Before trying to conceive, you should have a pre-conception appointment.

This consultation will include a detailed medical and surgical history and physical examination (with special emphasis on the gynecological exam), as well as a family and marital medical history, in search of factors that may affect the prognosis of a future pregnancy and that may eventually be corrected before conception or that imply specialized monitoring.

At this consultation, you will be prescribed folic acid (400 mcg/day) to reduce the likelihood of having a baby affected by a neural tube defect (spina bifida, etc.). You will also be asked to undergo a set of tests: complete blood count with platelets, creatinine, glucose, blood type and Rh factor, indirect Coombs test, serological tests for rubella, toxoplasmosis, hepatitis B and C viruses, HIV, CMV and syphilis, urinalysis and urinalysis. A cervical cytology (Pap smear) and/or screening for high-risk HPVs will also be performed if the current test is not up to date.

To increase the chances of getting pregnant, a woman should know her fertile window. This fertile window begins 5 days before ovulation and ends the following day. This is because sperm can survive in the vagina for up to 5 days, while the egg does not survive for more than 24 hours.

Identifying the fertile window can be difficult: menstrual cycles vary from woman to woman and in the same woman they can vary from one cycle to another. A woman with 28-day cycles generally ovulates on the 14th day. In women with cycles of a different length, ovulation generally occurs 14 days before the day of their next menstruation.

There are methods and techniques to determine the day of ovulation: basal body temperature charts and a test that detects the surge of a hormone (LH) that usually occurs 36 hours before ovulation.

WOMAN

• Eat a balanced diet;

• If you are overweight or underweight, you should aim to reach your ideal weight;

• Reduce stress;

• Don't smoke: tobacco increases the incidence of infertility, reduces the response to medications used to induce ovulation, and increases the likelihood of miscarriage;

• Don't drink more than one coffee a day;

• Reduce or eliminate alcohol consumption.

MAN

• Don't wear tight pants or underwear;

• Avoid hot baths, especially immersion baths;

• Don't smoke or drink;

• Avoid exposure to chemicals and radiation;

• If you are overweight, you should lose weight.

• Anabolic steroids;

• High-dose corticosteroids;

• Cyproterone, cimetidine, spironolactone;

• Colchicine, nitrofurantoin, sulfasalazine;

• Amiodarone;

• Nifedipine;

• Propranolol, quinine, chlorpromazine;

• Tricyclic antidepressants, MAO inhibitors, phenothiazines;

• Thiazide diuretics.

The success rates of Medically Assisted Reproduction (MAR) techniques are easily manipulated.

To critically analyze success rates, there are certain factors you should know beforehand to avoid creating false expectations:

• The main prognostic factor in both natural and assisted reproduction is the woman's age: the older the woman, the lower the probability of success;

• The probability of a couple under 35 conceiving naturally in a given cycle is around 20%; this probability drops to 5% after age 40;

• The success rates of any technique depend on the characteristics of the population to whom the technique is applied: a program that restricts access to a particular technique for couples with a poor prognosis obviously increases the success rates of that technique;

• In the case of IVF, the more embryos transferred, the greater the probability of success, but also the greater the probability of multiple pregnancies. The current trend is to transfer only one embryo.

GENERAL CONSIDERATIONS

Recurrent miscarriage is defined as the occurrence of two or more early embryonic or fetal losses.

Most losses are pre-embryonic or embryonic (before nine weeks), with recurrent fetal loss between nine and 15 weeks being rare.

Recurrent miscarriage occurs in approximately 1% of women of reproductive age.

It is important not to confuse recurrent miscarriage with sporadic (non-consecutive) miscarriage, which occurs in 10 to 15% of all clinically recognized pregnancies.

The risk of miscarriage after two consecutive miscarriages is about 30%, similar to the risk of miscarriage after three consecutive miscarriages.

Maternal age influences the rate of recurrent miscarriage (approximately 25% in women under 30 and approximately 60% in women over 40).

Only in about 50% of cases of recurrent miscarriage is it possible to establish a cause.

A couple with unexplained recurrent miscarriage has about a 70% chance of having a successful future pregnancy.

CAUSES OF RECURRENT MISCARRIAGE
The following are only the causes that are not controversial.

• STRUCTURAL CHROMOSOMAL ABNORMALITIES IN THE COUPLE

In approximately 2 to 4% of couples, one partner carries a balanced structural chromosomal abnormality.

• MOLECULAR GENETIC ANOMALIES

Some molecular abnormalities linked to the X chromosome are a cause of recurrent miscarriage.

• RECURRENT EMBRYONIC ANEUPLOIDY

It is possible, even with a normal karyotype for the couple, that recurrent embryonic aneuploidy is a cause of recurrent miscarriage.

• UTERINE ANATOMICAL ANOMALIES

Approximately 10 to 15% of women with recurrent miscarriage have uterine malformations, the most frequently implicated being a septate uterus.

• Antiphospholipid Syndrome

Antiphospholipid syndrome (APS) is characterized by the presence of a significant level of antiphospholipid antibodies (anticardiolipin, anti-β2-glycoprotein, and lupus anticoagulant), in addition to one or more clinical manifestations, one of which is recurrent miscarriage.

STUDY OF COUPLES WITH RECURRENT MISCARRIAGE

The indicated examinations refer to the basic study:

• Exclusion of uterine malformations (transvaginal ultrasound, hysterosalpingography, hysterosonography, hysteroscopy)

• Karyotype of the couple

• Antiphospholipid antibody test

TREATMENT OF RECURRENT MISCARRIAGE

Here are some situations that can be treated:

• Uterine malformations (for example, the uterine septum can be removed by hysteroscopy).

• Antiphospholipid syndrome: treatment with low molecular weight heparin and low-dose aspirin.

• Couples with balanced structural chromosomal abnormalities should receive counseling from a geneticist. Preimplantation Genetic Testing may be considered.

The range of functions performed by a Clinical Psychologist in this context is broad and varied. They range from supporting couples in the pregnancy process (from pre-conception support, managing expectations and anxiety throughout the pregnancy in both partners, to psychoeducation about the process). In addition, they are also responsible for the selection process of sperm and egg donors.

No. A Clinical Psychologist working in this area also ends up working on different aspects of sexuality (for example, sexual dysfunctions), as well as doing more traditional work on anxiety and depression (for example, depression during pregnancy or postpartum depression), like any other Clinical Psychologist.

Pregnancy is one of the most significant processes in a couple's dynamic. It has positive consequences, but sometimes also negative ones, especially when the couple is not prepared for the change or there are other individual or marital variables contributing to it. A brief intervention by a specialist can make a fundamental contribution to ensuring things go smoothly.

When the process fails, it's necessary to grieve and reorganize. Decisions must be made (try again or change strategy). A psychologist is also helpful in this process, to accelerate it and maintain the functionality of the individuals involved, so that they are able to make the best possible decisions for you.