Recurrent Miscarriage

A number of pregnancy conceptions are generally abnormal and end in miscarriage. It is the most common complication of pregnancy. Recurrent miscarriage, the loss of three or more consecutive pregnancies, affects almost 1% of couples trying to conceive. It is usually associated with psychological stress and is often proved to be frustrating for both couple and fertility experts.

What is Recurrent Miscarriage?

Miscarriage is defined as the loss of a pregnancy before 20 weeks of gestation. Usually, almost 15% of pregnancies end in miscarriage, and most miscarriages occur within the first 12 weeks of gestation.

According to RCOG (Royal College of Obstetricians and Gynaecologists), three or more consecutive pregnancy losses can be defined as Recurrent Miscarriage. However, the American Society of Reproductive Medicine (ASRM) on the other hand defines Recurrent Miscarriage as two or more failed clinical pregnancies.

What are the recurrent miscarriage causes?

According to various researches and studies, the majority of miscarriages occur due to several factors. The patient may or may not have any prior symptoms. However, severe cramps or bleeding during pregnancy might be some of the associated symptoms. 

Some of the factors responsible for Recurrent Miscarriages are:

  1. Genetic Factors or Chromosomal Abnormalities: It has been estimated that approximately 2 – 4% of recurrent pregnancy loss is associated with genetic factors. In a small group of people, these defects if passed down in the sperm or egg affects the embryo quality leading to pregnancy loss.
  2. Anatomic Factors: Anatomic abnormalities account for 10 – 15% of the cases of spontaneous miscarriages. It interrupts the endometrium, prompting the inadequate and abnormal formation of the placenta. Such abnormalities include as fibroids, septum, polyps and scar tissue or adhesions in the uterus, etc.
  3. Immunological Factors: According to studies, approximately 20% of pregnancy losses is associated with immune etiologies, including autoimmune and cellular immune abnormalities.
  4. Endocrine/Hormonal Factors: It is estimated that around 17 – 20% of all pregnancy losses are a result of endocrine factors. Several abnormalities such as thyroid disease, uncontrolled diabetes, decreased ovarian reserve, progesterone, or any immunological issues have been implicated as the factors responsible for recurrent pregnancy losses.
  5. Cervical Weakness: The incompetent cervix also called cervical weakness, commonly causes pregnancy loss in the second trimester. In women with cervical insufficiency, the recurrence rate is comparatively high.
  6. Unexplained Factors: According to the studies, only 50% of the causes of recurrent miscarriages are identified, and the rest 50% remains unidentified and unexplained.

Moreover, some other repeated miscarriages causes include:

  • Advancing maternal age: As a woman crosses 35 years of age, there is a significant increase in the risk of miscarriage, which might be due to a deterioration in the egg quality. Poor quality egg, if fertilised, increases the risk of miscarriage.
  • Excessive Coffee Consumption: Reports from various studies suggest that increased coffee consumption in women might lead to miscarriages.
  • Smoking and Alcohol: Smoking is reported to be associated with recurrent miscarriages. It is also found that drinking alcohol more than 3 units per week increases the related risk of spontaneous miscarriages.

In the case of Recurrent Miscarriage, a couple is required to contact a recurrent miscarriage clinic and seek assistance from a recurrent miscarriage specialist. It is also important to understand that despite these conditions, there is still a good chance of couple falling pregnant and getting their babies.

How are recurrent miscarriage investigations done?

A woman suffering from recurrent missed miscarriages is required to undergo a complete physical examination, including blood tests, imaging tests etc. to help detect the probable cause of recurrent miscarriage. It helps in providing absolute treatment.

Recurrent miscarriage diagnosis is segregated on the basis of the nature of its cause:

  • In order to diagnose genetic or chromosomal abnormalities, a test called parental karyotyping is done.
  • The evaluation of anatomic abnormalities includes hysteroscopy or hysterosalpingography (HSG) test. 3D ultrasound is also very common today.
  • Diagnosis of immunological factors includes a blood test to check anticardiolipin antibody levels (Immunoglobulin G and Immunoglobulin M), and also lupus anticoagulant if required.
  • Endocrine disorders in the case of recurrent miscarriages are diagnosed by TSH (Thyroid Stimulating Hormones) tests. Other tests include insulin resistance testing, ovarian reserve testing, serum prolactin in case of irregular menses, antithyroid antibody testing, and very rarely luteal phase endometrial biopsy.

Diagnosis Tests for the Investigation of Recurrent Miscarriage Causes:

Recurrent Miscarriage Causes

Diagnosis

Genetic

Parental Karyotype

Anatomic

HSG TEST

Autoimmune

Anticardiolipin Antibody Levels or Lupus Anticoagulant

Endocrine

TSH (Thyroid Stimulating Hormones) Tests

What are the recurrent miscarriage treatment options?

If a couple is suffering from two or more miscarriages, they should talk to their healthcare provider or consult a fertility expert for proper guidance. Women often decide to continue trying to get pregnant naturally. However, it is important for the couples to seek proper assistance for the correct diagnosis of the cause and proper treatment to help reduce the risk of recurrent miscarriages.

Recurrent Miscarriage Treatment may include:

  1. Surgery: Surgeries can fix some problems in the uterus like extra tissues that divide the uterus, some fibroids, or scar tissue. Correcting the shape of inside of the uterus can often lower the chance of miscarriage
  2. Use of Blood-thinning Medications such as Heparin and Aspirin: Women diagnosed with autoimmune or clotting problems may be treated with low dose aspirin or heparin.
  3. Progesterone: Several studies and researches suggest that the use of progesterone medications or supplements, which is the essential hormone for maintaining pregnancy, may reduce the risk of miscarriages in women.
  4. IVF with PGT or Donor Egg: In-Vitro Fertilization, also known as IVF, is also one of the treatment options available for repeated miscarriages, as it is mostly caused either due to the chromosomal abnormalities of the embryo or due to certain other factors that affect infertility.
  • The fertility experts at first tend to remove any existing chromosomal abnormalities, immunological disorders, endocrinological abnormalities, infective or hormonal imbalances, before carrying IVF procedure, by performing laparoscopic surgeries or other treatment methods.
  • Even in the case of anatomical problems like polyp, fibroids, adhesions and septums, surgical corrections are done before carrying the IVF procedure.
  • IVF is a process in which the fertilisation takes place outside the body. Once the eggs and sperm are collected, they are fertilised in the lab, and with the help of pre-implantation genetic screening good quality embryo is selected to transfer it to the uterus. It helps in the selection of a good quality sperm and egg, to develop a quality embryo and reduce chances of miscarriage.
  1. Making healthy lifestyle choices: It includes stopping cigarette smoking or illicit drug use, limiting alcohol and caffeine intake and maintaining a healthy weight, may also lower the risk for recurrent miscarriage. Women who have chronic health conditions like diabetes, hormonal imbalance, the thyroid can be benefitted by treating them
Recurrent Miscarriage Successful Pregnancy – Medicover Fertility

After four miscarriages and several medications and pre-natal care, I was almost broken. It was then, that a friend of mine suggested me to get a consultation at Medicover Fertility. After a thorough investigation of it, we decided to visit the clinic. After a few tests, it was diagnosed that we were facing some genetic abnormalities. The doctor suggested us to go for IVF. Our decisions couldn’t be any better. It was because of Medicover that we are parents now. I am thankful to the entire team for such care and support, and also for making us believe in the possibilities.

Conclusion

In case a woman experiences recurrent miscarriages, especially due to genetic or chromosomal abnormalities, and wants to try again, then visiting a good fertility centre is recommended.

One such international fertility chain, Medicover Fertility, with its European standards, clinical expertise, state of the art laboratory and advanced technology has actually helped a lot of women facing spontaneous miscarriages. There are many cases where It has been successful in the Treatment of Recurrent Miscarriage. The advanced technology treatment at Medicover Fertility has helped overcome issues that are often faced in recurrent miscarriages.

If you wish to contact Medicover Fertility for the recurrent miscarriage consultation or treatment, dial +917862800700.

FAQs

Q – How to avoid recurrent miscarriages?

A – In order to prevent recurrent miscarriages, a woman must follow a healthy lifestyle and eating habits. It should also be noted that before planning the next pregnancy, a thorough check-up with a good clinician is required.

Q – How to stay positive after recurrent miscarriage?

A – Miscarriages are really stressful. However, in order to stay positive, a woman must believe in herself and do whatever it takes to diagnose and treat the cause as early as possible. One must also believe that even after 3 miscarriages, there is an increased chance that you can successfully carry a pregnancy.

Q – What to do after recurrent miscarriage?

A – After Recurrent miscarriages, a couple must visit a recurrent miscarriage specialist for proper consultation and treatment. The treatment may include a range of options like medications, surgery, use of some procedures such as IVF etc.

Q – What are the causes of recurrent miscarriage at 6 weeks?

A – The most common causes include factors such as, genetic, immunological, anatomic, endocrinological, environmental etc.

Q – Is recurrent miscarriage considered infertility?

A – Although, miscarriages are not a sign of infertility, however, repeated miscarriages may result in fertility issues.

References

https://academic.oup.com/humupd/article/8/5/463/656070

https://www.sciencedirect.com/science/article/pii/014067369092159F

https://link.springer.com/chapter/10.1007/978-1-4419-1436-1_17

https://academic.oup.com/humrep/article/17/2/446/568974

https://www.sciencedirect.com/science/article/pii/S0165037810000148