Recurrent Miscarriage

Updates in fertility

This information is important to know so that you do not feel alone and frustrated. The vast majority of early miscarriages are due to genetic abnormities in the fetus, nature’s way of sorting out viable fetuses. It is not something you did or did not do. Miscarriages before 10 weeks are likely due to genetic factors. Miscarriages between10 and 20 weeks are more likely due to clotting disorders, immune system problems, or physical defects of the uterus or cervix. And, even after multiple miscarriages, the odds of a successful pregnancy are still greater than 50%!

What is a recurrent miscarriage?

It is defined as having two or more failed pregnancies. 5% of couples trying to conceive experience 2 or more consecutive miscarriages. 1% of couples attempting to have children experience 3 or more failed pregnancies. In about 50% of women, the cause is never found. Recurrent miscarriage is also called recurrent pregnancy loss or RPL.

When should I get checked?

If you have any concern about recurrent miscarriages you should seek help, especially if you are over age 35. You do not need to wait to suffer 3 miscarriages before seeking help from reproductive fertility specialists like those at California Fertility Partners.

What causes repeated miscarriages?

In about 15% of women, the cause is a congenital abnormality in the physical structure of the uterus. The most common uterine disorder associated with miscarriage is a septate uterus. It does not prevent conception but increases the risk of a first or second trimester miscarriage or preterm labor. It is identified by ultrasound, MRI or hysteroscopy, and is easily treated with minor surgery during a hysteroscopy. However, it varies in severity and many women do not require treatment.

Fibroids and polyps, as well as uterine adhesions and scarring can contribute to miscarriages. Cervical incompetency can lead to pregnancy loss, usually in the second trimester. This is a medical condition where the cervix of a pregnant woman dilates and thins before delivery, without contractions or labor. While rare, it affects about 1% of pregnancies, and causes about 20-25% of second trimester miscarriages. It is only treated where it affects pregnancies. The treatment is called cervical cerclage, a technique to reinforce the cervical muscles with sutures to narrow the cervix.

In a small number of cases, there is a genetic abnormality called chromosome translocation in one or both of the partners which leads to abnormal chromosomes in the egg or sperm, causing the embryo to be nonviable. But it does not affect every embryo. In about 3% of cases, this genetic disorder can result in repeated miscarriage. If chromosomal translocation is identified as the cause In Vitro Fertilization may be your best option for successful pregnancy. You will also need special genetic testing called pre-implantation genetic diagnosis or PGD, to select unaffected embryos.

Some medical disorders can cause recurrent miscarriages. An autoimmune disorder called Antiphospholipid syndrome (APS) causes recurrent pregnancy loss due to disorders in blood clotting. It can be diagnosed with a blood test, and treated with aspirin or anticoagulants like heparin. Diabetes can cause miscarriages due to high blood sugar levels and poor control. Also, polycystic ovary syndrome (PCOS) increases the risk of miscarriage.

Diagnosis

To determine the cause of repeated miscarriages, your doctor will review your medical and health history, and past pregnancies. You will receive an ultrasound exam and blood tests to identify genetic or immune system problems. Imaging tests of the uterus may be used to determine whether a uterine problem is the problem.

The Psychological Impact of Recurrent Miscarriage.

Experiencing miscarriage is devastating. The grief is real, even if unacknowledged. The joy turns into disappointment and emotional pain. Loss of the pregnancy often includes feelings of hopelessness and loss of dreams of your future. Anxiety is common, and can carry over to a subsequent pregnancy. It is important to express your feelings and seek help when needed. The good news is that even if the cause cannot be identified, 65% of women will go on to have a successful subsequent pregnancy.

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