Treatments to prevent early miscarriages (miscarriages at 6 weeks to 8 weeks) depend on what the root cause of the miscarriage is. At CHR, a thorough testing round helps our physicians pinpoint miscarriage treatments at its precise cause for each patient.
Putting in place preventative steps before a pregnancy happens is crucial when it comes to treatments for early miscarriages. Having reason to believe that conditions exist that predisposes women to miscarriages--early miscarriages or otherwise--preventive steps must be taken as soon as possible.
At CHR this means that treatment is “case-specific.” Once a patient is suspected of having a hyper-active immune system that may interfere with development of appropriate tolerance pathways toward the implanting embryo, she becomes a candidate for early miscarriage treatment. What that entails will depend on her laboratory findings. For example, if she demonstrates inflammatory markers, she may require longer-term anti-inflammatory treatments that may be started weeks to months before IVF cycle start. Acute allergic responses will be treated in more contemporary fashion with antihistamines and boosts of prednisone. The most complex treatment is reserved for patients with evidence of autoimmunity and is individualized not only in medications used but also in dosages of those medications.
The general principle of preventing a potentially preventable early miscarriages and miscarriages later in pregnancy is to eliminate any causes. If an endometrial polyp is present, it should be removed. If a submucous myoma is present, it may have to be shaved off. If a uterine septum is detected it may have to be excised. If a hyper-active immune system is suspected, it must be suppressed and, thereby, hopefully prevented from attacking an implanting embryo or an already existing pregnancy.
Because here involved areas of study are experimentally difficult to access, they, rightly, have remained controversial. It, therefore, is important to understand that, currently, there is in principle no right or wrong treatment of pregnancy loss. No treatment, indeed, can claim to have established itself as sufficiently effective. CHR investigators fully recognize this fact when making treatment suggestions, as in this case.
In its various treatment approaches, CHR, however, attempts to extract treatment principles form similar biological circumstances which, in the case of pregnancy and pregnancy loss, must be the allogeneic organ transplant since the fetus is basically just a semi-allogeneic organ transplant from male to female partner.
Because the treatment of immunologic pregnancy loss has changed very little over the last 30 or more years, significant progress in the treatment of allogeneic organ rejection must, sooner or later, sharpen our understanding and, ultimately treatment of miscarriages. So far, many of recently successfully introduced anti-rejection drugs in organ transplantation have found only limited utilization in the treatment of immunological pregnancy complications, like miscarriages. The principal reason is that drug companies not only never express desire to investigate their drugs in pregnancy but, because of liability concerns, often actively oppose use of their drugs in pregnancy. Fortunately, however, post-marketing surveys of women who unknowingly conceived while on some of these drugs, increasingly demonstrate their relative safety in pregnancy. One, therefore, can assume that, in addition to such medications as intravenous gamma globulin (IV-Ig), intralipid, and granulocyte-colony stimulating factor (G-CSF), soon other medications, like for example Tacrolimus (an immunosuppressive anti-rejection drug), will find increasing utilization in the prevention of certain miscarriages. CHR has for decades been on the forefront of research in this area of reproductive medicine and will remain a pioneer in utilization of any of these new treatment options.
This is a part of the September 2019 CHR VOICE.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
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