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Probably no aspect of infertility is more traumatic than becoming pregnant and then losing the baby to miscarriage. And while most women who miscarry do go on to give birth to a healthy baby in the next pregnancy, infertility specialists are often called in when a woman experiences recurrent pregnancy loss.
The incidence of pregnancy loss among all women is about 15%. Statistics show that if the first pregnancy ended in miscarriage, the second has only a slightly elevated possibility - 18% - of the same outcome. After two miscarriages, however, the risk rises to 25%-30%. For this reason, most doctors recommend that a woman see a fertility specialist if she has experienced two miscarriages in a row.
For a woman who has had three consecutive miscarriages but no history of live birth, the next pregnancy has a 30-45% chance of ending in miscarriage. Keep in mind, however, that this means she still has better than 60% odds of carrying the next pregnancy to term! |
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It had long been believed that - unlike "first" miscarriages, of which a little over half are caused by chromosomal abnormalities - recurrent pregnancy loss had other causes. However, recent research has demonstrated that about 60% of recurrent miscarriages also are caused by chromosomal abnormalities. Researchers are still debating what causes the remainder. Possibilities include immune system malfunction, hormone imbalances, distortions of the uterine cavity, and pelvic infections. Studies have also linked the use of alcohol, cigarettes, and excessive caffeine consumption to an increased risk of miscarriage. |
 The risk of miscarriage increases with age and can be attributed to in many cases to an abnormal egg. As a woman gets older, the quality of her eggs diminishes resulting not only increased miscarriage rate but also increased infertility and congenital anomaly rates.
When a woman seeks medical care for recurrent miscarriage, her doctor will first seek to diagnose the cause.
 A cause for the miscarriage can be identified in only 50 % of the cases. The treatment will depend on what was found. Your doctor may recommend gentic studies (chromosomal analysis) for you and your spouse. The incidence of chromosomal abnormality in either spouse is approximately 1-3 %. Whenever possible a genetic study of the miscarriage tissue should be obtained . Preimplantation Genetic Diagnosis(PGD) may be considered in cases of repated miscarriages attributed to abnormal chromosomal study in either spouse. |
 If, for example, the woman is found to have uterine fibroids or polyps (two types of benign growths) surgery may be performed to remove these. Similarly, if she has a uterine septum (a congenital condition in which the uterus has a wall through the middle of it), surgery can correct this.
If blood tests find that a patient has a hormonal dysfunction known as "luteal phase defect" (not producing enough of the hormone progesterone to support an early pregnancy), she can be given progesterone vaginal suppositories. If the miscarriage is caused by faulty ovulation, treatment with fertility medications such as clomiphene citrate(Clomid, Serophene) can restore normal ovulation and may improve likelihood of a successful pregnancy. In some patients with ovulatory dysfunction caused by
Polycystic Ovary Syndrome (PCOS) treatment with Insulin blocker (Metformin) has been shown to improve ovulation and significantly decrease the risk of miscarriage. |
 In some patients a miscarriage can associated with the presence of an organism called "Ureaplasma", which can be detected by a simple cervical culture and treated with an antibiotic, such as, Doxycline.
If there are immunologic factors (such as Antiphospholipid antibodies or Factor V), aspirin therapy (81mg daily) may be prescribed during pregnancy. Low dose Heparin
therapy has also been shown to be effective for patients with recurrent pregnancy
losses. Such therapy has been demonstrated to be successful in about 80% of patients.
Recent studies demonstrated both aspirin and heparin therapy to be equally effective
in treting recurrent pregnancy loss resulting in over 80% live birth rate.
Intravenous immunoglobulin (IVIG) therapy
has been evaluated in patients with recurrent
miscarriages. The treatment is expensive and ihas been shown to provide no significant
benefit in preventing further miscarriages. Similarly, natural killer cells (NK)
have been implicated in recurrent pregnancy loss, but it is still not certain that
NK are necessarily bad in humans.
When the miscarriage is caused by a chromosomal (genetic)abnormality in either parent or in the pregnacy tissue following a miscarriage, In Vitro Fertilization (IVF) with Preimplantation Genetic Diagnosis (PGD) can be undertaken to select only normal embryos for transfer into the uterus. |
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