Recurrent miscarriage and treatment for it ?

Recurrent miscarriage and treatment for it ?
Miscarriages are a frequent occurrence, but some women experience multiple miscarriages, which is known as recurrent pregnancy loss. Various factors can contribute to repeated miscarriages, and the need for treatment varies depending on the underlying causes. While some women may eventually have a successful full-term pregnancy without intervention, others may require medical assistance. In this article, we will explore the treatments available for recurrent pregnancy loss, considering a range of potential causes including medical conditions and genetic factors.

How common is recurrent miscarriage? (Epidemiology)

Miscarriage is the most prevalent complication during pregnancy, characterized by the spontaneous termination of a pregnancy before the fetus reaches viability, typically before 24 weeks of gestation (or 20 weeks in certain regions). Statistics indicate that miscarriage affects approximately 12-24% of recognized pregnancies. Furthermore, about 1% of couples attempting to conceive face the challenge of recurrent miscarriages, which is significantly higher than the 0.34% probability of three consecutive miscarriages occurring by chance alone.
After experiencing three consecutive miscarriages, the likelihood of further miscarriages rises to approximately 40%. It’s worth noting that some women may encounter recurrent miscarriages even after having a successful pregnancy. It is important to mention that many women who suffer from recurrent miscarriages do not have an identified underlying cause for their condition.

Causes of recurrent miscarriage (aetiology)

The causes of recurrent miscarriage, also known as recurrent pregnancy loss, can vary and are often multifactorial. Here are some potential causes or factors that contribute to recurrent miscarriage:

Genetic factors: Chromosomal abnormalities in either the embryo or one or both parents can increase the risk of recurrent miscarriage. These abnormalities can be inherited or occur spontaneously.

 

Hormonal imbalances: Imbalances in hormones, such as progesterone, estrogen, thyroid hormones, or insulin, can impact the viability of the pregnancy and lead to recurrent miscarriage.

 

Uterine abnormalities: Structural abnormalities of the uterus, such as septate uterus, bicornuate uterus, or uterine fibroids, can interfere with implantation and the development of a healthy pregnancy.

 

Autoimmune disorders: Certain autoimmune conditions, such as antiphospholipid syndrome, lupus, or thyroid autoimmunity, can increase the risk of recurrent miscarriage by affecting the body’s immune response and blood clotting.

 

Blood clotting disorders: Inherited or acquired disorders that increase the risk of abnormal blood clottings, such as Factor V Leiden mutation or antithrombin III deficiency, can impair the blood supply to the developing fetus and lead to miscarriage.

 

Infections: Certain infections, including bacterial, viral, or parasitic infections, can increase the risk of miscarriage, especially if they occur during early pregnancy.

 

Maternal age: Advanced maternal age (typically 35 years and older) is associated with an increased risk of chromosomal abnormalities in eggs, which can lead to recurrent miscarriage.

 

Lifestyle factors: Certain lifestyle choices, such as smoking, excessive alcohol consumption, drug use, and obesity, can contribute to recurrent miscarriage.

 

Environmental factors: Exposure to environmental toxins, radiation, or certain medications during pregnancy can increase the risk of recurrent miscarriage.

 

Unknown causes: In some cases, despite thorough testing, the underlying cause of recurrent miscarriage remains unknown. This can be frustrating for couples seeking answers, but ongoing research aims to uncover additional factors that may contribute to recurrent pregnancy loss.

It’s important to note that this list is not exhaustive, and the specific causes of recurrent miscarriage can vary from person to person. Consulting with a healthcare provider and undergoing appropriate testing can help identify the underlying factors and guide appropriate treatment options.

Diagnostic tests to determine the causes of miscarriage

To diagnose potential causes of your recurrent miscarriages, your medical history, a pelvic exam, and a series of tests are typically conducted. The following tests may be recommended:

Karyotype: This test involves mapping your chromosomes to identify any genetic defects that could contribute to recurrent miscarriages.

 

Hysterosalpingogram: A radiology procedure using special dye and fluoroscopy to evaluate the shape of your uterus and check the patency of your fallopian tubes.

 

Saline Sonohysterogram: This procedure involves introducing sterile water into the uterus while performing a transvaginal ultrasound. It helps detect abnormalities in the endometrial cavity, such as polyps, fibroids, and scar tissue that may increase the risk of miscarriage.

 

Hysteroscopy: A narrow fiberoptic scope is inserted into the uterus to visually examine the uterine cavity.

 

Vaginal ultrasound: This scan uses high-frequency sound waves to assess the uterus, ovaries, and fallopian tubes for any abnormalities.

 

Blood hormone levels: Blood tests measure hormone levels like prolactin, thyroid-stimulating hormone, and progesterone to assess hormonal imbalances that could contribute to miscarriages.

 

Endometrial biopsy: A procedure where a sample of the endometrial tissue is examined under a microscope to identify any infections that might hinder pregnancy progression.

 

Glucose screening: A blood test to diagnose diabetes mellitus, as uncontrolled diabetes increases the likelihood of miscarriage.

 

Antiphospholipid antibody testing: Blood tests are used to detect abnormalities in the immune system that may contribute to recurrent miscarriages.

 

Ovarian reserve testing: Tests to assess the quantity and quality of your eggs, which can help determine if age-related decline in ovarian function is a factor in pregnancy loss.

 

Sperm DNA fragmentation testing: This test examines sperm quality and DNA fragmentation to determine if it plays a role in pregnancy loss.

These tests, along with a comprehensive evaluation, can help identify potential causes and guide appropriate treatment options for recurrent miscarriage. It’s important to consult with your healthcare provider to determine the most suitable tests for your specific situation.

Unexplained recurrent pregnancy loss

Ovulation induction: Medications or hormonal treatments to stimulate ovulation and improve the chances of successful conception.

 

Progesterone therapy: Supplementation with progesterone, a hormone essential for maintaining a healthy pregnancy, to support the uterine lining and prevent miscarriage.

 

Low-dose aspirin: The use of low-dose aspirin, under medical supervision, enhances blood flow to the uterus and reduces the risk of blood clotting issues that can contribute to miscarriage.

 

Injectable blood thinners: In some cases, injectable blood thinners may be prescribed to prevent blood clotting disorders that can lead to miscarriage.

 

Antibiotics for presumed chronic uterine inflammation: Antibiotic treatment may be considered if there is a suspected chronic inflammation of the uterus, which can contribute to recurrent miscarriage.

 

In vitro fertilization (IVF): IVF may be recommended to bypass certain fertility issues and increase the chances of a successful pregnancy.

Preimplantation Genetic Testing for Aneuploidy (PGT-A): PGT-A involves screening embryos created through IVF for chromosomal abnormalities before implantation, increasing the likelihood of a healthy pregnancy. Intracytoplasmic sperm injection (ICSI) with the assistance of the ZyMotTM device: This technique combines ICSI, where a single sperm is injected directly into an egg, with the use of the ZyMotTM device to improve fertilization rates. These treatment options can provide hope and support to individuals experiencing recurrent pregnancy loss. It is crucial to consult with a healthcare provider to determine the most appropriate approach based on individual circumstances and medical history.
As a fertility specialist, Dr. B. Kiranmayee has evaluated and treated many women in Hyderabad and elsewhere for recurrent pregnancy loss.
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