What is the most effective treatment option for women who have recurrent miscarriages?

 Many patients come to us who've had recurrent, unexplained first-trimester miscarriages, and they want us to do surrogacy for them. Which makes a lot of sense, doesn't it? After all, she is getting pregnant, which means she doesn't have any fertility problems, but she is not capable of carrying the pregnancy, which means for some reason she is miscarrying. And if she is miscarrying, then doesn't that mean that there's a problem with the uterus, and isn't it also very logical that if you switch the uterus and use the surrogate, the surrogate would go on to have a healthy baby?  but actually, it's not true at all, and let me explain why. Most recurrent first-trimester miscarriage patients miscarry because there's a genetic problem in the embryo.

We all know that the commonest reason for a first-trimester miscarriage is a genetic problem, and this is nature's defense mechanism. Rather than give birth to an abnormal baby, you stop the pregnancy there. Now if that's the issue, then obviously changing the uterus is not going to help, which is why surrogacy is a complete waste for these women.

The problem is that the embryos that they're creating are genetically abnormal. Now part of the problem is that these genetic errors are random. We have no control over them. We can't predict them, we can't treat them, we can't prevent them, and that can be very frustrating. But one thing we do know is that these genetic problems in embryos are usually because of genetic problems in the egg, and these problems are much more common in older women because as their eggs become older, they accumulate a lot of genetic defects.

So, statistically, the chance of having a genetically abnormal embryo is much higher in an older woman. This is why the eggs in these women are okay enough for them to ovulate and even to get pregnant with or without IVF, which means they can continue forming an embryo up to maybe six weeks or eight weeks, but then after that, because of that genetic abnormality, the cells stop dividing and this embryo cannot grow.

As a result, they miscarry, which could either be because the ultrasound shows no beating heartbeat or because they start bleeding. Now the reason for the miscarriage, the underlying reason, the root cause is because of an abnormal embryo, because of an abnormal egg. Doing surrogacy is not going to help. What these women actually require is donor eggs I know this sounds completely counter-intuitive but that's the truth and the reason for that is because embryos are active. The uterus, which is the soil, is very passive. It's the embryo, which is the seed, and if you have a good quality embryo, it's going to implant and continue to a healthy pregnancy.

But if you have a poor-quality embryo that is good enough to implant but not good enough to give rise to a healthy pregnancy, these are the women who miscarry. And I know using donor eggs may seem very counter-intuitive for these women, but especially if they're older, this is actually the best treatment option because that way they can carry their pregnancy and go on to have a healthy baby.

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