Most patients in a fertility expert’s office are there because they have problems getting pregnant, but for some, the problem is staying pregnant. According to the American Society for Reproductive Medicine (ASRM), recurrent pregnancy loss, also known as RPL or recurrent miscarriage, is a condition that is defined as two or more consecutive pregnancy losses before 20 weeks of gestation.
“Experiencing recurrent pregnancy loss can be an emotional time for patients, and we want to be there to support them,” shares SGF Houston physician, John Crochet, M.D., who sees patients at SGF’s Beaumont and Clear Lake, Texas, offices. “Providing testing and treatment options can give patients a path forward and lead to successful pregnancies.”
Below, we highlight the 5 most common causes of recurrent pregnancy loss, as well as treatment options that are available.
1. Genetic abnormalities
In many cases, miscarriage is the result of chromosomal abnormalities. Recurrent pregnancy loss may be caused by faulty chromosomes carried within the egg and/or the sperm, resulting in an embryo with chromosomal abnormalities that often result in miscarriage. Women over the age of 35 are also at a higher risk of producing eggs with chromosomal abnormalities.
Treatment options: We can offer a blood test to analyze chromosomes for the presence of genetic defects, also known as karyotyping. Depending on the outcome, genetic counseling is recommended. IVF with genetic testing of the embryos can be effective.
2. Untreated medical or endocrine conditions
Medical conditions, such as diabetes, and endocrine disorders, including thyroid disorders, are known to have unfavorable impacts on the uterus. This environment can result in embryos that have difficulty growing and thriving in the uterus.
Treatment options: Medications are often available to help correct imbalanced hormone levels.
3. Anatomical abnormalities, including uterine malformations
Many women born with a uterine malformation are unaware of their condition until they have difficulty conceiving or suffer from recurrent miscarriages. Congenital uterine abnormalities can make it difficult for embryos to properly implant in the uterus or result in the inability to carry a pregnancy to full-term. Anatomical abnormalities may also include fibroids, polyps or excess scar tissue.
Treatment options: Often, the shape of the uterus or other abnormalities can be detected on an ultrasound, or during a hysterosalpingogram, hysteroscopy, or laparoscopy. Some uterine abnormalities can also be repaired surgically.
4. Cervical insufficiency
A weakened cervix occurs when there is structural problem with cervix, which can lead to miscarriage. When the cervix shortens and opens early, it is unable to hold the embryo or fetus in the uterus. These problems typically arise in the second or third trimester.
Treatment options: You may be offered a scan to determine the length of your cervix and have continuous monitoring throughout pregnancy. If you’re at high-risk of premature labor, a cervical stitch or cerclage may be recommended. In some cases, a gestational carrier may be needed.
5. Lifestyle factors
Using recreational drugs, excessive alcohol consumption, and smoking are known to increase the likelihood of miscarriage. Heavy drinking can cause serious harm to a developing fetus and increase chances of pregnancy loss. Smokers also have twice as many miscarriages as those who do not smoke.
Treatment options: Physicians can help to identify applicable lifestyle modifications and facilitate a connection with a nutritionist.
Other causes of recurrent pregnancy loss
Several other causes are often widely debated within the medical community, and research continues to influence the things that we consider in patients who experience recurrent pregnancy loss. These include:
- Autoimmune conditions, including anti-phospholipid antibodies
- Poor Sperm quality
- Stress and environmental factors
- Infections
- Endocrine disorders, like polycystic ovary syndrome (PCOS) or luteal phase deficiency
Recommended screening for recurrent pregnancy loss
A basic fertility work-up is the first step to understanding the causes of RPL. Early intervention is best to determine the course of action, taking into account female age and medical history. Patients should seek an evaluation from a fertility specialist after two or more miscarriages.
RPL recommended screening includes:
- Antiphospholipid antibody testing
- Parental karyotypes for both partners
- Uterine cavity evaluation
- Thyroid-stimulating hormone
- Prolactin
- HgbA1C
There are many options to treat RPL! Treatments can range from simple lifestyle modifications to more advanced, highly effective treatments, such as in vitro fertilization or genetic testing.
There is hope
As disheartening as it is to experience even one miscarriage, the best news is that most patients are able to achieve a successful pregnancy. Recurrent miscarriage patients in the Shady Grove Fertility practice receive the attention from staff and access to treatment and technology to feel confident that they will go on to have a healthy pregnancy.
Medical contribution by John R. Crochet Jr., M.D.
John R. Crochet, Jr., M.D., is board certified in obstetrics and gynecology (OB/GYN) as well as reproductive endocrinology and infertility (REI). Dr. Crochet received his medical degree from the University of Texas Medical Branch in Galveston. He then completed his residency in OB/GYN at the University of Texas Southwestern Medical Center in Dallas where he received commendations for his teaching and was recognized for excellence in laparoscopic and endoscopic surgery and ultrasonography.
