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Recurrent Miscarriage

Recurrent Pregnancy Loss (RPL)

Spontaneous pregnancy loss is a surprisingly common occurrence. Whereas approximately 15% of all clinically recognized pregnancies result in spontaneous loss, there are many more pregnancies that fail prior to being clinically recognized. Only 30% of all conceptions result in a live birth. Recurrent Pregnancy Loss (RPL) is described as having two or more miscarriages. A complete physical examination is suggested after three repetitive miscarriages.

Recurrent Pregnancy Loss

What are the causes of RPL?

  • The biggest reason for RPL is an abnormal number of chromosomes or genetic material in the embryo.
  • Additionally, hormonal disorders (Diabetes and Thyroid problems), uterine problems, and immunological factors may also add to recurring miscarriages.
  • Other reasons like smoking, caffeine and alcohol intake, exposure to toxic products, and being overweight may also add to the RPL.

Uterine factors may involve:

  • Inherited uterine deformities such as the uterine septum, double uterus.
  • Presence of large polyps and submucosal fibroids
  • Asherman’s syndrome (presence of scar tissue in the uterine cavity)

Genetic Factors (Aneuploidy)

Miscarriage results due to a chromosomal anomaly in the embryo.

Embryo is formed by the fusion of an egg and sperm. If the egg or sperm carries some genetic defect, then the same will be carried forward to the embryo resulting in miscarriage.  Chromosomal translocation is a condition where part of one chromosome is attached to another chromosome. Patients with chromosomal translocation may or may not have symptoms, however their gametes might be genetically abnormal.

Endocrine Disorders

Thyroid dysfunction and unregulated blood sugar levels can lead to RPL. Furthermore, owing to alterations in the endocrine profile, even PCOS patients carry a greater risk of pregnancy loss.

What are the causes of RPL?

  • Most miscarriages occur randomly when an unusual number of chromosomes reaches the embryo during fertilization.
  • The biggest reason for RPL is an abnormal number of chromosomes in the embryo.
  • Additionally, hormonal disorders (Diabetes and Thyroid problems), uterine problems, and immunological factors may also add to recurring miscarriages.
  • Other reasons like smoking, caffeine and alcohol intake, exposure to toxic products, and being overweight may also add to the RPL.

Uterine factors may involve:

  • Inherited uterine deformities such as the uterine septum, double uterus.
  • Presence of large polyps and submucosal fibroids
  • Asherman’s syndrome (presence of scar tissue in the uterine cavity)

Genetic Factors (Aneuploidy)

Miscarriage results due to a chromosomal anomaly in the embryo.

In couples experiencing frequent miscarriages, one partner carries a chromosome in which a portion is relocated to another chromosome. The process is referred to as translocation. People with translocation typically do not present signs. Some chromosomal deformities can be seen in some of their eggs or sperm. If an embryo receives a high or low amount of genetic material, it may indicate a miscarriage.

Endocrine Disorders

Thyroid dysfunction and unregulated blood sugar levels is an indicator of RPL. Furthermore, owing to alterations in the endocrine profile, even PCOS patients carry a greater risk of pregnancy loss.

Is there any effect of other health conditions on the risk of miscarriages?

Females with these health conditions are at an increased risk of frequent miscarriages.

  • Problems with the immune system, such as an autoimmune disorder
  • Antiphospholipid syndrome (APS) is an autoimmune disorder. In this, antibodies are formed by an individual’s immune system. These antibodies target certain substances that play a key role in the blood clotting process. APS is found to be linked to RPL and fetal deaths.
  • Hormone problems
  • Females with a condition named PCOS or Polycystic Ovary Syndrome also carry a greater risk of miscarriage
  • Extremes in weight, such as obesity or being too thin

How is Recurrent Pregnancy Loss assessed?

  • Assessing Recurrent Pregnancy Loss (RPL) typically begins with a thorough review of the patient’s medical history and a comprehensive physical examination.
  • A series of diagnostic tests can be done, including blood tests and uterus examination. This examination detects any deformities or acquired factors, including fibroids and polyps, that may hinder the embryo’s implantation.
  • A genetic compatibility test can also be done on the couple to assess and predict the potential genetic deformity in the embryo. This helps predict potential genetic factors contributing to recurrent miscarriages. Overall, a combination of patient history, physical exams, and specialized tests forms the basis for evaluating and understanding Recurrent Pregnancy Loss.

How to treat Recurrent Pregnancy Loss RPL?

The treatment for recurrent pregnancy loss (RPL) depends on what’s causing the condition.

i) Chromosomal cause
In cases where an abnormality of chromosome structure is causing RPL, one possible therapy is in vitro fertilization (IVF), with biopsy and chromosomal evaluation of each embryo, called pre-implantation genetic diagnosis.

ii) Anatomical abnormalities
Diagnostic tests such as hysterosalpingograms, saline sonohysterography and hysteroscopy (an endoscopic inspection of the uterus) can be used to evaluate the uterine cavity. Many abnormalities within the uterine cavity can be corrected with minor surgery.

iii) Immunological causes
Antiphospholipid antibody syndrome (APS) has been shown to respond to treatment with blood thinning medications.

iv) Blood clotting disorders (thrombophilias)
Currently, there is no evidence that blood thinning medications can prevent miscarriage, although studies are ongoing.

v) Hormonal abnormalities
In cases of uncontrolled diabetes or thyroid gland dysfunction, correcting the hormonal imbalances is recommended.

vi) Unproven tests and treatments
In the search for a solution for RPL, several tests and therapies have been used that are not proven to be helpful. These include:

  • Maternal antibodies directed against paternal cells
  • Chemicals toxic to embryo development (embryotoxic factors)
  • Intravenous immunoglobulin (IVIG)
  • White blood cell (leukocyte) immunization

Types of treatment related to this article

IVF means in vitro fertilization. In vitro means in the laboratory ( outside the body) and fertiliza…
Intracytoplasmic sperm injection (ICSI) is a technique developed to overcome male infertility attrib…
Preimplantation genetic testing for aneuploidies (PGT‐A), formerly known as preimplantation geneti…
PGT-SR is a genetic test for detecting inherited chromosomal structural rearrangements in embryos pr…

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Why do I have Repeated or Recurrent Miscarriages?

FAQ's

  1. Q. What are the success rates for IVF, and what factors can affect those rates?

    The success rates for IVF vary depending on factors such as the woman’s age, the cause of Infertility, the duration of Infertility, the number of embryos transferred, and past instances of recurrent implantation failure and miscarriages. On average, the success rate for women under 35 across a couple of cycles is around 60-70%, which decreases as a woman’s age increases.

  2. Q. How does age affect the success rate of IVF?

    The age of a woman is a crucial factor in IVF success rates since the chances of a successful pregnancy decrease rapidly after the age of 35, especially for women over 40 years. Also, the risk of miscarriage and congenital disabilities in the child increases after 35 years.

  3. Q. Can a couple have a baby through IVF after a miscarriage?

    Even if you have had multiple miscarriages and recurrent pregnancy loss, the good news is that an IVF treatment with genetic testing (PGT-A) can lower the risk of miscarriages and increase the chances of a successful pregnancy.

  4. Q. I am an active smoker, will I affect my pregnancy chances.

    Yes, smoking affects the chances of getting pregnant. It can reduce fertilization rates even during fertility treatments, resulting in miscarriages or ectopic pregnancies.

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