Find Answers to Recurrent Pregnancy Loss
Recurrent pregnancy loss is a condition in which women experience two or three consecutive pregnancy losses.
Recurrent pregnancy loss is very different than sporadic miscarriage. Sporadic miscarriages are relatively common, occurring in about 15-25% of all pregnancies. In the majority of cases, the underlying cause is a chromosome abnormality. In contrast, recurrent pregnancy loss is relatively rare, affecting only about 5% of women. Further, the underlying causes of recurrent pregnancy loss are very different than the causes of sporadic miscarriage.
While any pregnancy loss is emotionally painful, recurrent pregnancy loss can be associated with uniquely profound emotional distress. With each loss, the fear and anxiety of another pregnancy can become overwhelming. The good news is that despite the emotional toll, the majority of women who experience recurrent pregnancy loss will eventually successfully carry a pregnancy to term.
There are several possible causes for recurrent pregnancy loss:
Anatomical: Uterine abnormalities such as the presence of a uterine septum or other congenital anomalies can cause recurrent pregnancy loss. In addition, acquired uterine abnormalities such as the uterine polyps, uterine fibroids or scarring within the uterus, can also cause sporadic miscarriages or recurrent pregnancy losses.
Chromosome abnormalities: The presence of chromosome abnormalities can cause both sporadic, as well as recurrent pregnancy loss. As a woman gets older, the risk of a miscarriage increases significantly due to random chromosomal errors within the embryo. There are, however, some age independent chromosomal conditions, such as translocations, that can be transmitted from either the mother or the father to the offspring. Such conditions may increase the risk of miscarriage significantly.
Immunological factors – anti-phospholipid syndrome: There are certain conditions, such as the anitphospholipid syndrome (APLS), in which the body produces factors known as antibodies that interfere with the development of the pregnancy. The mechanism by which these factors cause miscarriage is not well understood, but some experts believe that the antibodies increase the risk of blood clot formation within the placenta, ultimately disturbing the blood supply to the uterus and baby. Some immunological factors can be easily diagnosed and are well established, while other are more controversial or difficult to diagnose. The presence of natural killer cells, anti-thyroid antibodies, HLA and others are examples of the later.
Infection: Infection with Chlamydia, gonorrhea, rubella, CMV and others have been found to be associated with sporadic miscarriage, but not recurrent pregnancy loss.
Hormonal and metabolic factor: Certain conditions such as thyroid disease or diabetes can increase the risk of miscarriage. If not properly diagnosed and treated, these conditions can contribute to recurrent pregnancy loss.
Sperm abnormalities: Abnormal sperm has traditionally not been considered a cause for recurrent pregnancy loss. New studies evaluating damage to the genetic material of the sperm, known as DNA fragmentation, are considered a possible important new potential cause.
Psychological factors: There is no doubt that recurrent pregnancy loss leads to enormous physiological stress. Many, if not most, women who go through RPL, experience anxiety, depression, anger and grief. A very controversial question is whether that physiological stress increases the risk of another miscarriage. A famous study conducted in the 80s evaluated a group of 158 pregnant women with a history of three consecutive miscarriages. The subjects were randomly divided into two groups, one with regular obstetrical care, the other with obstetric care plus TLC (tender-loving care), including psychological support, more frequent ultrasounds and examinations. Ultimately 85% of women in the TLC group successfully completed their pregnancies as opposed to only 36% in the normal obstetrical group.
While this issue is still controversial, the doctors of the Los Angeles Reproductive Center believe that psychological support and TLC should be offered to all women who experience a miscarriage. This is even truer for those with recurrent miscarriages.
Lifestyle: Lifestyle choices such as cigarette smoking, alcohol abuse, drug use and excessive caffeine consumption have all been found to be associated with an increased risk of miscarriage. Optimizing a patient’s lifestyle prior to pregnancy is a good idea from both a fertility point of view as well as for the pregnancy and delivery.
Unexplained:Iin 50-75% of the cases of recurrent pregnancy loss a cause can’t be found. The positive aspect is that although in many cases of unexplained recurrent pregnancy loss, empiric treatment and close monitoring can result in a successful outcome.
Dr. Marc Kalan and Dr. Nurit Winkler have successfully treated many couples with a history of recurrent pregnancy loss. If you have questions about sporadic or recurrent miscarriage, the physicians of LARC will be happy to discus with you the correct tests, diagnosis, and treatment for recurrent pregnancy loss.