Recurrent pregnancy loss can be defined as three or more continuous miscarriages or termination of pregnancy before 20 weeks of gestation. Recently American Society of Reproductive Medicine (ASRM) has redefined it to be as two or more consecutive pregnancy losses. It is very common with a least 1% of couples getting affected by it. After recurrent pregnancy loss couples may feel frustrated and drained of hope. It is important to seek medical advice and undergo thorough investigation after two or more losses such that you don’t experience loss in the subsequent pregnancy.
CAUSESThere are various causes of which some are treatable. In some cases, an exact cause cannot be determined even after extensive investigations. Fortunately, even though an exact cause of loss is not known a good majority of women with recurrent miscarriages experience live birth in the subsequent pregnancy. The causes can be classified as
Uterine Abnormalities: Congenital conditions such as uterine septum or those acquired later such as fibroids and polyps may interfere with the successful implantation of the embryo. These anomalies can be easily diagnosed using imaging studies such as hysteroscopy, hysterosalpingography(HSG), vaginal ultrasounds or sonohysterograms. Fertility may be restored and pregnancy loss may be reduced by surgical correction using operative hysteroscopy
Cervical Abnormalities: Cervical conditions such as a weak cervix in the second trimester may cause miscarriage. This is known as incompetent cervix when the cervix dilates without any detectable contractions. Cervical cerclage which is a suture in the cervix may help reduce the risk of abortions.
Random genetic errors are responsible for a majority of pregnancy losses. Normally during fertilization 22 autosomes and one sex chromosome each of the egg and the sperm unite resulting in 46 chromosomes in the embryo. Presence of an extra chromosome, known as trisomy or absence of a chromosome, known as monosomy represents common genetic abnormalities that may result in recurrent miscarriages. Its incidence increases with increased maternal age as the quality and quantity of egg decreases. Hormonal evaluation of ovarian reserve through blood tests may help assess the probability of recurrence.
A pre-existing genetic defect such as a balanced translocation or Robertsons translocation in either of the parents may result in genetically abnormal embryo. A balanced translocation is a condition in which a portion of one chromosome has moved to a different chromosome resulting in one chromosome with too much genetic information and another with too little genetic information. Embryos formed from such an egg or sperm may often result in genetic abnormality and in turn miscarriages. A simple blood test called karyotype is used to detect such abnormalities. IVF with genetic testing can help prevent another miscarriage in case a genetic defect is identified.
Certain hormonal abnormalities like hypothyroidsm, diabetes, polycystic ovarian syndrome have been linked to recurrent abortions. Occasionally, insufficient secretion of progesterone may result in luteal phase defect. Diagnosing and treating these disorders with medications or supplementing with progesterone is important prior to conceiving.
4. Thrombophilia Some studies suggest that inherited blood clotting disorder or Thrombophilia may be associated with miscarriages though there is no clear evidence regarding this. Anticoagulants like heparin or aspirin may be helpful in reducing blood clots.
Autoimmune disease in the mother such as antiphospholipid syndrome may lead to recurrent pregnancy loss. It is characterized by the formation of blood clots that travel to the placenta and form clots. This may lead to miscarriages, still birth or premature birth. Anti coagulants like heparin or aspirin has been found to be effective to remove clots.
6. Infections Maternal infections such as rubella, measles, herpes simplex etc may cause recurrent pregnancy loss though there is no clear evidence to support this.
7. Environmental and Lifestyle Factors Environmental factors such as exposure to toxins, drug abuse, alcohol or smoking may increase your chances of miscarriage though there is no clear evidence that suggest so.
In case you have gone through recurrent pregnancy loss then you may seek the help of our specialists who can perform thorough investigations and suggest treatments suitable for you.