Hysteroembryoscopy in repeated early pregnancy loss due to suspected thrombophilia

Abstract

Introduction: The cause of a 1st trimester repeated pregnancy loss (RPL) under treatment with aspirin and /or heparin due to suspected thrombophilia was investigated. Using hystero-embryoscopy (HEpy) and embryo genetic analysis the embryo development was correlated to its karyotype. Patients and methods: Seventeen first trimester pregnant women recruited in the study. They all had a history of at least 2 consecutive 1st trimester recurrent miscarriages, underwent an investigation for the cause of RPL and diagnosed to suffer from hypercoagulation. Thromboprophylaxis was administrated in all 17 pregnant women during their next pregnancy, postulating that their past cause of miscarriage was due to a hypercoagulability state. Twelve patients had positive Anticardiolipin and /or Antiphospholipid antibodies and 5 patients had MTHFR high titers. Embryo autopsy was performed by hysteroscopy technique using 2.9mm – 5mm hysteroscopes, 5Fr graspers and scissors and normal saline as distending medium. The embryo morphology results were correlated with the genetic results and compared with the patients’ diagnosis and treatment during the last miscarriage. Results: HEpy revealed that in 11 out of 17 cases embryos had chromosomal abnormalities ensuring patients that the problem of their loss was not the followed treatment. In all 4 cases with decidua haematoma and umbilical cord defect patients received aspirin and LWMH, raising the possibility of anticoagulation overtreatment. Conclusion: In-situ autopsy of a miscarriage embryo can provide useful information regarding the morphology of the embryo, ruling out anatomical defects and collecting the embryo under direct vision anticipating an accurate embryo karyotyping. Embryoscopy results may assist to change the management of the next pregnancy in RPL cases and patients with hypercoagulability state.