Some pregnancies simply end because of random chromosomal abnormalities in the egg or the developing embryo. Recurrent miscarriages (or recurrent pregnancy loss) can be physically difficult and emotionally devastating. But not knowing why this problem is happening can be even more distressing. Patients may experience feelings of self-blame, failure, or desperation. It is important for patients to seek emotional support during this time. Professional mental health support will also be beneficial for patients coping with recurrent loss and those who have been trying to conceive under stressful situations. Fortunately, most women trying to conceive do go on to carry a healthy pregnancy to term after a miscarriage. In this article we tell you all you need to know about miscarriage & recurrent pregnancy loss, including causes, prevention, and treatment.
What is Miscarriage?
Miscarriage is when pregnancy ends on its own, and is the most common type of pregnancy loss. Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage, and some of these will be chemical pregnancies, where a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of her expected period.
In medical terms, early miscarriage is usually referred to using the following terms:
- Chemical pregnancy loss (when HCG levels in the urine or blood rise initially to indicate pregnancy and then drop again, indicating that the pregnancy has ended)
- Early pregnancy loss (when an embryo or fetus that is clinically detectable through tests such as ultrasound is lost in the first trimester)
Because the underlying cause of most miscarriages is chromosomal abnormalities, the various therapies and techniques typically promoted for prevention are not proven and are unlikely to be useful, if there is a chromosomal issue. If there is a hormonal deficiency or other health issues, pregnancies can be supported with good nutrition, rest, certain medications if warranted, and weekly acupuncture treatments
What Causes Miscarriage?
The following are the most common known factors in miscarriage:
According to the American Society for Reproductive Medicine, the usual cause of early miscarriage is aneuploidy. This is an abnormality in the number of chromosomes (such as missing or duplicated chromosomes). Up to 60% of all miscarriages are thought to be the result of random chromosomal abnormality. The reason for most of these errors is not known. Women over the age of 40 are more likely to lose an embryo due to chromosomal abnormalities. In fewer than 5% of cases, a genetic abnormality in the chromosomes of one of the parents is found to be the cause.
Congenital malformation or acquired abnormalities in the uterus are found to be the cause of recurring miscarriage in about 10-15% of patients. Uterine septum (a congenital condition in which the interior of the uterus is divided by a partition of tissue) is a well known factor in miscarriage. Polyps and fibroids that may form later in life can also contribute to miscarriage. When an embryo implants on an abnormal surface, it cannot obtain adequate nutrition or establish blood flow.
Hormonal, metabolic, and autoimmune disorders may also play a role in recurring miscarriage. These conditions include:
- Endocrine disorders such as diabetes and PCOS
- Thyroid or adrenal dysfunction
- Antiphospholipid antibody syndrome in which antibodies attack the placenta. This condition also increases the risk of blood clots. APAS is identified as the cause of recurring miscarriage in 3-15% of patients.
How Common Is Miscarriage?
A high percentage of fertile women who have unprotected sex will experience loss of a pregnancy at some point. According to the American Society for Reproductive Medicine, 25% of recognized pregnancies end in miscarriage. The total number of miscarriages (including cases where the woman is unaware of the pregnancy) is estimated at about 50%. Pregnancy losses occurring within the first 8 weeks are most common. Few women experience miscarriage after the 12th week.
Pregnancy After Miscarriage
Fortunately, most women trying to conceive do go on to carry a healthy pregnancy to term after a miscarriage. This includes 60-70% of women who have experienced recurring pregnancy loss with no identifiable cause. Following a healthy lifestyle including good nutrition, diet, weight control, prenatal supplementation, exercise, rest, and general self care is the best course of action for women who wish to increase their chances of a normal pregnancy in the future.
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.
Testing And Treatment For Women Who Experience Recurrent Miscarriage
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.
Can Recurring Miscarriage Be Prevented?
Because the underlying cause of most miscarriages is chromosomal abnormalities, the various therapies and techniques typically promoted for prevention are not proven and are unlikely to be useful. This includes over the counter, herbal, and alternative treatments.
Treatable Causes of Recurring Miscarriage
Occasionally, a patient is diagnosed with a medical condition that may cause or contribute to recurrent miscarriage. Treatment or correction of the underlying disease, deficiency, or abnormality may reduce the chance of future miscarriage for some patients.
Here are a few examples:
Problem: Identifiable genetic abnormalities in one or both parents or advanced maternal age increasing the risk of chromosomal abnormalities in the embryo.
Treatment: During an In Vitro Fertilization cycle, preimplantation genetic diagnosis (PGD) may be used to identify a chromosomally normal embryo for implantation.
Problem: Uterine problems including polyps, fibroids, or a uterine septum (distortion of the interior of the uterus by abnormal tissue formation).
Treatment: Surgery may be suitable for some patients to restore a normal uterine surface to enable implantation and ongoing support of future embryos.
Problem: Diabetes or insulin resistance (such as found in patients with PCOS)
Treatment: Management of blood sugar through lifestyle changes and/or with appropriate medications to consistently maintain blood sugar at normal levels.
Problem: Antiphospholipid antibody syndrome which may cause excessive blood clotting and an antibody reaction to the placenta.
Treatment: Blood thinning therapy with aspirin and heparin may help prevent clotting. According to the American Society for Reproductive Medicine, medical treatments such as leukocyte (white blood cell) immunization and intravenous immunoglobulin (IVIG) therapy for preventing miscarriage have no proven benefit at this time.
Recurrent Miscarriages, Sperm Quality & Male Infertility
When a couple goes through recurrent miscarriages, there are many issues that the must be looked into, one of which is male factor issues involving the man’s sperm. Even something as simple as a medication, a varicocele or an old sports injury in a man’s past could effect sperm quality and may show up on a semen analysis or a DNA fragmentation test. A man may also have a chromosomal issue that were not previously picked up on in a SA (Semen Analysis), or he may be taking certain medications on and off that he does not think could effect his sperm.
What can be done? Whether a man or couple chooses to take the natural route or it looks like assisted reproduction holds the key, especially if there is a genetic issue, a man wants his sperm to be as strong and as healthy as possible. Looking into what medications you’re taking, getting in better shape (losing weight if necessary, and cutting out things like alcohol, coffee, lots of processed soy and sugar) are vastly important. And no overheating – avoiding hot tubs and jaccuzzis is beneficial, and even loose underwear or pants can help. Doing this for about 3 months of preconception care can be incredibly helpful.
Laptops may be another thing to watch as they can heat the lap temperatures, negatively effecting the testicles. And even vegan-ism and extreme vegetarianism can be a disadvantage. Reducing processed protein forms like soy and tofu and adding in some organic animal products might be helpful according to these theories. Harvard University studies suggest that the pesticides in fruits and veggies may also hinder male fertility – so go organic whenever possible.
If your doctor finds other medical conditions such as low levels of progesterone hormone or other hormonal irregularities, these may be treated as well. The efficacy of such treatment for preventing recurring miscarriage is not yet known.
When To See a Fertility Specialist
If you are experiencing a recurring pregnancy loss, it’s time to see a fertility specialist. There are known causes of miscarriage that can be identified and possibly treated, as well as other advanced fertility treatment options, like IVF and donor eggs. We’re here to answer any questions that you may have; contact us online or call (310) 566 14 70.