Investigation of Embryoscopy in Recurrent Pregnancy Loss
The purpose is to test the value of embryoscopy in women with missed abortions after recurrent miscarriages (at least two previous miscarriages) in the past. This project will assess two functions of embryoscopy:-
- Whether embryoscopy allows the diagnosis of structural anomalies (disorganized embryos). This is a fetal cause of embryo loss which cannot be diagnosed by other means.
- Whether embryoscopy allows an accurate biopsy of embryonic tissue for karyotyping.
However, it may be that embryoscopy will be found to have no advantage.
|Study Design:||Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Diagnostic
|Official Title:||Investigation of Embryoscopy in Recurrent Pregnancy Loss|
- To test the value of embryoscopy in women with missed abortions after recurrent miscarriages [ Time Frame: Yearly ] [ Designated as safety issue: No ]
- Whether embryoscopy allows the diagnosis of structural anomalies [ Time Frame: Annual ] [ Designated as safety issue: No ]
- Whether embryoscopy allows an accurate biopsy of embryonic tissue for karyotyping. [ Time Frame: Annual ] [ Designated as safety issue: No ]
|Study Start Date:||January 2006|
|Study Completion Date:||January 2009|
|Primary Completion Date:||January 2009 (Final data collection date for primary outcome measure)|
Embryoscopy will be evaluated in women with at least two previous miscarriages, after confirmation of missed abortion by ultrasound. Embryoscopy will only be performed in patients in whom curettage is clinically indicated, and will only be added to the D&C if there is a possibility of visualizing embryonic tissue, i:e. from approximately 5½ weeks onwards when there is an embryonic pole detected on ultrasound.
An 8mm hysteroscope with irrigation channel and 30 degree view will be inserted into the uterus prior to curettage in cases of recurrent missed abortion
In this project, embryoscopy will be evaluated in women with missed abortions (pregnancies which have ceased developing and in which the embryo is dead), after at least two previous (recurrent) miscarriages. The procedure will have two main purposes:- To allow the diagnosis of structural anomalies (disorganized embryos), and to allow an accurate biopsy of embryonic tissue for karyotyping. Hence, this procedure will lead to a more accurate diagnosis of the cause of recurrent miscarriage.
After confirmation of missed abortion by ultrasound, dilatation and curettage (D&C) is normally performed under general anesthetic to evacuate the uterus in missed abortions. In this project embryoscopy will be added to the standard D&C. An 8mm hysteroscope with irrigation channel and 300 view will be used with continuous saline flow. The embryo will be visualized, and the findings recorded. Biopsies will be taken for chromosomal analysis from the embryo and the placental villi. Embryoscopy will be performed with a hysteroscope which is in normal clinical use for investigating the uterine cavity, but for a slightly different indication.
The first stage will be a pilot study on 20 patients to judge the value of embryoscopy.
|Herzlia Medical Center|
|Sheba Medical Center|
|Tel Hashomer, Israel, 52621|
|Principal Investigator:||Howard JA Carp, MB BS. FRCOG||Sheba Medical Center, Tel Hashomer, Israel|