Recurrent Pregnancy Loss (Miscarriage)

Overview

One of the most heartbreaking experiences a woman trying to have a baby may encounter is recurrent pregnancy loss, or miscarriage.

Unfortunately, this is not an uncommon phenomenon. Approximately 25% percent of all pregnancies will end in this way, usually during the first trimester. It is estimated that fewer than 5% of women will experience two consecutive miscarriages and only 1% experience three or more. While the cause of the miscarriage will not be discovered 50% of the time, it is important to remember that most women who undergo this ordeal will ultimately go on to have a healthy baby.

Recurrent pregnancy loss is defined as having two or more failed pregnancies. If you find yourself in this position it is imperative that you be thoroughly evaluated by a specialist in order to attempt to determine the cause of the losses and, therefore, decrease your risk, if possible, of subsequent miscarriages.

There are a number of potential causes of recurrent pregnancy loss. These include:

• Genetic or chromosomal causes
• Advanced maternal age
• Poor egg quality
• Hormonal abnormalities
• Undetected infections, such as chlamydia
• Metabolic issues such as diabetes, obesity, polycystic ovaries or thyroid disorders
• Uterine cavity distortion caused by a variety of anatomic factors such as fibroids, polyps, scar tissue, or a uterine septum
• Asherman’s syndrome (scar tissue in the uterine cavity)
• Celiac disease
• Lupus
• Thrombophilia (tendency towards the formation of blood clots)

Work-up

For those who have experienced a pregnancy loss, an important concern is how to minimize the chance of another loss. If the reason for the pregnancy loss can be identified, subsequent miscarriages can often be avoided. If, for example, you have a family history of any chromosomal abnormalities, such as Down’s syndrome or Turner’s syndrome, make sure to let your physician know as these disorders sometimes have a genetic link.

There are a number of tests that can help to determine the underlying cause. These include:

• Hysterosalpingogram (HSG) to visualize the uterine and fallopian tube anatomy; the HSG can reveal risk factors such as including structural anomalies, uterine fibroids, uterine polyps, adhesions or scar tissue, adenomyosis, uterine septum or uterine didelphis (double uterus).
• Karyotype blood test to provide genetic information for both the male and female partner.
• Blood testing to detect an alteration of hormones which include tests for the pituitary gland, thyroid gland and ovaries.
• Preimplantation Genetic Diagnosis (PGD) to diagnose an underlying genetic condition present in the embryo prior to achievement of pregnancy. PGD for chromosome problems can increase the chance of an embryo implanting, decrease the chance of miscarriage and decrease the likelihood of having a child with certain genetic disorders such as Down Syndrome.

If no causative factor can be identified, as is the case about 50% of the time, the chance for a future successful pregnancy can exceed 60-70% depending upon one’s age and prior pregnancy history. Your physician may also wish to discuss with you empirical therapy, which is not designed to overcome a specific cause but rather to enhance your natural fertility.

What can be done?

Women who have undergone a pregnancy loss can benefit psychologically and emotionally from creating an action plan. Not only will being proactive about your physical well being and treatment options help to diminish many of the potential causes of recurrent miscarriage; it can also give much needed equilibrium to you during a difficult time of your life.

First and foremost, communicate with your physician. Make sure you are tested for every potential known cause of recurrent miscarriage. Be verbal about your concerns and your family histories. And make proactive changes, if needed, in your lifestyle to support your overall health and the potential health of your pregnancy. Changes to consider include:

• Losing weight if you are obese or have a BMI of >30.
• Stop smoking.
• Limit alcohol and caffeine consumption.
• Partake in moderate exercise such as daily walking, gentle yoga, or swimming.
• Avoid contact sports such as touch football or any sport or physical activity that might prove to be risky. Use common sense.
• Manage your stress as best you can. Consider psychological counseling or a support group, either in person or online.
• Take folic acid every day.
• Avoid exposure to known toxins in household products or in the workplace.

Tips for Coping

1. It is understandable that this may be a very difficult time for you. While no one has a crystal ball or can look into the future, it is an honest truth that most women who experience recurrent miscarriage will ultimately conceive and give birth to a healthy baby. You may be afraid to allow in that little window of hope for fear that it will be destroyed yet another time. Try to remember that hope is a very powerful tool and in the case of recurrent pregnancy loss, not an ill-founded one.
2. Men and women often display different grieving styles. Women are more apt to be expressive about their loss, displaying their emotions and seeking out support from others. Men, on the other hand, may appear to be less emotional, grieving in solitude and shying away from any type of outside support system. Men sometimes appear to avoid grief by focusing more on tasks and problem solving during this time. If grieving styles between two of any sex are divergent from each other it may give either partner the misimpression that the grief is not shared. This is rarely the case. Keeping grieving style differences in mind may help to go a long way towards giving each other some understanding as well as breathing room to experience the loss in his or her own way. Most importantly, it may give a sense of balance that will enable both of you to come together and find the courage to try again.
3. One change that you do not have to make is avoidance of sexual intimacy. Sex does not cause miscarriage. In fact, if you are part of a couple, intimacy between yourself and your partner can support not only the relationship between you but your own emotional health as well.

Sex can sometimes become a complicated minefield, particularly for couples who are grappling with a history of miscarriage. If you find that this part of your life has become difficult, consider counseling either together or individually, to simply talk or think it through. Remember that trauma and loss can either pull couples together or apart.

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