Recurrent Pregnancy Loss

What is recurrent pregnancy loss?

Repeated miscarriage, or recurrent pregnancy loss, is defined as having two or more miscarriages., It is indicated to have a gynecological examination and to have several tests to evaluate the cause of miscarriage after three miscarriages.

Most miscarriages (60%) occur due to chromosomal abnormalities which happen by chance, they are not caused by genetic defects that run in the family.However chromosomal abnormalities are more likely to occur as maternal age increases.

Rarely one of the partners may be carrying a chromosomal translocation that is transferred to the embryo.This means one piece of a chromosome is transferred to another chromosome.This partner does not have any physical signs or symptoms.and only has some genetically abnormal reproductive cells.The diagnosis can be made by a bood test for the affected parent’s karyotype.

Are there any anatomical problems associated with repeated miscarriage?

In some patients the uterus may have a congenital problem that causes recurrent pregnancy loss.The most common uterine problem associated with miscarriage is the uterine septum.It means there is a wall of tissue seperating the uterus totally or partially into two cavities.

Sometimes, there may be adhesions in the uterus due to previous surgery or curretage which is called the Asherman syndrome.

Uterine fibroids or polyps located inside the cavity may also lead to recurrent miscarriage in some women.

There are several imaging studies to diagnose such anatomical problems related to the uterine cavity. These studies can be summarised as:

• Ultrasonography
• Sonohysterography
• Hysterosalphingography
• Hysteroscopy

What are the medical problems increasing the risk of recurrent pregnancy loss?

There are several medical conditions that increase the risk of recurrent miscarriage:

• Antiphospholipid Syndome
• Polycystic Ovary Syndrome
• Diabetes Mellitus

Is it always possible to identify the cause of recurrent miscarriage?

In almost two thirds of the patients with recurrent pregnancy loss,the cause cannot be identified.

Are there any treatment options if the cause of recurrent miscarriage is identified?

In rare cases it may be possible to offer treatment to patients with recurrent pregnancy loss.Conditions that can be treated and the treatment options can be summarised as:

• Chromosome translocation: Genetic counselling and IVF (in vitro fertilisation) with preimplantation genetic diagnosis so that healthy unaffected embryos can be chosen
• Anatomical uterine problems: Corrective surgery for fibroids, septum, Asherman syndrome etc.
• Antiphospholipid syndrome: Medications that prevent blood clots are given. This is a combination of aspirin and heparin throughout pregnancy.

Is there still a chance for a successful pregnancy even if no cause was found for recurrent miscarriage?

Almost 65% of women with unexplained recurrent miscarriage have a successful next pregnancy even if no cause was found.