Recurrent Pregnancy Loss (RPL)
Repeated miscarriages and habitual abortions (HAB) can happen more often in women of advanced maternal age (over the age of 35), but having repeated miscarriages does not need to happen as much as it does. Seeking the help of a fertility doctor (a Reproductive Endocrinologist or “RE”) can help prevent this from happening.
Many women begin trying to conceive (TTC) naturally, and as a woman approaches her 30’s and 40’s the process tends to take longer, as egg quality and reserve begin to decrease in a woman’s late twenties and early thirties. By the time a woman reaches 40, there is about a 5% chance of getting pregnant, according to statistics. If a woman is healthy and has no other health issues, that number may be higher. Although a lot of fertility issues boil down to egg quality for many women out there trying to conceive, especially if over the age of 35.
Evaluation for women who have suffered more than one miscarriage should include examination of physical reasons, as well as chromosomal testing, and depending on the case may also include evaluation of alloimmune or autoimmune causes.Chromosomal testing can involve testing the products of conception which will tell right away if there were any chromosomal abnormalities with the embryo, and if so, whether it was spontaneous or due to an abnormal carrier state with the parents. In many cases, abnormalities are spontaneous and occur randomly, and typically cannot be prevented. If a second miscarriage occurs, it is recommended to do this testing. Treatments can vary, but many doctors recommend that women consider doing IVF with genetic testing (PGD or PGS), or consider using a donor egg, and transferring embryos that test normal.
If allo or autoimmune issues are suspected, further options for testing include histocompatibility testing, as well as antiphospholipid antibodies. Treatment may include prednisone, heparin and preconception care including weekly acupuncture treatments which improve clotting mechanisms and support hormonal production, as well as regulate immunity and help to reducing overall stress. When a structural issue is suspected, and all immune issues and chromosomal issues are ruled out, examination of the uterus is important – most patients will have a sonohysterogram, and some will be guided to do further testing, such as a semen analysis, DNA fragmentation testing for the male partner, overall blood testing, including a full thyroid panel, and possible certain biopsies. Treatments vary here, and may include using donor sperm or a surrogate, or may simply involve taking supplemental progesterone or baby aspirin. Some patients, depending on the cause of their miscarriage, may also simply make dietary changes and practice more holistic preconception care.
If you have had a miscarriage and have any questions about how to proceed, you should see a fertility specialist as soon as possible. If you have any questions feel free to call our clinic anytime – we are always happy to help you on your path to parenthood.