Recurrent Miscarriage: Causes And Treatment

Having one miscarriage can be devastating enough, but having one after another is often a very traumatic experience. The very thought of trying again can feel like an uphill struggle. Sometimes you may be already expecting another loss even before the pregnancy begins. Your future pregnancies are full of hope but also tinged with a high level of anxiety. You should launch an investigation with your physician, to find out a possible reason for the recurrent miscarriage.

Where possible, you should see a specialist who is dedicated to managing recurrent miscarriage. Often, quality supportive antenatal care makes a big difference. There is some evidence that attending an early pregnancy unit can even reduce the risk of further miscarriages.

What Is The Cause Of Recurrent Pregnancy Loss?

There are several possible causes for recurrent miscarriage, including:

• genetic and hormonal problems
• infection and thrombophilic (blood-clotting) defects
• uterine problems and cervical weakness

Unfortunately, even after investigation, it’s not always possible for doctors to identify the cause of a recurrent miscarriage. However, most couples who have had recurrent miscarriage have a good chance of having a baby in the future.

Advancing maternal age is associated with an increased risk of miscarriage, which is thought to be due to poor egg quality leading to chromosomal (genetic) abnormalities.

Causes Of Recurrent Miscarriage

• Genetic: In a few cases, one partner may repeatedly pass on an abnormal chromosome, causing recurrent miscarriage. Both you and your partner should take a blood test to check for chromosomal abnormalities (known as karyotyping). If the tests show a problem, your doctor will refer you to a clinical geneticist for further testing.

• Hormonal: In some rare cases an imbalance in your pregnancy hormones can lead to conditions such as polycystic ovaries. These are multiple cysts on your ovaries, caused by high levels of LH (luteinising hormone) and testosterone, and can cause miscarriage. Your healthcare professionals can discuss the pros and cons of medical treatment for this.

• Blood clotting disorders: Some blood clotting disorders, such as systemic Lupus Erythematosus and Antiphospholipid Syndrome can cause ‘sticky blood’, leading to recurrent miscarriage. These rare disorders of the immune system affect the flow of blood to your placenta. They may cause clots that prevent the placenta from functioning properly. Thus depriving your baby of essential oxygen and nutrients, which may lead to miscarriage. Treatment may involve taking aspirin and/or heparin therapy, which both help to thin the blood. Research shows that the blood of women who have recurrent miscarriage has an increased tendency to clot.

• Uterine problems: An abnormally shaped womb can increase your risk of recurrent miscarriage and premature birth. There are a number of ways to investigate the shape of the uterus. Depending on the findings, surgery may be recommended.
• Cervical weakness: If you are at risk of cervical incompetence or cervical weakness, your doctor will perform a scan. Or he will advise you to have stitch or cervical cerclage early in the pregnancy.

What Treatment is Available for Recurrent Pregnancy Loss?

Recurrent Pregnancy Loss Treatment

Your treatment recommendations for recurrent pregnancy loss are based on the underlying cause of recurrent pregnancy loss. No matter what the results of your tests are, you have a high chance for a successful future pregnancy: 77% if the there are no abnormalities, and 71% if there is an abnormality.

If you have a karyotypic (a chromosomal or genetic) abnormality, your doctor will refer you for genetic counseling. There, a specialist can discuss what the genetic abnormality is. He will also discuss the likelihood of having a normal or abnormal pregnancy in the future.

You may choose to undergo prenatal genetic studies during pregnancy. This is to check the genetic make-up of your baby. Your doctor can also perform In vitro fertilization (IVF) with pre-implantation genetic diagnosis. With this process, you take shots for several days so that many eggs grow in your ovaries. Your doctor then takes the eggs from the ovaries and injects one sperm cell into each egg, and allows the embryo to grow. One cell of the embryo is then biopsied and the genetic make-up is analyzed to avoid the transfer of an affected embryo.

If your doctor finds a uterine abnormality, he may perform surgery depending on the defect. In an antiphospolipid syndrome diagnosis, you may receive certain medications that reduce blood clot formation. If your diagnosis is thyroid dysfunction or diabetes, your doctor will prescribe specific medication.

Unexplained Recurrent Pregnancy Loss

Over one-half of patients with recurrent pregnancy loss will have unexplained recurrent pregnancy loss. This means that there's no specific cause identified in the tests. Doctors will offer various treatments to these patients, but there is no universal recommendation for treatment. Despite this, the overall chance of pregnancy is more than 50%, without any intervention at all.

Resource: UCLA

Also read: Things to avoid during pregnancy that cause miscarriage