Repeated (recurrent) miscarriage, also called recurrent pregnancy loss occurs when a woman has 2 or more consecutive pregnancy losses. Miscarriages are quite frequent, happening in 15–20% of all conceptions, most of the time during the first period of pregnancy before 12 weeks. In itself, a miscarriage of 1 or even 2 pregnancies do not predict future infertility. However, this may cause distress and anxiety to the couple and doubt whether or not they will be able to deliver a healthy baby. After experiencing the loss of multiple pregnancies, there is a chance that a couple will succeed in having healthy children without the assistance of medical professionals in more than half of all cases.
Repeated miscarriage is an uncommon condition that only affects 1% of married couples. However, treatment for repeated miscarriage is available in one way or another once the proper investigations and tests have been carried out by a specialist in the field.
CAUSE OF REPEATED MISCARRIAGE:
According to ACOG (American College of Obstetricians and Gynecologists), about 60% of all recurrent miscarriages are a result of a genetic abnormality, however, anatomic abnormalities also play a role. As a woman ages, the risk of miscarriage due to genetic abnormalities increases from 15% to 20% if she is under the age of 35, and if she is over 40 years old then the abnormalities increase up to 50%.
GENETIC ABNORMALITIES
A genetic abnormality can occur when an embryo (fertilized egg) receives an abnormal number of chromosomes during fertilization. This type of genetic cause usually occurs by chance and there is no medical condition associated with it. In a small number of couples who have recurrent miscarriages, one partner may have chromosome translocation (when one piece of a chromosome breaks off and attaches to a second chromosome).
ANATOMIC ABNORMALITIES
Various types of medical conditions can increase the risk of repeated miscarriage such as the following:
Antiphospholipid syndrome (APS) An autoimmune disorder that occurs when a person’s immune system mistakenly makes antibodies to certain substances that are necessary for blood clotting.
Thyroid/hormonal issues An overactive or underactive thyroid (an endocrine gland at the base of the neck) can result in hormonal imbalances. Hormonal imbalances can cause a miscarriage if the uterine lining doesn’t develop normally for implantation and nourishment of a fertilized egg. Elevated prolactin (a reproductive hormone produced in the pituitary gland) levels can alter the proper development of the uterine lining.
Fibroids and polyps Non-cancerous growths that can grow into and invade the uterus.
Asher man’s syndrome A condition in which scar tissue forms inside the uterus and may result in miscarriage.
What kind of treatment for repeated miscarriage is recommended?
Treatments for repeated (recurrent miscarriage) can involve lifestyle changes, medications, surgery, or genetic tests to increase the chance of a successful pregnancy. With certain conditions surrounding recurrent miscarriages, medical or surgical treatments can lower a woman’s risk for future miscarriage. If a doctor finds a chromosomal problem such as translocation, they may recommend genetic counseling. While many couples with translocations conceive a healthy pregnancy naturally, a doctor might suggest fertility treatments such as in vitro fertilization (IVF). The embryos can then be genetically tested using a technique called preimplantation genetic diagnosis (PGD), and only normal ones are transferred to the uterus. This improves pregnancy outcomes. Making good lifestyle choices, such as stopping smoking or illicit drug use, limiting alcohol and caffeine, and maintaining a healthy weight, may lower the risk of recurrent miscarriages. There is no proof that stress, anxiety, or mild depression cause recurrent miscarriages.
Blood tests To screen for problems, blood tests are done to decide the best treatment for repeated miscarriages. These conditions include blood coagulation problems, polycystic ovarian syndrome, and excessive levels of specific antibodies.
Surgical procedures Some issues that manifest in the uterus (lining of the uterus), such as damaged tissue, cysts (benign tumors), or excess tissue that splits the uterus (septum), can indeed be remedied through surgical procedures. In many cases, the risk of having a miscarriage can be reduced by modifying the structure of the interior of the uterus.
When repairing the internal structure of the uterus, the clinician will insert a device called a hysteroscope, which is equipped with a camera, into the uterine cavity. In most cases, you stay in the hospital for the day post-surgery and the time needed for recuperation ranges from a few mornings to a week.
Genetic testing and analysis Each of the parents of a child with repeated miscarriage has a transposition of their genomes in approximately 5% of all cases of repeated miscarriage among couples. A fetus can develop chromosomal imbalances and an increased risk of miscarriage if at least one of the parents has a translocation. It is possible to determine whether the grandparents have such a translocation by analyzing (karyotyping) their blood.
Your doctor may recommend repeated miscarriage treatment, like IVF even though many people who have translocations do ultimately spontaneously have a healthy child. Serum and eggs are combined as part of the IVF procedure. After IVF, eggs may be examined before being implanted into the uterus (preimplantation genetic screening). This makes it possible to select embryos that do not have any translocations, which in turn increases the likelihood of a viable pregnancy.