Recurrent miscarriage: causes, evaluation, and treatment.

Recurrent Pregnancy Loss (RPL) is defined as the loss of two or more pregnancies. It excludes ectopic pregnancy and molar pregnancy. Around one percent of all women experience recurrent miscarriages. Doctors define this as- “Loss of consecutive two or more 1st trimester or early 2nd trimester pregnancies”.

Having one miscarriage can be very much disturbing for the couple, but having one after another is often a very traumatic experience. Women with repeated miscarriages can be reassured that their chance of having a healthy baby is the same as women who have never miscarried, says Eminent Gynaecologist and Fertility Expert from Blossom Fertility and IVF Centre Dr Rupal Nirav Shah.

Investigations to find out possible reason for recurrent miscarriage is advisable after the third recurrent miscarriage, but in women of more than 30 years, investigations are advised even after 2 abortions. In more than 50% cases, it’s impossible for doctors to identify the cause for recurrent miscarriage.

Causes For Recurrent Miscarriage:

1. Hormonal: Polycystic ovaries, Thyroid dysfunction
2. Blood clotting disorders
3. Genetic: any one partner with an abnormal chromosome
4. Uterine problems: abnormally shaped uterus, intra-uterine adhesions
5. Male Factor: abnormal DNA fragments in sperms
6. Poor quality eggs
7. Cervical weakness(Incompetence)
Causes 1 to 6 are usually responsible for 1st trimester and 7 is responsible for 2nd trimester repeated miscarriages.

Apart from these causes, there are Environmental influences too. Though these may not lead to repeated miscarriages, they may increase chances of abortions.

How to diagnose Chances for Recurrent Miscarriage?

1. Hormonal and immunology blood workup
2. Genetic study of male and female and in selected cases of abortus.
3. 3 D sonography, Hysterosalpinography or hysteroscopy to study shape of uterus

The over prescribed TORCH infection test is not important to diagnose cause for repeated miscarriage as this may be a cause for a single miscarriage.

What are your chances of having a healthy baby after recurrent miscarriage?

If your miscarriages are unexplained, then you have a good chance of having a successful pregnancy in the future. Only close tender loving care(TLC) by your obstetrician and closed relatives can increase your chances of a successful pregnancy. Many hormonal and immunological conditions conditions are treatable. Your gynaecologist is the best person, whom you can discuss about your chances of success. Women with a history of recurrent miscarriage are at risk of developing preeclampsia in later pregnancies.

When there is no reason found and you don’t want to take any chance Pre-implantation genetic screening is a good option in which, selected cytogenetically normal embryos are transferred in uterus to avoid bad news again with help of IVF treatment.

Sometimes repeated miscarriages are because of Chromosomal Abnormality in any of partners, then IVF with donor eggs or sperms is the best solution.

At Blossom Fertility and IVF Centre before suggesting any treatment for repeated pregnancy loss, couples are first evaluated to see if there is an underlying health condition that may be causing multiple miscarriages and for which treatment is available. These include uterine abnormalities, such as fibroids, blood-clotting disorders, hormonal problems, thyroid disease or diabetes. Obesity and age can also increase the risk of miscarriage. Before suggesting any treatment all this factors are evaluated.