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What Is Recurrent Miscarriage And The Causes And Treatment For Recurrent Miscarriage

Recurrent Miscarriage

Recurrent miscarriage (also called recurrent pregnancy loss) is defined as two or more failed pregnancy losses. Two consecutive miscarriages happen in up to 5% of couples who have been trying to conceive.

General advice for couples with recurrent miscarriage includes:
  • Reduced consumption of alcohol and caffeine.
  • Smoking cessation.
  • Moderate exercises and weight management with a healthy lifestyle.
  • Supplementation of a woman's diet with folic acid and prenatal vitamins.
  • In addition, can consult a therapist who may help you with the feelings of loss and grief that are associated with recurrent pregnancy losses.
NOTE: If you have had three or more miscarriages, it is diagnosed as recurrent miscarriage.

Potential causes, tests and treatments for recurrent miscarriage include:

Due to chromosomal abnormalities in the fetus: Occur in    over 70% of unexplained miscarriages and this rate increases with age. In women under the age of 35, the chance of pregnancy loss is 14% and above the age 40, it can be up to 40%.

Tests: Chromosome testing of the fetal tissue.

Treatment: There is no treatment that has yet shown any improvements in ongoing pregnancy rates. But this situation may change with better technologies that become available in future. Women who are over the age of 40 with no other provable cause for pregnancy loss may consider going for donor eggs from a younger women.

Due to chromosomal abnormalities in the parents: This can result in severe chromosomal abnormalities of the fetus, which causes the fetus to hold back its development and results in miscarriage. This is a very rare cause of recurrent miscarriage occurs in less than 5% of couples.

Tests: Blood test for detecting chromosomes for both the couples.

Treatment: IVF with embryo biopsy to identify the deviated chromosome and by transferring the unaffected embryos to the woman’s uterus.

Thyroid disorders: Whether it is hypothyroidism (too low levels) or hyperthyroidism (too high levels) can lead to problems with recurrent miscarriages or infertility. In a woman who has low thyroid function, her body will allow it to compensate by producing hormones that suppress ovulation. Conversely, a thyroid that produces too many hormones may interfere with estrogen's ability to perform its job and make the uterus unfavorable for implantation and may lead to abnormal uterine bleeding.

Tests: Testing blood hormone levels for thyroid function and use of prolactin. An assessment for polycystic ovary syndrome (PCOS) and irregular ovulation is also recommended.

Treatment: Drugs as needed to normalize thyroid levels, stimulate normal ovulation, and lower prolactin levels.

Diabetes:  it is mostly the uncontrolled diabetes that causes a miscarriage. Women who are struggling with diabetes are advised to speak to their doctor about various ways to control their blood sugar.

Tests: Blood sugar testing. 

Treatment: Medications and diet modifications to keep the blood sugar levels in normal range.

Uterine abnormalities: Such as a septum, abnormal growths in the uterine cavity such as polyps or fibroids, and scar tissues in the uterine cavity. All these may cause poor surroundings for embryo implantation.

Tests: Hysterosalpingogram, saline infusion sonogram (ultrasound of the uterus by using saline to sketch the cavity), and hysteroscopy.

Treatment: Uterine surgery to correct the abnormality such as incision of a septum, removal of polyps and fibroids, or adhesion removals.

Antiphospholipid syndrome:  Important for adequate development of placenta and antibodies to this including anticardiolipin antibody and  lupus anticoagulant. This accounts for 3% to 15% of recurrent miscarriages.

Tests: blood tests for antiphospholipid antibodies in particular to anticardiolipin antibody and   lupus anticoagulant.

Treatment: Studies suggests showing some benefits from the use of low dose aspirin and heparin (an anticoagulant) when the levels of antibodies are in high range.

Thrombophilias: Thrombophilias are inherited disorders of coagulation which increase a person's chances of developing blood clots usually associated with fetal loss during the second half of pregnancy. When these are tested for and present, at times treatment is initiated with low dose of aspirin and heparin.

There are no studies that show a substantial benefit from these drugs when losses have been in the first trimester. These are usually of benefit if the losses are in later pregnancy.

Male factor: There is increased evidence that abnormal sperms DNA can affect embryo development and thus increase miscarriage rate.

Unexplained Reasons: After all the testing, no explanation is found in about 50% to 75% of couples with recurrent pregnancy loss, but studies suggest that the likelihood of incidental live birth is up to 60% to 70% in these couples.

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