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Recurrent Pregnancy Loss, or repeated miscarriage’s are common. About one out of every five or six pregnancies ends in miscarriage, usually in the first few months. The thinking now is that a good portion of infertility is simply very early miscarriage.

This theory was reported in the American College of Gynecology (ACOG) September 1995 Bulletin. “Approximately 50-70% of pregnancies end in spontaneous abortion. Some women experience repeated miscarriages, which can be caused by subtle genetic abnormalities in the couple’s chromosomes, problems with the uterine cavity (fibroids, scar tissue, developmental defects), or other disorders. Problems in the number or structure of the chromosomes or the genes can lead to miscarriage. Frequently this is nature’s way of ending a pregnancy in which the fetus was not developing normally. Most chromosomal problems occur by chance and are not likely to recur in later pregnancies. But in a small number of cases, chromosomal problems can cause repeated miscarriage. Most of these pregnancy losses are unrecognized because they occur before, or at the time of, the expected menses”.

All women who have three or more miscarriages should be tested, especially if the miscarriages are consecutive. The cause of Miscarriage can be identified in most couples and treatment can often resolve the problem.

Most miscarriages occur within the first 12 weeks of pregnancy (first trimester). If vaginal bleeding occurs after a viable fetus has been documented, the chance of miscarriage is increased to about 20 percent. The risk of miscarriage increases for women 35 years and older. One of the causes of early miscarriage is an abnormal number of chromosomes. In order to determine whether there is a genetic cause for miscarriage, a karyotype on the fetal tissue and/or on blood from both parents may be ordered. If both parents have a normal karyotype, it is likely that the miscarriage was a chance event and the couple should feel comfortable continuing to try to conceive.

In cases where a patient is going through IVF, another procedure called Preimplantation Genetic Diagnosis (PGD) can be performed on the embryo prior to implanting it back into the uterus. Although there are only a handful of Fertility programs throughout the United States currently performing PGD, Coastal Fertility Medical Center will pioneer the use of PGD in Orange County beginning in the fall of 2000.

Approximately 10 to 15 percent of women with a history of recurrent pregnancy loss have an abnormally shaped uterus. A septate uterus, which involves tissue protruding into the inner cavity of the uterus, causes miscarriage due to inadequate blood supply to the fetus. Another uterine abnormality involves patients whose mothers took Diethylstilbestrol (DES) while pregnant. Women exposed to DES, who subsequently become pregnant, have a significantly greater incidence of miscarriage, premature labor, and infertility.

Uterine fibroids (common, non-cancerous tumors) can also interfere with the implantation or growth of a fetus. Fibroids can increase in size during pregnancy and result in miscarriage. This condition can usually be corrected with surgery.

In some cases, the cervix begins to open prematurely and is too weak to support a pregnancy. Once an incompetent cervix has been discovered and corrected, a subsequent pregnancy can usually be carried to term.

In the luteal phase (second half of the menstrual cycle), under the influence of the hormone progesterone, the endometrium thickens and becomes a healthy environment for a growing embryo. If progesterone production is low, the endometrium fails, preventing the embryo from implanting. This is easily corrected by administering progesterone either by capsules or injection.

Infections may cause recurrent pregnancy loss. Chlamydia has also been linked to miscarriages.

Another theory suggests that during a normal pregnancy, the fetus containing the father’s foreign genes, survives in the mother’s uterus because of a protective response from the mother’s immune system. In certain couples, this protective response does not occur allowing the maternal immune system to actively attack the fetus, recognizing the father’s material as foreign, resulting in miscarriage.

Smoking, drinking, and illegal drug use can increase the risk of miscarriage. Women should always consult their physician before taking any medicine during pregnancy, and also need to alert doctors and dentists before receiving x-rays or prescriptions for medicine.

The volume of blood flowing to the uterus effects implantation and development of the fetus. The position of the uterus and the diameter of the vessels to the uterus affects blood flow. Another factor that affects blood flow is the position of the patient. At Coastal Fertility Medical Center, we use medications, hormones, and activity to influence blood flow.

Many abnormalities of the uterus, which are linked to miscarriage, can be treated with surgery. A special X-ray (hysterosalpingogram) can detect abnormalities of the uterine cavity, and an endometrial biopsy can provide information about the uterine lining, where implantation occurs.

In some cases the mother’s illness has been linked to miscarriage. Systemic Lupus Erythematosus and other autoimmune disorders, congenital heart disease, severe kidney disease with high blood pressure, uncontrolled diabetes, thyroid disease or an intrauterine infection interferes with pregnancy. When these illnesses are treated, the chances for a successful pregnancy improve.

Disorders of the immune system can also lead to miscarriage. The immune system defends the body against disease by recognizing and attacking foreign substances. The mother’s body normally protects the fetus from an attack by her own antibodies, but in some cases this protection may be absent in a woman’s blood. Problems in the immune system can be diagnosed with a blood test.

Hormone imbalance may also lead to recurrent pregnancy loss . The hormone progesterone prepares the lining of the uterus for the fertilized egg during the second half of the menstrual cycle. When an egg is fertilized, this hormone continues to prepare the uterine lining for the embryo. Enough progesterone must be made to maintain the pregnancy, otherwise miscarriage will occur. If tests indicate that a woman’s body is not producing enough progesterone, supplements can be prescribed to correct the problem.

After a miscarriage, it’s normal for couples to questions why, and experience a period of grief. These reactions are normal, and it is important to understand that each partner may feel and cope differently. Although it may be difficult, couples should talk about the loss with family and friends. (see our section on “Coping with Infertility“.)

Some women who have experienced recurrent miscarriage may feel doubtful that they will ever have a child, but the encouraging news is that the success rate with treatment is high, especially with certain uterine and hormonal causes. In cases where no cause is discovered and no treatment prescribed, the chance of achieving a healthy pregnancy despite having had several miscarriages is still generally better than 50 percent.

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