Early pregnancy loss: the default outcome for fertilized human oocytes

Abstract

Early pregnancy loss is by far the most frequent outcome of human reproduction. It occurs when despite the timely interaction of gametes and initiation of embryogenesis and implantation of the conceptus, pregnancy continuance fails. From a clinical perspective, early pregnancy loss represents a neglected but relevant issue because of the high incidence, the evolving and yet not fully elucidated mechanism, the possible association with other relevant medical conditions, and the potential psychological sequelae. Our growing understanding of the dialog established between the embryo and the endometrium provides new insights into the etiology of pregnancy loss. Aneuploidies as a cause of early pregnancy loss are known for a long time, but there is now evidence that endometrium is not a passive player. An active selection aimed at impeding implantation of unhealthy embryos actually occurs at the endometrial interface. The concept of selectivity is substituting the one of mere receptivity.

Keywords: Cardiovascular risks; Endometrium; Genetic testing; Implantation; Miscarriage; Misoprostol; Pregnancy loss.

Fig. 1

Endometrial secretions and their effect on embryo implantation and early pregnancy loss (EPL) (Courtesy of Joanne Muter)