The Role of Hysteroembryoscopy in the Management of Spontaneous and Repeated Pregnancy Loss
Hystero-embryoscopy (HEpy) can be used for an in situ autopsy of an embryo in spontaneous as well as in repeated pregnancies loss (RPL). Such an 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. In this prospective study the cause of a spontaneous miscarriage (SM) and RPL was investigated. Many RPL cases that have been diagnosed and treated may experience a consequent miscarriage during next pregnancy. This constituted a major interest in our research. Embryo autopsy was performed by hysteroscopy technique using 2.9–5 mm 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. Chromosomal abnormalities diagnosed in 70% of both SM and RPL cases while morphological defects observed in 51% and 15.7% respectively. In 10.6% of the SM and 5.9% of the RPL cases HEpy failed to diagnose a clear cause of the miscarriage indicating other etiological factors, probably due to myometrial dysfunction. Embryoscopy seems to be a valuable method for accurate diagnosis of the miscarriage cause during first trimester SM and RPL and can be especially useful for future treatment purposes. Standardization of RPL patients’ clinical characteristics criteria and treatment protocols are imperative to perform studies with reliable results. The combination of 4D sonography, in situ embryo autopsy together with embryo genetic analysis will probably enlighten our knowledge about the cause of SM and RPL.
KeywordsHysteroscopy Embryoscopy Hystero-embryoscopy Repeated pregnancies loss Spontaneous miscarriage
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