Pregnancy loss can be one of the most difficult experiences of a woman’s life. Fortunately for most women, a single miscarriage does not increase the chance of having another pregnancy loss in the future. Some women however, suffer multiple miscarriages; this scenario is termed recurrent pregnancy loss (RPL).
By strict definition, recurrent pregnancy loss is 3 consecutive miscarriages which occur before 20 weeks gestation. In reality, many women with 2 consecutive losses or those with 2-3 non-consecutive losses often seek evaluation and treatment.
The causes of recurrent pregnancy loss can be divided into 4 main categories and each category requires its own specific tests and treatment. Depending on a patient's specific history and physical, some tests and treatments may be more pertinent than others.
Anatomic causes for RPL include congenital abnormalities of the uterus such as uterine septum as well as acquired uterine abnormalities such as scarring or fibroids. Anatomic causes may be evaluated by a variety of imaging tests such as HSG, ultrasound, MRI and more. Ultimately, surgery may be able to correct the anatomic abnormality and prevent future losses.
Genetic causes of RPL can originate in the mother’s DNA, the father’s DNA or both. Highly specialized and advanced tests may be used to evaluate that DNA through a simple blood sample. Ultimately, if the DNA is implicated in the RPL, IVF can be employed to create embryos which are then evaluated for the abnormality prior to placement in the uterus. The embryo evaluation is performed using preimplantation genetic diagnosis (PGD).
Immune/ Hormonal/ Clotting
The hormonal and immune and thrombotic environment during gestation is critically important to successful a pregnancy. While some factors associated with immunity or blood clots are clearly associated with RPL (antiphosphidlipid antibodies for example), other factors (natural killer cells) have considerably weaker scientifically based connections. With that being said, our doctors are experts at choosing which tests to order and not order to best evaluate for this type of pregnancy loss. Once the cause is established, a variety of treatments are available.
Despite the vast array of tests available, about 1/3rd of all cases of RPL remain unexplained. While we may not ever elucidate the cause, this does not prevent us from taking specific empiric measures to improve the chance for successful pregnancy. Depending on a patient’s history, basic medications such as aspirin and progesterone plus frequent monitoring have been shown to improve outcomes. In other cases, injections, infusions or PGD may also be used.
Recurrent pregnancy is devastating. At our center, we believe that the combination of appropriate testing, aggressive and creative treatment plus compassionate care can lead to success in even the most dire circumstances. If you have questions about recurrent loss, please contact us, we will be happy to speak with you.