Larsen, Elisabeth Clare5; Christiansen, Ole Bjarne6; Kolte, Astrid Marie7; Macklon, Nick8
1 The Faculty of Medicine, Aalborg University, VBN2 Aalborg University Hospital, The Faculty of Medicine, Aalborg University, VBN3 Klinik Kvinde-Barn og Urinvejskirurgi, The Faculty of Medicine, Aalborg University, VBN4 Gynækologi, Graviditet og Fødsel (Gynækologi og Obstetrik), The Faculty of Medicine, Aalborg University, VBN5 The Fertility Clinic, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.6 Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, VBN7 Institut for Klinisk Medicin8 Ph.d.-studienævnet for Medicin
Sporadic miscarriage is the most common complication of early pregnancy. Two or three consecutive pregnancy losses is a less common phenomenon, and this is considered a distinct disease entity. Sporadic miscarriages are considered to primarily represent failure of abnormal embryos to progress to viability. Recurrent miscarriage is thought to have multiple etiologies, including parental chromosomal anomalies, maternal thrombophilic disorders, immune dysfunction and various endocrine disturbances. However, none of these conditions is specific to recurrent miscarriage or always associated with repeated early pregnancy loss. In recent years, new theories about the mechanisms behind sporadic and recurrent miscarriage have emerged. Epidemiological and genetic studies suggest a multifactorial background where immunological dysregulation in pregnancy may play a role, as well as lifestyle factors and changes in sperm DNA integrity. Recent experimental evidence has led to the concept that the decidualized endometrium acts as biosensor of embryo quality, which if disrupted, may lead to implantation of embryos destined to miscarry. These new insights into the mechanisms behind miscarriage offer the prospect of novel effective interventions that may prevent this distressing condition.