About Recurrent Miscarriage
Miscarriages are common; approximately 20% of pregnancies end in miscarriage. However, when a woman has lost two or more pregnancies, most commonly in the first part of the pregnancy, it is considered recurrent pregnancy loss. She should consult a fertility doctor to try to determine if there are underlying causes.
While some miscarriages are the result of maternal causes like uterine anomalies and hormone/endocrine irregularities, up to 70% of recurrent pregnancy loss is due to genetic abnormalities in the embryo. Sometimes eggs with chromosomal errors fertilize, resulting in genetically abnormal, or aneuploidy, embryos.
Spontaneous pregnancy loss can be very emotional when it happens. But recurrent miscarriages can feel devastating when they continue to occur. Our fertility doctors and our team are very sensitive to the emotions that accompany this type of infertility condition. We also have experienced counselors we recommend to help you and your partner work through the difficult emotions you are experiencing.
Diagnosis of Recurrent Miscarriage
When you have had multiple miscarriages, your fertility doctor will want to rule out maternal causes. The uterus must be evaluated and determined to be normal. An abnormal uterus with fibroids, polyps, uterine septum, or congenital defect can be a cause which can be corrected. Some of the common tests that may be recommended are below.
Blood work:
- Thyroid panel: to confirm that your thyroid function is normal.
- Hormones: checking levels of progesterone, follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH) and luteinizing hormone (LH) will help determine if there is an underlying ovulation issue.
- Carrier screen: to determine whether the partners have a matching gene mutation that could affect pregnancy loss.
Uterus evaluations:
- Hysterosalpingogram (HSG): this shows blockage in the fallopian tubes as well as the shape of the uterus. A hydrosalpinx (fluid-filled tube) may contribute to miscarriage.
- Hysteroscopy: to examine the condition of the uterus.
- Transvaginal ultrasound: to check the uterus, ovaries and endometrial lining for problems.
Treatment of Recurrent Miscarriage
If a maternal cause is found in the testing, your doctor will explain the next steps in working to correct the issue. Sometimes this involves taking certain medications, and other times, fertility surgery may be necessary.
If there is no maternal cause, one way to solve the problem is to do in vitro fertilization (IVF) with preimplantation genetic testing. While women over 35 years old are more likely to have miscarriages due to chromosomal abnormalities, younger women can also be affected. When genetic testing is done, the embryos that develop after IVF are biopsied to do PGT-A to tests the embryos for chromosomal abnormalities. Only normal euploid embryos are replaced. This can reduce the rate of miscarriage dramatically.
