Yasmina Ben-Aicha, MD
Obstetrics & Gynaecology & Reproductive Medicine Specialist, Equipo Juana Crespo
Miscarriages and RPL, Success Stories
Hormonal imbalance can be related to the thyroid or the ovaries. When it comes to thyroid dysfunction, there are some treatments that we can do. There are also some hormonal imbalances when we have some disorders in the FSH, LH. When we have a polycystic ovary, also we can have some hormonal imbalance, so we have to arrange it during the ovarian stimulation. We work together with the endocrinologist when there are some problems with the thyroid, we can work with them and just give medication.
Normally, we try to work multidisciplinary to arrange it and make a good treatment for the patient. In a general medical background, the TSH is normal till 4. However, when we are looking for pregnancy, the recommendation is to have a TSH lower than 2.5. That’s why even if it’s 3, your GP will tell you, it’s a good level, but when we look for pregnancy to have a healthy first trimester of the pregnancy, the good level is lower than 2.5. We recommend checking it with your endocrinologist or starting with a low medication and performing a blood test 4 weeks later.
We have to take into account what’s adenomyosis. Adenomyosis is like an inflammation, some points of endometriosis inside the uterus, inside the wall that are just giving inflammation, and it causes bad preparation of the uterus. Most of them, we can check with an ultrasound, but sometimes, we have to do some mock cycles, some trials, give some medication to see how the uterus is responding when destructions are high.
Normally, the most effective way is to do an ultrasound. Sometimes, we perform an MRI at some specific points of the cycle. We also perform a laparoscopy to check the ovaries, the fallopian tubes. However, that will not give us information related to adenomyosis.
In that situation, it’s important to normalize it and double-check with your endocrinologist that there’s nothing else to add or check before controlling it as much as possible. If you’re not going to use your own eggs when you go for an embryo transfer, and there’s no male problem, we can just avoid the PGT-A.
It all depends on the reason for the previous miscarriages, that’s why it’s really significant to know the case and the reason. For example, if these two miscarriages happened because of an abnormal embryo, I would be more confident to go with the embryo donor cycle with no other treatment or no other points to check. If the embryos were normal, then we have to look further, and check the uterus or look for some endocrinological disorders, etc. There are some unknown reasons sometimes. We always try to find the reason for the miscarriages to occur.
Recently, there are some discussions because the sperm is playing a part. Nowadays, there are some extra tests, but we don’t know exactly how to use them, they are related to DNA fragmentation. Some studies show that they play a part. Some of them are not giving a lot of importance to that factor, so there’s a discussion.
Here, in our clinic (Juana Crespo), we pay more attention to the egg and the uterine factor. Sometimes, when there are is bad sperm, we check further, but we don’t pay a lot of importance to the DNA fragmentation because we have to take into account that in the sperm, most of the time, there are millions of spermatozoa, and we have experienced embryologists who can check and select the perfect spermatozoa to fertilize the eggs one by one.
The spermatozoid is giving the chromosomal information, and a good egg could improve a medium or low sperm sample. Some groups say that they take it into account, others say that it’s not worth it, and they are not paying a lot of attention to it. It’s still being discussed.
That’s a difficult question, so it is true, there’s some percentage of unexplained infertility cases. Personally, and here in our clinic, we always want to know the cause because it’s not bad luck, we want to know why as all the doctors, I guess, we like to know the reason, to analyse the case. Most of the time, we can find the reason.
Although, sometimes we think that it’s the cause. Each couple and each case is completely different, you cannot compare situations, but I always try to find the reason and improve that situation to get a good result.
As I said previously, the sperm plays a part. The most important thing with the sperm is the appearance and the specific selection. Even if there is no motile sperm, the ICSI method solves that problem.
The motility gives us the information that the sperm is not able to reach the fallopian tube and the egg in that situation. When we go for a testicle biopsy, for example, we obtain spermatozoa with no motility, so it’s only to give the chromosomal information, it does not affect it at that point.