4.1. Literature Analysis
This study revealed significant data about the correlation between women’s views, perceptions of marriage satisfaction, intimacy issues, and stress levels with the diagnosis of thrombophilia with recurrent pregnancy loss. Among the important results from these respondents was the observation that they participated in sexual behavior less often. Additionally, it was found that the women in the reference group who did not give birth had a significantly higher proportion of three or more pregnancy attempts (54.1% vs. 39.5%) and a significantly higher proportion of three more pregnancy losses (68.8% vs. 55.6%). It was observed that patients in the reference group were more likely to be emotion-oriented (42.7% vs. 27.2%). Also, women in the reference group had higher levels of dissatisfaction and lower levels of self-acceptance, pleasure, and marital quality scores. The total SII and DSCS scores were significantly lower than women with thrombophilia with a history of RPL who eventually gave birth. Women from the reference group had significantly greater intimacy problems and stress levels while having lower openness scores and self-esteem scores than women in the control group.
RPL not only creates a great deal of psychological and financial struggles for the concerned women and their spouses, but it also affects the couples’ relationships and the way they interact with their family and relatives [
13,
27]. Failed marriages are more likely for women with RPL than for those without losses or with live births [
28]. There is no known explanation, and research has been restricted. According to studies, women have a larger desire to discuss their losses than their male partners, and these discrepancies may lead to unhappiness and strain on the relationship [
29]. In addition, males often take a significant role, supporting their relationships and exhibiting resilience in times of difficulty. This reduces their capacity to demonstrate emotional sensitivity when it is required of them and may cause them to hide their own emotions and needs [
30]. There is also evidence that couples, after a miscarriage, may have sexual difficulties. In contrast, the relationship may also be a protective factor for mental health, as spousal engagement and marital fulfillment are connected with reduced anxiety and depression scores after a single pregnancy loss or RPL [
31].
Regarding active social support, observers often misunderstand the impact of RPL and, in particular, the challenges they constitute for males [
32]. According to research, 41% of the women surveyed were dissatisfied with the responses of their friends and family following miscarriages and accused of a lack of empathy and attention [
29]. This is concerning since social care from family and friends is recognized as a protective factor for mental health and is related to reduced levels of depression and anxiety in women with RPL. Little is known about the degree of family and friend assistance that women with recurrent pregnancy loss and their partners seek to receive [
33]. Two qualitative studies from the United States and Australia provide preliminary evidence that the support of friends and family members with comparable circumstances is seen as beneficial by women who have had one or more miscarriages and their spouses [
34]. Offers to cook meals or care for youngsters from friends and families, as well as offers of time off and assistance from businesses and churches were highly appreciated. Proposals to anticipate future pregnancies and efforts to emphasize good elements of the miscarriages were seen as callous, as were remarks suggesting that the women’s lives and/or choices may have contributed to their losses.
Another research study showed that women with RPL and severe depression had worse sexual function scores, which is consistent to our findings where patients with RPL had significantly more intimacy problems [
35,
36]. Due to the fact that emotional and sexual difficulties are not identified by health care providers because fertility concerns are prioritized or because such difficulties are considered taboo, the evaluation of sexual and mental health must be included in the consultation for women with a history of RPL, regardless of whether the patient pursues help for depression and sexual dysfunction.
Although thrombophilia and the severity of mutations are known to significantly impact the occurrence of miscarriage, it is also hypothesized that several socio-economic factors can directly or indirectly affect this risk. Studies confirm that unhealthy lifestyle habits, lower levels of education, and number of habitual abortions are more frequent among women from lower socio-economic classes [
37,
38,
39]. Therefore, the socioeconomic status of a woman with thrombophilia might further increase the risk of recurrent miscarriage.
Regarding the influence of thrombophilia on the success of pregnancy, in our study, it was observed that the reference group was affected by significantly more thrombophilia mutations, as the proportion of three or more mutations was 55.4%, compared to only 19.8% in the control group. It was also observed in our study that pregnant women with thrombophilia affected by RPL but who successfully gave birth after many attempts accessed significantly more often assisted reproductive techniques (ART) (64.2% vs. 24.8%). Other studies reported that ART is associated with a higher risk of thrombo-embolic events, therefore increasing the risk among patients with thrombophilia [
40].
A recent comprehensive analysis indicated that the antepartum risk of VTE after IVF is twice that of the typical pregnant population as a whole. VTE was always related to pregnancy, while arterial thrombosis was documented earlier and even in the absence of pregnancy. Less than forty percent of patients had concomitant thrombophilia. This higher risk of VTE in IVF pregnancies is a result of a five- to tenfold greater risk in the first trimester [
41]. However, the existing evidence does not support a correlation between thrombophilia and ART results [
42]. Consequently, the ease of access to ART among these individuals might readily fix their issues. Considering the possibility of a link between congenital thrombophilia and unfavorable pregnancy outcomes, anticoagulation has only been demonstrated to be advantageous in the context of antiphospholipid syndrome (APS) [
43].
4.2. Strengths and Limitations
A first limitation of the study is that the sample size requirements were not entirely met, as the computed optimal size of the sample was 381 participants, while only 238 patients were ultimately included. Therefore, it may be essential to collect additional examples to obtain appropriate statistical power. Also, control samples were not matched; therefore, confounding variables could not be controlled for. Thus, a matched sample may provide more precise findings. As a second limitation, the cross-sectional design may be regarded as an important constraint since it does not give a convincing evaluation and assessment in time of the participants’ stress levels and relationship difficulties. Since the surveys only examine the participants’ responses at a single moment in time, it is impossible to identify with precision the levels of stress and pair satisfaction. As a third limitation, the use of questionnaires may result in a high subjectivity index from all respondents who agreed to complete them, which might lead to many biases in the acquired data. In conclusion, the results of the current study can only be extrapolated to the community that was studied due to the likelihood that religion and culture, as well as other population-specific characteristics, might have an influence on the observations.