Recurrent Miscarriage Reasons

First of all, it is better to know that there is a difference between the terms miscarriage and abortion. The term “miscarriage” refers to a spontaneous pregnancy loss before the week 20 or expulsion of the fetus under 500 g, while the term “abortion” refers to the intentional termination of the pregnancy by the use of medications or surgery which according to WHO, it happens around 40-50 million times every year.

Having a miscarriage can be extremely devastating and hurtful to the couples. But when you talk about two or more recurrent miscarriages in row, you are speaking about a tragic experience that it is very hard to handle. Miscarriage can happen in 15 to 20 percent of the pregnancies, often in the first trimester.

More than half of the cases can get pregnant and have a healthy child after a while without getting any medical help. However, the miscarriage reasons should be found and treated especially when they occur two or three times. But the important thing if you have experienced a miscarriage is that you should not blame yourself or the others about it. Try to talk about your feelings with your partner and if it is necessary, you can consult with a therapist.

What is Recurrent Miscarriage?

Recurrent miscarriage occurs when you have 3 or more miscarriages in a row. This is not something common and it only happens in 1 percent of the couples. However, in around 50% of the cases, the cause of frequent miscarriages may not be found that can lead to frustration and despair among the couples.

Types of Recurrent Miscarriage

There are usually two types of pregnancy loss: recurrent early miscarriages and late miscarriages.

Recurrent early miscarriages happen because of genetic problems. Embryos that have abnormal chromosome number can face miscarriage up to 50 to 80 percent. This can also occur due to structural uterus problems.

Recurrent late miscarriages can happen because of uterine problems, inefficient cervix, premature labor or autoimmune issues.

How is Recurrent Miscarriage Evaluated?

When recurrent miscarriages happen, patients often go through a comprehensive analysis to find out the reasons of their pregnancy loss. Timing of the loss and the fundamental features of pregnancy before the miscarriage should be analyzed carefully. Couples should be physically and genetically evaluated by doing a series of tests such as blood work, uterus evaluation through ultrasound in order to looking for fibroids, scar tissues or polyps and also other tests such as endometrial evaluation, sperm analysis, checking out for infections, etc. If there is a tissue left from the previous pregnancies, it can be used to have a genetic examination for the causes of miscarriage to solve them or at least carefully monitor them for the next pregnancy.

Over 20% of patients with recurrent miscarriages will face no specific reasons for their loss. In these cases, there is no general recommendation for treating their problems. However, they can be cured without any interventions in more than half of the cases.  if there are reasons that have remained unexplained, emotional support and counseling of the medical team and family members can be considered as a valuable help to the upset couples.

Recurrent Miscarriage Causes

Although the reasons of recurrent pregnancy loss may often be unknown, there is still a 65% chance of having a healthy pregnancy after two losses. Having an expert physician can help you identify the root of your pregnancy problem. But there are common issues that may lead to a recurrent miscarriage.

• Uterine problems:

• uterine abnormalities can raise the risk of recurrent miscarriages or premature birth. These abnormalities can be detected by using ultrasound technology. Some women may have inborn abnormal-shaped uterus while some others may have developed irregularities in their womb by the pass of time. Having fibroids, polyps, uterus scars and poor blood supply can be named as the common uterine problems which may cause women have a pregnancy loss. However, most of these issues can be solved before insemination to increase the chances of a healthy pregnancy.

• Endocrine issues:

• this can contain thyroid and pituitary glands related diseases, diabetes or polycystic ovarian syndrome.

• Genetic cause:

• in some cases, one of the parents or both of them may have an abnormal chromosome which is passing on to the embryo. These abnormalities can cause about 50-80 percent of the miscarriages in the first trimester. Although sometimes the parents have a slight genetic irregularity, their children may be severely affected and end up having a pregnancy loss. If this is your issue, you can have a Karyotype test to get your blood or body fluids examined. In vitro fertilization with preimplantation genetic diagnosis (IVF+PGD) can extremely help by finding the genetic abnormal embryos and put them away in order to transfer only healthy embryos into the uterus.

• Cervical weakness:

• you might have a late miscarriage experience because of cervical weakness. In this case, you can assess the length of your cervix from the week 14 and you may be advised to have a cervical cerclage.

• Autoimmune diseases:

• in this case, the mother produces antibodies that leads to blood clotting in vessels which are nourishing the embryo, so that the embryo does not receive oxygen and nutrition and dies. This is called antiphospholipid syndrome. Doing blood tests can help detecting this issue. Doctor may prescribe taking daily low-dose aspirin or heparin to prevent blood clotting.

• Other factors:

• environmental factors like being exposed to certain chemicals, drugs, pollutions, X-ray emission, excessive use of alcohol, smoking etc. may also increase the risks of miscarriage. Obesity is one of the other factors that can affect the pregnancy result.

Advanced age of the couples can also affect pregnancy usually because of poor quality of the gametes among women over 35 and men over 40.

Recurrent Miscarriage Treatment

Miscarriage treatment must be chosen based on the reason of pregnancy loss. You have to know that the chances of future pregnancy are still high no matter what is the miscarriage reason. If the final results do not show any abnormalities, there is 77% chance of success for a future pregnancy, and if the results find the abnormality, then the future success chance would be 71%.

Using PGD technology through IVF can solve the problem of genetic abnormalities. If there is a uterine abnormality, having a surgery may be the best option. Also certain medication can help antiphospholipid syndrome to prevent blood clotting. If diabetes or thyroid dysfunction are recurrent miscarriages reasons you have to take your prescribed medications.

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