Recurrent miscarriages can be disheartening. Oftentimes, women are reluctant to discuss pregnancy loss even though it is more common than most know. Unfortunately, the stigma around miscarriages still remains strong in certain situations. 

All clincially recognized miscarriages actually make up about 12-15% of pregnancies. However, the estimate of all conceptions that end within the first 12 weeks of gestation is thought to be at least 30-60%. About 50% of the time, most women don’t even know they are pregnant. 

The risk of miscarriage can increase with each previous miscarriage but that number still remains under a 50% chance. This means one miscarriage can normally prompt a doctor’s visit but more than one should inquire a thorough exam. 

In the past, identifying what causes a miscarriage normally resulted in a mystery. With advancements in modern reproductive medicine, an accurate diagnosis is more likely possible and has led us to solving 60% of recurrent miscarriage cases. 

With dedicated programs, doctors can treat women in a comprehensive and compassionate manner. 

What Is A Recurrent Miscarriage?

A recurrent miscarriage, or pregnancy loss, was originally classified as consecutive pregnany loss of three or more. As of recently, the ASRM (American Society of Reproductive Medicine) has redefined it as two or more pregnancy losses. A pregnancy loss is clinically recognized as involuntary loss of pregnancy before 20 weeks. This means that the pregnancy was visually confirmed as a loss with an ultrasound or identification of pregnancy tissue loss. 

Causes For Recurrent Miscarriages

The reasons for recurrent miscarriages can be a result of many issues. Some are random and others are results from chromosomal, or genetic abnormalities and/or advanced maternal age. These abnormalities can come from any part of the early embryo, egg or sperm. 

Chromosomal Abnormality

A lot of recurrent miscarriages can be attributed to chromosomal abnormalities. In fact, about 60% of miscarriage cases can be the result of chromosomal abnormalities. As we age, the quality of our eggs and sperm start to dwindle. This can result in genetic abnormalities and lead to spontaneous miscarriages. These miscarriages happen by chance and no medical condition causes it. It only becomes a higher risk as we get older. 

Currently, there is no treatment for aging. However, the alternative option can be using a donor for intrauterine insemination or a donor for in-vitro fertilization. For this alternative option, healthcare providers can use a test called Assisted Reproductive Therapy (ART). This is a way to examine the embryos and ensure that only healthy and genetic defective free embryos are transferred. 

Anatomy

A smaller percentage of recurrent miscarriages are caused by uterine abnormalities. About 18% of miscarriages can be traced back to an abnormal uterine shape such as a:

• Bicornuate Uterus – A bicornuate uterus describes a uterus that is shaped irregularly. A bicornuate uterus is described as heart-shaped, appearing to have two sides instead of being one hollow cavity. It’s a rare, congenital condition that can cause complications during pregnancy. It can only be treated with surgery.

• • Uterine septum – a thin tissue or membrane that ultimately divides the uterus. This is very common. This can cause an issue for the fertilized egg that implants on the septum. This means the egg doesn’t get enough of a blood supply to grow properly. A uterine septum can be diagnosed via MRI, ultrasound or hysteroscopy. Normally the treatment for this is an outpatient surgery that removes the septum. Without this treatment, the risk of recurrent miscarriages is at a high 65%. 

• Unicornuate Uterus – A unicornuate uterus is a congenital irregularity where a person has only one fallopian tube and an abnormally shaped uterine cavity. It’s a rare condition that causes pregnancy complications. Certain variations cause pelvic pain. Your healthcare provider may recommend treatment depending on the type of unicornuate uterus you have.

• • Uterine Fibroids – small tumors/bumps or leiomyomas are bumps that grow in the uterus. Normally most fibroids are benign, or not cancerous, and are diagnosed via MRI, hysteroscopy, hysterosalpingography, ultrasound, or hysterosonography. They are also treated with medication that can be both hormonal or non-hormonal. If symptoms are more severe, the treatment may require surgery. 

• Didelphic (double) Uterus – Uterus didelphys is a rare congenital condition where you’re born with two uteruses. It’s commonly called a double uterus. It can cause pregnancy complications and painful menstruation. Some people have surgery to treat uterus didelphys, but most cases don’t require treatment.

Medical

There are some medical conditions that can affect pregnancy. Some of those could include:

• Diabetes
• Blood clotting
• Immune system disorders
• Metabolic disorders
• Hormonal disorders – for example: Polycystic Ovarian Syndrome (PCOS)
• Immune system disorders – for example: antiphospholipid syndrome (APS)
• Thyroid disease

These conditions can cause fertility issues and make it difficult to get pregnant to begin with. Treatments are determined by the condition. For instance, blood clotting disorders can be treated with medication. Progesterone supplementation for certain hormonal issues. Thyroid conditions or diabetes can be adjusted with medication to help prevent future pregnancy loss. 

Lifestyle

Aside from medical conditions that affect pregnancy, there are a few things that we may do daily that could increase the risk of recurrent miscarriages. 

• Alcohol
• Overuse of caffeine
• Illegal drugs
• Cigarettes
• Marijuana 

Preparing your body for pregnancy is very important. Lifestyle changes are necessary to ensure the health of both mama and baby. For additional help, your OBGYN can connect you to resources necessary to aid change. 

Unidentified Miscarriages

Women will go through many tests to try and narrow down the reason for a miscarriage. The healthcare professional will inquire about past pregnancies, medical history, perform a complete physical exam, blood tests, and imaging tests. 

Unfortunately, even with all of the access to advanced testing, sometimes there is no simple answer to explain recurrent miscarriages. In about 50-75% of women can find no sure cause for miscarriages. These can be the most difficult to work through. Having an unexplained loss means having a problem with no easy solution. 

This does not mean a woman should blame herself for pregnancy loss. There is hope to continue on from pregnancy to delivery even after three miscarriages. The chance of conceiving and carrying to full term is 60-80%. About 65% of women with no true explanation for recurrent pregnancy loss have a successful following pregnancy. 

Trying Again

When going through pregnancy loss, you might feel like you want to try again. Talk to your doctor about your condition or when it may be safe to try again. Your body may need time to prepare for another baby. 

While you may feel emotionally ready to conceive, it’s important to check in with yourself to make sure you are both emotionally and mentally prepared to conceive. Talk to family, friends, and support groups to help you through the process. Having a community is very helpful. If you need resources, ask your OBGYN for recommended support groups and information. 

Call Rosh Maternal & Fetal Medicine For All Recurrent Miscarriage Concerns

The doctors at Rosh Maternal and Fetal Medicine will do everything to help you through pregnancy to birth. We understand that recurrent pregnancy loss can put families through stress. Working with patients to help determine the cause of the first step towards a healthy pregnancy. 

If you have any additional questions about miscarriages, if you think you are having a miscarriage or may have had one, schedule an appointment with Rosh Maternal & Fetal Medicine today!

The team at Rosh MFM can help you get through this stage in your life with ease. Call or schedule an appointment in NYC today to talk to our doctors who specialize in working with women and their needs.