Abstract
Recurrent miscarriage (RM) remains unexplained in >50% of patients and causes both physical and psychological burdens in women without specific risk factors for miscarriage. Unexplained RM is defined as a failure to achieve delivery owing to chance or undetectable causes of pregnancy loss, including unbalanced maternal immune tolerance, impaired intrauterine circumstances, and perturbation of decidualized endometrium. In 60–70% of patients with a history of three to four miscarriages, delivery is achieved without any treatment, whereas the miscarriage rate in patients with five or more pregnancy losses is >50%, of which ≥60% are losses of fetuses with normal embryonic karyotypes. Thus, the rate of miscarriage and the number of losses of fetuses with normal embryonic karyotype increase with an increase in the number of pregnancy losses, suggesting that maternal, not fetal, risk factors are present in patients with a history of multiple pregnancy losses. However, 75% of patients with unexplained RM achieve delivery after an appropriate treatment.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Teklenburg G, Salker M, Heijnen C, Macklon NS, Brosens JJ. The molecular basis of recurrent pregnancy loss: impaired natural embryo selection. Mol Hum Reprod. 2010;16:886–95.
Sugiura-Ogasawara M, Suzuki S, Ozaki Y, Katano K, Suzumori N, Kitaori T. Frequency of recurrent spontaneous abortion and its influence on further marital relationship and illness: the Okazaki Cohort Study in Japan. J Obstet Gynaecol Res. 2013;39:126–31.
Vissenberg R, Manders VD, Mastenbroek S, Fliers E, Afink GB, Ris-Stalpers C, Goddijn M, Bisschop PH. Pathophysiological aspects of thyroid hormone disorders/thyroid peroxidase autoantibodies and reproduction. Hum Reprod Update. 2015;21:378–87.
De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S. Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:2543–65.
Sugiura-Ogasawara M, Ozaki Y, Katano K, Suzumori N, Kitaori T, Mizutani E. Abnormal embryonic karyotype is the most frequent cause of recurrent miscarriage. Hum Reprod. 2012;27:2297–303.
Ogasawara M, Aoki K, Okada S, Suzumori K. Embryonic karyotype of abortuses in relation to the number of previous miscarriages. Fertil Steril. 2000;73:300–4.
Teklenburg G, Salker M, Molokhia M, Lavery S, Trew G, Aojanepong T, Mardon HJ, Lokugamage AU, Rai R, Landles C, Roelen BAJ, Quenby S, Kuijk EW, Kavelaars A, Heijnen CJ, Regan L, Brosens JJ, Macklon NS. Natural selection of human embryos: decidualizing endometrial stromal cells serve as sensors of embryo quality upon implantation. PLoS One. 2010;5:e10258.
Weimar CHE, Kavelaars A, Brosens JJ, Gellersen B, de Vreeden-Elbertse JMT, Heijnen CJ, Macklon NS. Endometrial stromal cells of women with recurrent miscarriage fail to discriminate between high-and low-quality human embryos. PLoS One. 2012;7:e41424.
Brosens JJ, Salker MS, Teklenburg G, Nautiyal J, Salter S, Lucas ES, Steel JH, Christian M, Chan Y-W, Boomsma CM, Moore JD, Hartshorne GM, Sucurovic S, Mulac-Jericevic B, Heijnen CJ, Quenby S, Koerkamp MJG, Holstege FCP, Shmygol A, Macklon NS. Uterine selection of human embryos at implantation. Sci Rep. 2014;4:3894.
Macklon NS, Brosens JJ. The human endometrium as a sensor of embryo quality. Biol Reprod. 2014;91:98.
Salker M, Teklenburg G, Molokhia M, Lavery S, Trew G, Aojanepong T, Mardon HJ, Lokugamage AU, Rai R, Landles C, Roelen BAJ, Quenby S, Kuijk EW, Kavelaars A, Heijnen CJ, Regan L, Macklon NS, Brosens JJ. Natural selection of human embryos: impaired decidualization of endometrium disables embryo-maternal interactions and causes recurrent pregnancy loss. PLoS One. 2010;5:e10287.
Gellersen B, Brosens JJ. Cyclic Decidualization of the human endometrium in reproductive health and failure. Endocr Rev. 2014;35:851–905.
Kolte AM, Olsen LR, Mikkelsen EM, Christiansen OB, Nielsen HS. Depression and emotional stress is highly prevalent among women with recurrent pregnancy loss. Hum Reprod. 2015;30:777–82.
Li W, Newell-Price J, Jones GL, Ledger WL, Li TC. Relationship between psychological stress and recurrent miscarriage. Reprod Biomed Online. 2012;25:180–9.
Clifford K, Rai R, Regan L. Future pregnancy outcome in unexplained recurrent first trimester miscarriage. Hum Reprod. 1997;12:387–9.
Brigham SA, Conlon C, Farquharson RG. A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. Hum Reprod. 1999;14:2868–71.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Kuroda, K. (2018). Unexplained Recurrent Miscarriage: Introduction. In: Kuroda, K., Brosens, J., Quenby, S., Takeda, S. (eds) Treatment Strategy for Unexplained Infertility and Recurrent Miscarriage. Springer, Singapore. https://doi.org/10.1007/978-981-10-8690-8_7
Download citation
DOI: https://doi.org/10.1007/978-981-10-8690-8_7
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-8689-2
Online ISBN: 978-981-10-8690-8
eBook Packages: MedicineMedicine (R0)