatives), effect on human embryo quality and pregnancy outcome not reflected as a chromosomal abnormality. Damaged sperm DNA may have a negative impact on fetal development and presents clinically as hidden or early clinical miscarriage. Sperm Chromatin Structure Assay (SCSA) test or sperm DNA integrity (SDIA), which measure the same endpoints are newer and improved methods for assessing the potential sperm DNA factors.More About Implementation Immune Dysfunction (IID) alloimmunity (where there is a reaction against antigens derived from another member of the same species) are believed to be a relatively common cause of immunologic recurrent pregnancy loss.A pregnancy should be recognized by the agency of mothers as a foreign object to activate the appropriate immune mechanisms that allow the embryo to implant and grow. Sometimes, when a male partner transmits (through their contribution to the sperm of the embryo) genes that are very similar to the genetic mother, the immune system rejects the embryo. Such rejection usually takes the form of an early miscarriage, but sometimes (rarely) rejection can be so abrupt as to completely prevent the recognition of pregnancy. In such cases, the couple may present with unexplained infertility or unexplained IVF implantation failure.Alloimmune dysfunction is a common immunologic recurrent pregnancy loss. Alloimmune similarities Testing is therefore an important part of the evaluation of recurrent pregnancy loss chromosomes. It requires the comparison of mothers and fathers and HLA DQ alpha state (see below). When the provider of the sperm and the embryo recipient HLA antigens share a number (eg HLA, B, C, DR, DQ or DP), may occur implantation failure, manifested as RPL or sometimes even as failure.Autoimmunity IVF without explanation refers to an immune reaction produced by the person to their cellular components / bodys your account. The most common antibodies are formed in such situations are: a) antiphospholipid antibodies (APA), b) antithyroid antibodies (ATA), c) antibodies Antiovarian. But it is only when specialized immune cells in the lining of the uterus is known as natural killer cells are activated (NKA) and begins to release toxins that attack the root system of the embryo and endangers the deployment potential. Diagnosis of NK cell activation (NKA) requires highly specialized blood and / or evidence of endometrium can be performed only in a handful of reproductive immunology laboratories in the United States. Since Implementation of autoimmune dysfunction is usually genetically transmitted, it is not surprising that it is more likely to arise in women who have a family (or personal) history of primary autoimmune diseases like lupus erythematosus (LE), scleroderma, clinical hypothyroidism or subclinical, rheumatoid arthritis, etc. reactionary (secondary) autoimmunity may occur in connection with any medical condition associated with widespread tissue damage. One of gynecological conditions such as endometriosis. Implantationdysfunction autoimmune usually lethal for embryo implantation. This is because it destroys the root system of embryonic getgo. Therefore, most often presents as unexplained infertility or unexplained (often repeated) IVF failure, rather than a miscarriage. Implementation of autoimmune dysfunction is easy to investment through timely, properly managed, targeted immunotherapy (see below). Diagnose the cause of RPLEstablishing the correct diagnosis is the first step in determining an effective treatment for couples with recurrent abortions. RPL results from a problem in the pregnancy or in the uterine environment, where the pregnancy implants and grows. Useful diagnostic tests to identify those most at risk of having a problem with the pregnancy itself are: chromosome analysis carried out on both prospective parentsChromosome analysis results of previous pregnancy losses and both parents Ultrasonography of the uterine cavity after injecting sterile water or hysterosonography (saline ultrasound, Sonohysterogram, fluid ultrasound, ultrasound) Dye Xray test of the uterus and fallopian tubes or hysterosalpingography hysteroscopic evaluation of the uterine cavity Assessment hormonal response of the uterine lining immunological tests useful for diagnosis and treatment of recurrent pregnancy loss in affected couples. These tests include: a) The antiphospholipid antibodies (APA) panel, b) antinuclear antibodies (ANA), c) the panel of thyroid autoantibodies (thyroglobulin and antibodies, ie antimicrosomal), d) reproductive immunophenotype, e) the activity Natural killer cell (NKA), using the tests target cell K562 test.Alloimmune of male and female pair (alpha and HLADQ) Thrombophila PanelTreatment of RPLTreatment of anatomic abnormalities of the uterus involves the restoration through surgical removal of local lesions such as fibrosis, scarring and endometrial polyps or timely insertion of a cervical cerclage (a dot placed around the cervix weakened) or resection of a uterine septum when indicated.A thin endometrial lining has been shown to correlate with pregnancy outcomes in danger. Many times this is associated with reduced resistance to blood flow in the endometrium. This decrease in blood flow to the uterus could be improved by treatment with sildenafil (Viagra), terbutaline and possibly aspirin.Sildenafil (Viagra) therapy Viagra has been used successfully to increase uterine blood flow. Yet, to be effective, should be administered as soon as the period stops until the day of ovulation and should be administered vaginally (not orally). Viagra en forma de supositorios vaginales que figura en la dosis de 25 mg cuatro veces al d�a se ha demostrado que aumenta el flujo sangu�neo uterino, as� como el espesor de las paredes del �tero. To date, we have seen a significant improvement in the thickness of the uterine lining in about 70% of treated women. Successful pregnancy outcome in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously suffered repeated IVF failures.Terbutaline This is a medicine that relaxes muscles in the uterine wall and allows it to improve the delivery of the hormone of the endometrium. The use of terbutaline often cause an increase in heart rate. Not be prescribed to women who have irregular heartbeats (arrhythmias), and women who have decreased cardiac reserve.Aspirin This is a antiprostaglandins that improves blood flow in the endometrium. It is administered in doses of 81 mg orally every day since the beginning of the cycle to the use of immunotherapy ovulation.Selective Intralipid, heparin, aspirin and corticosteroidMany causes of pregnancy loss or failure can be treated with immunotherapy comprising a combination of aspirin and heparin, and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate the increase in NKA. Achieving the optimal success with Intralipid / corticosteroid treatment requires that treatment be started long before ovulation takes place (about 714 days before implantation in advance). Given the fact that only 1015% of natural cycles (with or without the use of insemination and / or fertility drugs) will result in a pregnancy, it follows that the repeated administration of Intralipid is necessary in most cases before a pregnancy occurs. IVF achieved pregnancy rates that are typically 23 times faster. This often makes IVF treatment of choice in cases of recurrent abortions IVFPreimplantation diagnostic immunological loss.Role genetic (PGD), a procedure by which the embryo can be screened for genetic abnormalities or structural chromosome requires the use of fertilization in vitro to select the best embryo (s) to transfer to the uterus. In cases of structural chromosome (translocations) donation of eggs or sperm often worth considering other options ... In cases where due to difficult anatomy or alloimmune dysfunction IVF repeatedly is not correct or is not an option, gestational surrogacy might represent the only recourse to other adoption.If couple with RPL is open to all options diagnosis and treatment mentioned above, a live birth rate of 70% 80% is ultimately possible. br br
