Recurrent Pregnancy Loss
Recurrent pregnancy loss is the loss (i.e. miscarriage) of three or more consecutive pregnancies. Almost 20% of all pregnancies end in miscarriage. The risk of miscarriage is 9.5% for women younger than age 24 and rises with age, to 11% by age 30 and 33% by age 40. For women over age 44, the incidence of miscarriage increases dramatically to 53%. Often the cause(s) of recurrent pregnancy loss are unexplained and diagnostic tests are inconclusive. However, 60% of all women who are diagnosed with unexplained recurrent pregnancy loss achieve a successful pregnancy with minimal treatment. The success rate improves to over 75% for women who have an identifiable cause and undergo appropriate treatment.
Possible causes for recurrent miscarriage are:
- Anatomical Factors
- Genetic Factors
- Immune Factors
- Endocrine Factors
- Unexplained Factors
It is important to note that there is no clear evidence to support the concept that miscarriages can be traced to a specific partner or the hypothesis that some women miscarry due to an inappropriate immune system response.
You Are Not Alone
Pregnancy loss can take a tremendous emotional toll on individuals and couples attempting to build a family. This emotional distress alone can prevent a successful pregnancy.
EmBIO IVF strongly recommends that you seek the emotional support made available through the programs offered at our unit to enhance your chance for a successful pregnancy.
ABOUT RECURRENT PREGNANCY LOSS
The following factors may contribute to recurrent miscarriage:
Uterine abnormalities are a possible cause of recurrent pregnancy loss. A saline-ultrasound (sonohyserography) or an x-ray dye examination (hysterosalpingogram) can be performed to evaluate the uterus. Surgery to correct uterine abnormalities is an effective and low-risk outpatient procedure. In patients diagnosed with a uterine septum (fibrous bands of tissue that splits the uterine cavity in two) most fertility specialists perform a septum resection as a therapeutic procedure in order to improve their chances for a successful delivery.
Approximately 70% of early spontaneous miscarriages are associated with fetal chromosomal abnormalities. In addition, 30% of second trimester miscarriages and 3% of stillbirths have abnormal chromosomes. In most cases, blood tests reveal that both partners have normal chromosomes and that fetal chromosomal abnormality is a random event.
PDG can be performed in conjunction with IVF and allows genetic testing to be done on embryos prior to transfer. PDG have also benefit women with a history of repeated miscarriages, those at risk for having a child with an inherited genetic disorder (e.g. cycstic fibrosis, muscular dystrophy), or those who have failed to achieve pregnancy after multiple attempts with IVF.
There is a well-established association between recurrent miscarriage and antiphospholipid antibodies (aPL) -- a class of proteins that in some cases appears to attack an early developing pregnancy. The live birth rate may be as low as 10% in women with recurrent miscarriages attributed to aPL. The live birth rate significantly improves to 70% when aPL is treated with low dose aspirin together with low dose heparin.
Hormonal problems (called 'endocrine' in medical terminology) in a mother -- such as diabetes and thyroid disease -- have been associated with miscarriage. But well-controlled diabetes is not a risk factor for recurrent miscarriage, nor is properly treated thyroid function.
Inadequate secretion of progesterone during the menstrual cycle and in the early weeks for pregnancy is considered a possible factor in many cases of recurrent miscarriage. However, a review of pregnancy rates following hormonal treatments concluded that progesterone supplementation after conception does not improve pregnancy outcome.
Another possible endocrine factor is the prevalence of polycystic ovaries (PCO), a condition of the ovaries where there are many medium-sized follicles around the rim of the ovaries, often seen with the ovulation disorder polycystic ovary syndrome (PCOS). The occurrence of PCO is significantly higher among women with recurrent early miscarriage (56%) when compared to the general population (22%). Unfortunately, recent studies have not found improved pregnancy rates following hormonal treatments.
For a number of women, the recurrent episodes of pregnancy loss will remain unexplained despite careful investigation. It is important for these women to know that the prognosis for future pregnancy with counselling alone is approximately 75%.
But we can do much more for you, so you won’t risk another miscarriage.
Find out about Preimplantation Genetic Diagnosis (PGD)
Would you like a Free initial consultation with Fertility Specialist Thanos Paraschos?
Talk to us about your history of miscarriages, and find out how you can have your baby!