Recurrent pregnancy loss (miscarriage) overview
Recurrent Pregnancy Loss (RPL) is a devastating condition when a woman has 2 or more clinical losses (miscarriages) before the pregnancy reaches 20 weeks. Losses are classified by when they occur. Loss of a “clinical pregnancy” is diagnosed by a healthcare provider using ultrasound. In most cases, a pregnancy can be seen with ultrasound as early as 5-6 weeks gestational age (or 1-2 weeks after a missed period).
A “biochemical pregnancy” loss is one that has been detected only by urine or blood hormone testing before disappearing. Biochemical losses are not usually included in making an RPL diagnosis.
There are a variety of potential causes of RPL and patients who suffer from this condition deserve a thorough and comprehensive workup to try to determine the underlying reason for their circumstance. An accurate diagnosis also guides with appropriate treatment.
At Conceive NJ, we take RPL very seriously and our philosophy is that this condition, although uncommon, requires close and careful evaluation and follow up.
Causes of recurrent pregnancy loss (miscarriage)
Genetic and chromosomal
Many early miscarriages (the ones that happen in the first 3 months of pregnancy) are due to genetic abnormalities in the embryo or fetus and don’t necessarily recur in future pregnancies. Another cause of RPL is a genetic abnormality in one of the partners which may have a condition which predisposes to recurrent losses. Disorders such as a chromosomal translocation or inversion are associated with a higher rate of pregnancy loss due to offspring with an abnormal number of chromosomes.
Abnormalities of the uterus, such as a septate uterus, uterine adhesions or scarring, may be associated with RPL. Diagnostic modalities such as 3-D
Ultrasonography, HSG, Hysteroscopy, or Saline Sonography will be able to diagnose these conditions and guide appropriate treatment.
Progesterone is a critical hormone necessary for the health and maintenance of a pregnancy. Low levels of progesterone have been associated with RPL.
Untreated or poorly treated conditions such as thyroid disorders, glucose intolerance/diabetes or other endocrine abnormalities can be associated with RPL. A thorough diagnostic evaluation of RPL will include testing for these conditions and guide proper care.
Antibodies (Anti phospholipid Antibody syndrome)
Antibody and autoimmune conditions may be related to RPL. A complete panel looking for these conditions is part of our standard testing panel for patients with RPL.
A variety of infectious and inflammatory pathogens may be a reason for RPL. Each of these need to be explored to uncover the cause of the pregnancy losses.
Male infertility or sperm quality issues
Interestingly, sperm factors can have an impact on the health of the pregnancy. Men whose sperm has higher levels of DNA fragmentation may be a reason for RPL. Special testing for DNA fragmentation may uncover abnormal patterns in sperm.
As women age, the miscarriage risk due to these genetic abnormalities increases — from 10%-15% in women younger than 35 years old to more than 50% in women over 40 years old.
Those suffering from RPL should be counseled regarding lifestyle habits which could impact on their condition, such as cigarette smoking, alcohol use, weight issues, and exercise frequency.
Recurrent pregnancy loss patients frequently display a range of emotions including depression, anxiety, feelings of guilt and/or grief and sometimes even anger. These feelings are normal and justified in the context of their struggle. Psychological evaluation and counseling are an important part of the entire process. The emotional impact of RPL is tremendous and we fully support our patients who are going through this difficult chapter in their lives.
Recurrent pregnancy loss (miscarriage) testing & diagnosis
Important facts to keep in mind about RPL:
- A precise reason for the RPL will not be found in every case despite thorough testing.
- The majority of miscarriages are sporadic and not recurrent and are thought to be related to genetic causes which may be influenced by maternal age.
- Even after suffering 3 or more pregnancy losses, a woman has a 60-80% chance of carrying a full-term pregnancy.
- Stress is definitely associated with RPL but there is currently no scientific evidence that it is a direct cause of recurrent losses.
Contact us today to schedule an appointment.