Cytogenetic and Immunological Survey in Women with Repeated Reproductive Losses

Among the various reasons of reproductive losses (recurrent pregnancy loss, failure of ART) genetic and immunological factors have the greatest value on early periods.

The most common among genetic factors are chromosomal abnormalities. Chromosomal mutations occur mostly de novo in the gametes or at the early stages of the zygote development and mostly end in abortion. The frequency of miscarriages with chromosomal aberrations is especially high in the first trimester of pregnancy. Maternal age and heterozygous carriage of translocations in one parent are recognized factors that provoke the formation of unbalanced gametes and zygotes in human. Particularly, IVF procedure (method of hormonal stimulation, temperature control when cultivation of the embryo) leads to higher frequency of aneuploydy. The total part of chromosomal abnormalities following implantation that leads to miscarriages is about 45%. Frequency of the chromosomal anomalies carrying to spontaneous abortions and infertility, fluctuates from 1,3 to 10,7%, in case of the recurrent abortion (RA) reaches 25% that exceeds population level at 10-20 times (0,5-1%).

Today transfer of only genetically healthy embryos is considered reasonable. In Israel preimplantation diagnostics is carried out in all cases, it is covered by national health care (Carp, 2015).

As for immunological factors, the single classification created currently is work of A.Beer and J.Kwak, 2000. The question of volume and need of immunological survey in women with repeated reproductive failures still remains open. Our view of a problem is provided in table 1. In women with repeated reproductive failures of not clear etiology cytogenetic and immunological survey is mandatory.

Table 1. Frequency of the factors influencing development of pregnancy in early periods