What are the causes of a miscarriage

causes

Changes in the uterus

In around 10% of women with frequent miscarriages, changes in the uterus are found to be the cause. Often, septa are found in the uterine cavity (a fine, easily removable partition in the uterus), or other anomalies that, if left untreated (depending on the severity of the anomaly), can lead to repeated losses in 25-67%. Myomas (muscle nodes in the uterus) can also be complications, especially if they protrude into the uterine cavity and thus impair the function of the mucous membrane. After the appropriate diagnosis, we will discuss surgical therapeutic approaches with you, if necessary.

Infections

Local bacterial and viral infections as well as fungal infections in the vagina, on the cervix / cervix or the uterus itself impair the complication-free course of a pregnancy. Usually the influence of an infection only becomes significant after the first trimester of pregnancy. Possible pathogens are Toxoplasma gondii, Chlamydia trachomatis, mycoplasmas, ureaplasma and other anaerobic germs. A ruptured bladder, fever, or other signs of infection may be signs of infection. Often these problems also occur in connection with a weak cervix (cervical insufficiency) (e.g. after previous operations on the cervix). This can lead to a silent opening of the cervix with infection of the amniotic fluid and the fruit (amniotic infection syndrome). Treatment with antibiotics, strict monitoring of the bacterial colonization in the vagina (measurement of the vaginal pH value) and surgical closure of the cervix may be considered therapeutic measures. Of course, we will discuss and weigh these aspects with you in great detail.

Genetic causes, genetic counseling, genetic diagnostics

Investigations on abortion material have shown that predominantly chromosomal disorders, spontaneously occurring chromosomal misdistributions, are responsible for miscarriages. The risk of repetition is only minimally increased. In rare cases, however, one of the two parents already has a chromosome change, which can be the cause of a chromosomal imbalance in the offspring. This very often results in miscarriages. The risk of repetition is significantly increased. Genetic counseling and testing can clear up such situations.

Immunological causes / antibodies against the placenta

Often an excessive or misdirected reaction of the immune system (defense system) is responsible for increased losses. The immune system can attack its own tissue (auto-antibodies) and also damage the pregnancy. In addition, in some cases the mother's immune system seems to recognize certain tissue properties inherited from the father as "foreign" and reject them. These reactions can apparently also lead to miscarriages. We carry out very extensive examinations of the immune system in order to determine whether or which disorders are present and which therapy options are available for you. We will then discuss these with you in great detail.
One focus of our scientific work lies in this sub-area.

Research / science

There are new findings about the causes and treatment options of frequent abortions, which we are currently researching, a focus of our scientific work. So far it has been possible to identify antibodies against the placenta in women with repeated miscarriages (Rogenhofer et al., Fertilsteril 2012). We would be happy to advise you on the determination and possible consequences.
We were also able to demonstrate paternal involvement for the first time (Rogenhofer et al., FertilSteril 2013).

Increased blood clotting

It has been shown that in the case of miscarriages, an excessive coagulability of the maternal blood in the vessels of the placenta can be recognized. This blood clot obstructs the blood flow and thus the supply of the child, which can lead to insufficient supply, growth disorders or even growth stoppage and death of the fruit. As part of our diagnostics, we can identify a number of (previously mostly undetected) coagulation anomalies. This often results in treatment options for another pregnancy. A clear diagnosis is important, as this is the only way to achieve targeted treatment.

Hormonal considerations

Polycystic Ovarian Syndrome (PCO) is discussed as an important hormonal cause of disturbed early pregnancy. Most of them are very early miscarriages. Apparently there is no adequate maturation of the egg cell and the subsequent disturbance of early pregnancy occurs.
Other hormonal disorders affect the corpus luteum hormone (corpus luteum insufficiency), the thyroid gland (including the increased occurrence of autoantibodies against the thyroid gland), the milk hormone (prolactin) and the male hormones (hyperandrogenemia). After identifying these disorders, we will work out a therapy concept with you.

New insights into recurrent implantation failure

The scientific working group of the Hormone and Fertility Center under the direction of Prof. Dr. med. Nina Rogenhofer and Prof. Dr. med. Christian Thaler managed to get one Risk factor for recurrent implantation failure to uncover: the M2 haplotype of the Annexin A5 gene(M2 / ANXA5). This gene variant leads to a significantly reduced expression of the annexin on the surface of the placenta, around which the maternal blood flows. The result is a thrombotic situation in the placenta.

Indeed, recently in the presence of the M2 / ANXA5 placenta-associated pregnancy complications such as preclampsia, growth retardation of the fetus, prematurity and repeated abortions are described. We were able to do that in our own work M2 / ANXA5 Confirm the haplotype as a risk factor for the complications mentioned. In addition, it was possible for the first time to demonstrate the same risk transfer from the father to M2 sponsorship for growth retardation, premature birth and repeated abortions. This fact can be explained by the fact that the M2 / ANXA5 The haplotype is encoded in the embryo.

Our scientific innovations now include evidence that M2 / ANXA5 represents a risk factor for recurrent implantation failure (RIF), whereby the paternal risk transfer is just as high as the maternal. Consequently, when clarifying a couple with RIF, both partners should refer to the M2 / ANXA5 Variant to be examined. Our findings have already been published in the scientific journal "Journal of Assisted Reproductive Genetics".