Treatment for recurrent miscarriages can be a difficult conversation to have, even among family and friends. Miscarriages are surprisingly frequent. According to some studies, up to half of all early pregnancies end in miscarriage. Most are known to happen even before a woman knows she is pregnant.  

Known miscarriages can be absolutely heartbreaking although not uncommon. Recurrent miscarriages can feel like constant confusion. Recurrent pregnancy loss is considered a loss of two or more clinical pregnancies. Meaning, the parents were aware of the pregnancy prior to the loss. 75% of these happen within the first twelve weeks of pregnancy and are documented by an ultrasound or a pathologic diagnosis. Which is different from sporadic losses which happen within the first ten weeks of pregnancy. 

Multiple miscarriages can happen in up to 20% of women. Women who have a history of two or more miscarriages, will have an increased risk of 40% for an additional miscarriage. 

Talk to your doctor or an infertility specialist to start narrowing down the causes and treatment for recurrent miscarriages. 

Common Underlying Causes

A lot of common causes for recurrent miscarriages are a result from genetic, or chromosomal abnormalities. These abnormalities tend to be random events that stem from the sperm, early embryo, or the egg. Half or 50% of women don’t even realize she was ever pregnant before these miscarriages occur. 12 to 15% of all conceptions end with clinical miscarriages which is typically less than 50% total. However, it increases the risk for future miscarriages if women don’t seek treatment for recurrent miscarriages over time. 

Common causes and reasons for recurrent miscarriages:

Advancing Maternal Age-

As women get older, mostly women over 35, the risk for miscarriage increases greatly. It is thought that age causes a higher risk for poor egg quality and leads to genetic abnormalities. Even slight irregularities in both or either partner’s genes can affect the mother or the father slightly, but severely affects the developing fetus.

Abnormal Genetics-

Most studies show that 50 to 60% of all miscarriages in the first three months are a result of genetic problems or abnormalities in the developing fetus. Either one or both partners can pass on a genetically predisposed abnormality from the sperm or the egg, that can cause a miscarriage.

Abnormal Hormone Levels-

Women with thyroid, diabetes, and adrenal gland problems are at higher risk for miscarriage. These can contribute to abnormal hormone levels which results in the fertilized egg not having the best environment for implantation and nourishment. In addition, higher prolactin levels can disrupt the normal uterine lining development and miscarriages can occur when the uterine lining does not develop sufficiently. 

Immunological Problems-

There are multiple categories of immunity issues that can cause a miscarriage. One of those categories are Antiphospholipid antibodies. Antibodies that are associated and found in 50% of women with Lupus. Blood tests are used to detect these antibodies and your doctor might prescribe you a blood thinner such as baby aspirin or a specific medication to take during ovulation into pregnancy to help thin the blood. Also, another category of immune issues that may cause a miscarriage are those that prevent a women’s protective response to the embryo. 

Environmental Problems-

The consistent exposure or use of marijuana, tobacco, caffeine, and alcohol can affect fetal development. To avoid possible miscarriage, most doctors suggest to limit, and preferably, avoid use during pregnancy.

Structural Problems-

The shape of the uterus can affect the development of the fetus. Structural problems of the uterus or within the uterus can cause a miscarriage by interfering with the implantation of the fertilized egg. Growths or uterine fibroids can grow on the uterine wall, or position themselves to block the opening of the Fallopian tubes which can change the normal function of the uterine lining. A fibrous wall or septum can divide the uterine cavity and cause poor implantation that can also result in miscarriage. Also, exposure as a result from a drug prescribed by doctors decades ago called DES, can cause structural problems resulting in a T-Shaped uterus can also contribute to miscarriages.

Infections-

Certain infections or viruses like herpes simplex, HHV-5, chlamydia, and german measles, can affect fetal development. Also, contribute to some recurrent miscarriage cases. 

Cervical Issues-

When the cervical muscle is weakened it is called an “incompetent cervix”. For the developing fetus to grow it needs to remain closed. As the fetus grows and reaches a certain weight, it puts more pressure on the cervical opening and can cause a miscarriage.

Are there Symptoms before a Miscarriage?

Miscarriage experiences can vary throughout different women. Some women experience symptoms of a miscarriage and some women experience nothing at all. A few signs of a onset miscarriage can be: back pain, fever, passing blood clots, the absence of fetal movement, cramping with vaginal bleeding, spotting that starts dark brown and changes to pink or red, abdominal pain, and a decrease in breast tenderness and fullness. 

It is likely that some of these symptoms are similar to some pregnancy symptoms and although can be common, it is recommended to be proactive and call your doctor. Everything could be okay and completely normal, but it’s just with peace of mind that nothing is wrong along the way. 

What Types of Testing Are Available?

Especially if you have experienced more than two miscarriages, you should talk to your OBGYN or a fertility specialist to help narrow down the possibilities of what’s causing them, how to utilize treatment for recurrent miscarriages and how to prevent future losses based on testing. 

The doctor will run a series of tests to find out the underlying causes of infertility and miscarriages. 

Tests your doctor may recommend:

Blood Tests-

Women will have blood tests to test for diseases or conditions that will raise the risk of a miscarriage. Conditions such as pelvic inflammatory disease, a sexually transmitted infection or disease, and rare autoimmune diseases will also be tested for:

Hormonal Tests-

Along with blood tests your doctor may recommend a hormone test. They may want to test your levels of progesterone which thickens the lining of the uterus, thyroids, and certain proteins needed to maintain a pregnancy. They may also check for prolactin and follicle stimulating hormones or FSH. FSH stimulates the ovaries to produce eggs which grow inside follicles. These follicles dwindle with women in their later ages which also contributes to infertility. High levels of FSH could mean the ovaries don’t have any eggs ready for pregnancy, and low levels could contribute to a miscarriage. 

Structural Tests or Hysterogram-

Your doctor may run a HSG test to view the reproductive organs for structural problems. Anatomical problems such as fibroids, scar tissue from conditions caused by endometriosis, polyps, or a septal wall, all could affect implantation. 

Your doctor will insert a catheter that injects a dye into the uterus which produces an image such as an X-ray that they can evaluate for such conditions. 

Ultrasound-

A transducer, or wand, is inserted into the vagina which helps with detailed images of the reproductive organs. Sound waves are used to create images of the reproductive organs in the body, the doctor is able to detect possible issues such as uterine growths, fibroids, etc., that can cause infertility or a miscarriage. 

Genetic Screening-

Some recurrent miscarriages are a result of an irregular number of chromosomes. A chromosomal rearrangement called translation, is a condition in which the genes are joined together abnormally. Genetic variations are noticeable in both man or woman and result in chromosomally unbalanced sperm or eggs. Which can cause the embryo not to develop properly and result in a miscarriage. 

A Karyotype test may be referred to both mother and father to determine if they carry the correct number and configuration of chromosomes. 

Immunological Tests-

Some immunologic responses can cause recurrent pregnancy loss. Usually due to specific antibodies. These can be antithyroid antibodies, anticoagulant factors and anticardiolipin antibodies. Some of these antibodies promote a blood clotting mechanism within the placenta and some cause the pregnancy to go unprotected by being rejected by the mother’s body. 

Endometrial Biopsy or Uterine Lining Tests-

On a specific day, later in your cycle, your doctor will run a test on your uterine lining. An endometrial biopsy is a way for your doctor to remove a small piece of tissue from the uterine lining and test it. They will be looking for thickness, the development of the lining on the day of your cycle, irregular cells that may indicate other conditions like infection or polyps. 

If there are any indications of there being an issue, your doctor will treat you. Throughout your treatment, it is important to continually repeat the biopsy to see that treatment is improving your conditions. 

Finding Support and Treatment

Based on the underlying causes of recurrent miscarriages, treatment can vary. Studies have shown no matter the results of the causes, the chances of having a successful pregnancy with treatment is as high as 71%. Even with abnormalities found.  

Parents who found a chromosomal or genetic abnormality, are referred to genetic counseling or prenatal genetic studies. Normally with a CVS sampling, a piece of biopsied placenta, or removed amniotic fluid for research. 

There is also an option for IVF where shots are given to the mother for several days so her body develops more eggs in her ovaries. With a minor surgical procedure, the eggs are retrieved from the ovaries and the sperm is injected into the eggs for them to grow. The cells of the embryo are biopsied and analyzed before transfer back to the womb.  

There are cases where over one-half of recurrent miscarriages will be unexplained and no specific cause could be found for the pregnancy loss. Despite these numbers, the chances of a pregnancy overall are good.

Find support in family and friends, and talk to your doctor about your concerns. 

Looking At Treatment for Recurrent Miscarriages?

At Rosh Maternal & Fetal Medicine, our doctors are 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.

Talk to our team by phone or book an appointment online to get started. Call one of our six convenient NYC locations or schedule a video consultation online today. Come visit your NYC OBGYN.