What is recurrent pregnancy loss? Recurrent pregnancy loss or recurrent miscarriages are considered three or more repeated miscarriages. For women who experience recurrent miscarriages, a thorough physical exam and testing are recommended. 

The likelihood of having recurrent miscarriages are very small. Around 1% of women will have repeated miscarriages. Most miscarriages, about 60%, occur at random. This happens when an embryo receives an unusual amount of chromosomes during fertilization. This happens by chance, and normally there isn’t a medical condition that helps the cause. However, women who are at a mature reproductive age have a higher chance and recurrent miscarriages start to become more common.

Miscarriages, although, are common. They occur in about 15% to 20% of all pregnancies. Normally, in the first trimester or first 13 weeks of pregnancy. Miscarriages are not the definition of a woman’s fertility and more than half of the time, these couples go on to have healthy children. Even after two miscarriages. 

However, beyond two or three miscarriages, looking into possible causes of why you’re having recurrent miscarriages may need a closer look.

Types of Miscarriages

Miscarriages can be the result of many things. Some which doctors aren’t even sure of, but they are usually divided into two groups: early and late.

The most common being within the first trimester. Mostly due to chromosomal problems or genetic issues with the embryo. Studies show that 50-80% of spontaneous losses are due to abnormal chromosomal numbers. As well as structural problems within the uterus. 

Late recurrent miscarriages may be the result of autoimmune problems, uterine abnormalities. Premature labor or an incompetent cervix. 

Causes

A history of recurrent miscarriage calls for evaluation and management. When it comes to determining a cause, a range of tests are performed on both the mother and father. Even fetal tissue if necessary. These tests could be one of the following:

• Blood clotting studies (*only indicated with personal or close family history of venous thrombo-embolism)
• Anatomical testing / sonography (ultrasound test or HSG / X-ray)
• Testing for auto-immune disorders (in cases of 3 or more losses)
• Chromosome testing of products of conception after losses (we can test fetal DNA from formalin fixed slides if you already had miscarriage)
• Testing for insulin resistance, diabetes, and other endocrinopathies related to the thyroid and pituitary glands
• Chromosome testing of parents looking for balanced translocations

Even with testing, it is often that the reason for a miscarriage isn’t exactly understood. But you should know that 65% of patients do go on to have a successful third pregnancy after two miscarriages.

Finding a cause for recurrent pregnancies can be difficult. Up to 50-75% of the cases the tests come back normal without any kind of answer, or direction for the cause. But once a cause is determined, it could very possibly be an easy fix.

Causes that could determine why you have had recurrent miscarriages:

Endocrine issues

Endocrine issues absolutely lead into investigation for recurrent miscarriages. These issues could include diseases like diabetes, thyroid, pituitary glands, or polycystic ovarian syndrome.

LPD (Luteal Phase Defect) may suggest that the woman’s womb is suboptimal. This can also result in miscarriage. To start, treatment for LPD can be ovulation induction medication like clomiphene citrate. 

Prior, progesterone therapy was used to combat similar endocrine issues, however, studies have shown that this form of therapy demonstrates few benefits, if any. Endocrine issues need proper evaluation to develop a plan for the best approach to remedy any of the many issues. 

Genetic (embryo or parents)

Genetic or chromosomal abnormalities of the embryo are pretty common and affect 50-80% of recurrent miscarriages in the first trimester. When this gets repeatedly passed on, this can contribute to the multitude of pregnancy losses. If two or more losses occur, it’s recommended you and your partner consider karyotype. This checks for a balanced translocation, which is a chance of about 4% in each parent. People who deal with a translocation normally don’t exert physical signs or show any symptoms. But, some of their eggs or sperm will show abnormal chromosomes. If an embryo gets too little or too much genetic material, it can often lead to miscarriage. 

For some situations, in vitro fertilization with preimplantation genetic testing can be considered. This can help combat a chromosomally abnormal embryo by being able to select a chromosomally normal embryo to increase the chance of live birth. This procedure is highly individualized and should be considered by consultation with your physician.

Autoimmune Diseases

There are specific autoimmune diseases that occur when the mother produces antibodies that cause clotting in blood vessels that lead to the developing fetus. This causes the fetus to be deprived of essential growth nutrients. Which normally results in a death in utero. This also causes a miscarriage.

There are blood tests that can be performed for autoimmune issues like these if you’ve dealt with three or more pregnancy losses. With the help of over the counter medications like heparin and aspirin, your doctor can recommend daily aspirin therapies that help to combat the effects of these autoimmune diseases. 

Medications like Heparin, which is an anticoagulant, can often be prescribed to help prevent blood clotting. Although, not popular or used frequently, talking to your doctor about the short and long term effects with medications like heparin during pregnancy can help determine if treatment like this is truly warranted. 

These issues are complex. Blood clotting disorders are not really felt to cause recurrent pregnancy loss but when it comes to patients with a personal or family history of blood clots, getting tested is optimal when it comes to pregnancy. Especially when it involved extremities or the lungs.

Uterine anomalies

Uterine structural problems lead to about 15% of miscarriages. These uterine abnormalities can be developed at birth, or congenital, like a double uterus or a uterus that is divided by a wall (septate uterus). Septate uterus is a disorder that is one of the most common associated with miscarriage. This disorder leaves the uterus in a condition where it’s separated into two sections by a wall of tissue.

There are also growths like polyps or fibroids that can cause issues for some women. This can happen anywhere in the uterus, which can not be any issue at all or can be the cause of many problems. 

Scars found in the uterus, or intrauterine scarring can also lead to miscarriages. This isn’t always a big deal. The majority of these issues can be remedied prior to conception through surgery. These procedures help increase the chance of a healthy pregnancy. Talk to your healthcare professional about proper evaluation for a problem like this or to see if it exists.

Syndromes like Ashman syndrome, may be associated with repeated miscarriages. This is where adhesions and scarring form in the uterus. This can occur long before a woman even knows she is pregnant. 

Environmental factors

When it comes down to our environment, that can play a huge part in a lot of risk factors. Especially pregnancy. When a mother is exposed to certain drugs, chemicals, x-rays, cigarettes, alcohol, etc., there’s always an increased risk of miscarriage. Some related to lifestyle, like excess use of caffeine, smoking, or alcohol – may affect pregnancy outcome. As well as lifestyle surrounding obesity. And some unavoidable – such as work relations – like chemicals and toxins found in the surrounding environment.

Medical Conditions

Certain medical conditions can most certainly increase the risk of repeated miscarriages. As previously referenced, autoimmune disorders like Antiphospholipid syndrome is an autoimmune disorder that should be evaluated prior to conception and during pregnancy. 

Other diseases like diabetes mellitus can also lead to miscarriages. This is when a high level of sugar, or glucose, is present in the blood. Women who don’t have this disease controlled or are poorly controlled have an increased risk of pregnancy loss. As well as women with Polycystic Ovarian Syndrome. 

Unidentified

It is also extremely common that the cause for repeated miscarriage cannot be identified. In about 50-75% of women, repeated miscarriage occur without any cause for the pregnancy loss. There may be a few clues,  but not one for-sure answer. 

Your healthcare provider may ask about your medical history and past pregnancies to try and assess the reasons and a complete physical exam, including a pelvic exam may be performed. Along with blood tests to help detect any deep rooted problems with the immune system, genetics and/or possible disorders. Plus imaging tests to consider if a uterine problem is the cause. 

Once, and if, your repeated miscarriages can be identified, your healthcare provider may suggest specific treatment to address the issue. 

Don’t Be Discouraged

It’s very common to have unknown reasons for repeated miscarriages. Even after two, the chances of a healthy birth are as high as 65% with no complications. It’s always recommended to seek a healthcare provider that specializes in repeated miscarriages to help understand and help treat the issue. 

Rosh MFM Is Here To Help! Call Us In NYC to Schedule An Appointment Today!

If you have recurrent miscarriage, you should know that the doctors at Rosh Maternal & Fetal Medicine understand the emotional toll of pregnancy loss.

They’re dedicated to supporting you through the challenges, finding the cause, and helping you have a healthy baby. If you’ve had two or more miscarriages, please call their office in the Midtown East area of New York City, or schedule a consultation online and let their expertise help you overcome recurrent miscarriage.