Delving into the issue of recurrent pregnancy loss, it’s been a longstanding mystery for many couples due to its unexplained nature, inducing recurring instances of sadness and despair as they try to conceive. There’s hope, though. Recent scientific breakthroughs have begun to shed light on the concealed origins of these recurrent losses, offering efficacious treatments to help women bring their pregnancies to term successfully.

Around 15 to 20 percent of pregnancies end in miscarriage, with the risk escalating with each successive loss. This sad reality reflects the necessity of understandingand solving the problem of recurrent losses. The American College of Obstetrics and Gynecologists are recommending testing for causes after a second loss, marking a shift in medical approach, primarily for women aged above 35.

Two major culprits behind recurrent spontaneous abortion or recurrent miscarriage have been identified. Firstly, an issue with the pregnancy itself, like chromosomal irregularities causing issues in embryonic development. Obtaining genetic testing of the aborted embryo or the chromosomes of the couple can offer clues to what’s going awry. Recently, gene deletions on the Y chromosome and fragmented DNA from the sperm have been associated with early pregnancy loss.

Secondly, an issue within the uterine environment can prevent the pregnancy from growing correctly. This may be caused by a myriad of factors from hormonal imbalances to structural abnormalities in the uterus. Problems of anatomic nature can be uncovered through a hysteroscopy or hysterosalpinogram, while hormonal assessment revolves around exploration of hormone levels and uterine response at the time of ovulation and implantation.

In fact, the immune system is being considered as a contributing factor to this complex issue. Normally benign in nature, the immune system can sometimes mistake a pregnancy as a foreign entity, triggering an attack. The innate immune system, our first line of defense, includes natural killer cells which can unfortunately cause issues if they attack the pregnancy. Another structure, the adaptive immune system, is signaled if innate immunity fails to neutralize the perceived invader. The adaptive immune system is a tenacious entity activating the natural killer cells specifically designed to attack the registered antigen or developing embryo, ensuring a faster future response against the same antigen due to its memory. With each successive pregnancy this problem can get worse which is why early testing with a reproductive immunologist can be helpful in identifying the recurrent loss problems.

If these immune responses are not delicately balanced, they can lead to drastic consequences like autoimmune diseases or recurrent miscarriages. It’s a nuanced enigma, where our body’s defense system, intended to protect us, might be causing us harm in certain circumstances. For more detailed information see the INCIID article: Immunology may be key to pregnancy loss.