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Host immunoregulatory mechanisms and the success of the conceptus fertilised in vivo and in vitro

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Early Pregnancy Loss

Abstract

In their classic article published in the Lancet in 1975, Roberts and Lowe asked, “Where have all the conceptions gone?”(1) They estimated from epidemiological data that 80% of conceptions were lost before term. As only In-1/7-1/10 clinically diagnosed pregnancies abort, approximately 75% of conceptions must be lost before the woman is known to be pregnant. Confirmation of this figure comes from laboratory measurements of early pregnancy factor (EPF) that appear in the woman’s blood within 24 hours of conception, and persist so long as the conceptus is viable.(2,3) Using the EPF assay, Rolfe estimated that approximately 75% of conceptions were lost in the first 14 days.(3) Based on the combined use of EPF and βhCG (which becomes positive after implantation), it can be estimated that of 100 fertilised embryos, 20–30 will not implant, 20 may make a transient attempt to implant (as reflected by a single low level, spike of βhCG-like material in blood or urine), and 5–10 may persist as true chemical pregnancies for a few days and silently abort; an additional 5–10 will abort after the diagnosis of pregnancy is made clinically (20 days post-conception and 14 days after implantation) by conventional βhCG testing and absent menses (3-11) From the studies of Hertig and others,(12.13) one anticipates a 50% incidence of lethal genetic and anatomical abnormalities in the early conceptus, and these embryos will comprise a major part of the 75% total mortality. Such defectiveness is random and not likely to explain recurrent loss manifest as apparent infertility or recurrent abortion. It must be noted that the proportion of early embryos lost may vary considerably with the population being studied. In older patients and in infertile couples, the occult abortion rate may be higher(8) whereas in other groups, the total early loss may be as low as 25%.(11)

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Authors
  1. D. A. Clark
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Editors and Affiliations

  1. Department of Obstetrics and Gynaecology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    Frank Sharp MD, FRCOG

  2. Department of Obstetrics and Gynaecology, St Mary’s Hospital, Praed Street, London, W2 1PG, UK

    Richard W. Beard MB, BChir(Cantab), MD, FRCOG

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© 1988 The Royal College of Obstetricians and Gynaecologists

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Clark, D.A. (1988). Host immunoregulatory mechanisms and the success of the conceptus fertilised in vivo and in vitro. In: Sharp, F., Beard, R.W. (eds) Early Pregnancy Loss. Springer, London. https://doi.org/10.1007/978-1-4471-1658-5_29

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  • DOI: https://doi.org/10.1007/978-1-4471-1658-5_29

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1660-8

  • Online ISBN: 978-1-4471-1658-5

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