Embryoscopy in Unexplained Recurrent Spontaneous Abortions Correlation of Embryo Morphology and Karyotype

Fifty six women with history of recurrent spontaneous abortions (RSA) were diagnosed with missed abortion at 7-11 weeks. These patients were previously investigated for RSA and in cases with intrauterine septum, hysteroscopic resection was performed, in cases with anticardiolipin syndrome heparine was administrated, etc. In 43% (24/56) no diagnosis of RSA etiology was established. In all cases progesterone was administrated once the pregnancy was diagnosed. Method: The patients were placed at the lithotomy position and transcervical hystero-embryoscopy of the dead embryos was performed, using a 2.7mm telescope of 30^o connected to Xenon cold light of 600W. Normal saline used as a distending medium. No analgesia or anaesthesia was used for the stage of embryoscopy. The decidua, the pregnancy sac and their contents were investigated. General anesthesia was then applied and endometrial evacuation followed. Results: In 93% (52/56) of the cases, trans-cervical hystero-embryoscopy was successful with excellent visualization of the uterine cavity, pregnancy sac and its contents. In 93% (51/56) the fetal karyotype was available while in 5 cases the fetal samples were infected and/or fetal cells did not survive during the culture. Overall 29% (15/51) cases had normal karyotype. In 36 out of 51 cases, 72% an abnormal karyotype was diagnosed.

We had 21 Trisomies, 8 Turner Sy and 7 Tetrasomies were diagnosed. The chorionic, the amniotic membranes and the cloaca were also affected by the embryos chromosomal polyploidity since characteristic abnormalities were visualized.

Correlation of the embryo external characteristics (phenotype) and embryo genetic analysis (karyotype).