Recovering from Recurrent Miscarriage
Miscarriage is a devastating event for a couple. However, repetitive miscarriage, is even more traumatic and distressing. The overwhelming majority of miscarriages occur due to a chromosomal abnormality within the fetus, not a problem with the mother’s ability to carry a baby.
Genetic errors in the egg or sperm result in embryos with too many or too few chromosomes. These chromosomal abnormalities result in pregnancies that are not compatible with life. Nature takes its course by shedding the uterine lining and begins to ready the body for another, hopefully viable pregnancy.
Although the majority of miscarriages are clearly genetic in nature there are some situations that may occur where a definable and treatable problem can be diagnosed.
Causes of Recurrent Miscarriage
According to the American Association for Reproductive Medicine (ASRM), the causes of recurrent miscarriage include:
Hormonal Abnormalities: Progesterone is necessary for a healthy pregnancy. There is controversy about whether low progesterone levels, often called luteal phase deficiency, may cause repeated miscarriages. Treatments may include ovulation induction, progesterone supplementation or injections of human chorionic gonadotropin (hCG), but currently there is no evidence to support the effectiveness of these treatments.
Metabolic Abnormalities: Poorly controlled diabetes increases the risk of miscarriage. Women with diabetes improve pregnancy outcomes if blood sugars are controlled before conception. Women who have insulin resistance, such as obese women and many who have polycystic ovarian syndrome (PCOS), also have higher rates of miscarriage. There is some evidence that suggests that medications that improve insulin sensitivity such as Metformin can lower miscarriage risks in women with PCOS.
Uterine Abnormalities: Distortion of the uterine cavity may be found in approximately 10% to 15% of women with recurrent pregnancy losses. Diagnostic screening tests include hysterosalpingogram, sonohysterography, ultrasound, or hysteroscopy. Congenital uterine abnormalities include a double uterus, uterine septum, and a uterus in which only one side has formed. Asherman’s syndrome, uterine fibroids, and possibly uterine polyps are acquired abnormalities that may also cause recurrent miscarriages. Some of these conditions may be surgically corrected.
Antiphospholipid Syndrome: Blood tests for anticardiolipin antibodies and lupus anticoagulant may identify women with antiphospholipid syndrome, a cause for 3% to 15% of recurrent miscarriages. In women who have high levels of antiphospholipid antibodies blood clots in the placenta and does not allow the normal transport of nutrients and oxygen to the baby which caused miscarriage. Pregnancy outcomes are improved by using aspirin and heparin to control the clotting factors in the blood and allow a term pregnancy.
Thrombophilias: Inherited disorders that raise a woman’s risk of thrombosis may also increase the risk of fetal death in the second half of pregnancy and may cause multiple miscarriages.
Unexplained: No explanation is found in 15-25% of couples with recurrent pregnancy losses.
Age: The chance of a miscarriage increases as a woman ages. After age 40, 25%-35% of all pregnancies end in miscarriage. Most of these embryos have an abnormal number of chromosomes.
After a miscarriage a healthy lifestyle and prenatal vitamins with folic acid is recommended before attempting another pregnancy. Smoking cessation, reduced alcohol and caffeine consumption, moderate exercise, and weight control may all be of benefit.
