[Unexplained recurrent early miscarriages: Role of immunomodulation?]

Area of Science:

• Reproductive Medicine
• Immunology
• Genetics

Background:

• Recurrent early miscarriage (≥3 fetal losses before 14 weeks) affects 1-3% of women.
• Genetic factors may explain up to 50% of recurrent early miscarriage cases.
• Immune dysregulation, specifically allo-immune responses, is a potential cause in remaining cases, but lacks diagnostic biomarkers.

Purpose of the Study:

• To review the potential genetic and immune causes of recurrent early miscarriage.
• To discuss the current status and limitations of pre-implantation genetic diagnosis.
• To evaluate the evidence for immunosuppressive and immunomodulatory treatments.

Main Methods:

• Literature review of studies on recurrent early miscarriage.
• Analysis of genetic testing and immunomodulatory treatment data.
• Discussion of diagnostic challenges and treatment recommendations.

Main Results:

• Pre-implantation genetic diagnosis is restricted in France.
• Biomarkers for immune-mediated fetal loss are currently lacking.
• Small studies on immunosuppressive treatments exist, but data are insufficient for recommendations.

Conclusions:

• Further research is essential to understand the causes of recurrent early miscarriage.
• Development of diagnostic biomarkers for immune-mediated loss is needed.
• Robust clinical trials are required to establish effective treatment guidelines.