The Role of Hystero-Embryoscopy in the Management of RPL

Introduction: Embryoscopy is the direct visualization of the embryo between 5 and 11 weeks’ gestational age. Method: A 30^o telescope inserted in the cervical os and progress towards the endometrial cavity reaching the extracelomic space when the procedure is done before 11 weeks or inside the amniotic cavity when it is done in more advanced gestational age. The cervical canal, the intrauterine cavity, the pregnancy sac, chorion and amnion, the umbilical cord, the embryo and yolk sac can be all clearly visualized. Using 5Fr scissor and grasper the embryo can be separated from the umbilical cord and send to genetic analysis. Hence embryoscopy can confirm and further clarify the embryonic development and chromosomal status of spontaneous and recurrent 1^st trimester missed abortions. Results: Among 118 total number of 1^st trimester, RPL cases, 21 cases (18%) received heparine treatment in previous pregnancies and already had one child. In these study pregnancies, were also treated with same protocols but having a miscarriage questioned the previous successful pregnancies how were achieved. Embryoscopy demonstrated morphological problems or karyotype abnormalities confirming that the previous successful pregnancies were not achieved by chance. In 16% with normal karyotype an abnormal phenotyope, according to Carnegie staging system was noted explaining the miscarriage. In cases with CNS anomalies like anencephaly and spine deformities high doses of folic acid can pre- and antenatal be administrated. In 6 IVF RPL cases embryoscopy revealed low implantation insertion and 2 cervical pregnancies. In only 5-7% of all cases will not be able to have a firm diagnosis of the abortion cause. Conclusion: Hystero-embryoscopy can provide the reason of the abortion and consequently, measures and treatments to protect a future pregnancy. The information of the miscarriage cause, answers to patients’ questions, alleviate their emotional distress and encourages them to seek another pregnancy soon after.