Multiple Miscarriages – Causes/Tests/Treatment
Miscarriages occur in around 15-20% of all pregnancies, usually during the first three months (first trimester). Having 1-2 miscarriages is not an indication for future infertility. However, recurrent pregnancy loss (RPL) can be a significant factor affecting fertility. Many couples go on to have children after one miscarriage, even two. However, when a woman experiences two consecutive miscarriages, an underlying cause must be considered.
Types of Miscarriage
Miscarriage is divided into two groups: early miscarriage and late miscarriage.
- Recurrent early miscarriages – Also called RPL, these occur during the first trimester. Recurrent early miscarriage is usually caused from chromosomal or genetic problems of the embryo, and around 60-80% of spontaneous aborted fetus have abnormal chromosome numbers. Another cause of miscarriage is structural problems with the uterus.
- Recurrent late miscarriage – This is the result of uterine abnormalities, an incompetent cervix, premature labor, or autoimmune problems.
Causes of Miscarriage
Not all women who have 1-2 miscarriages remain infertility. For women who have had two miscarriages, there is a 65% chance the third pregnancy will be carried to term. To treat miscarriage, the fertility specialist must understand the underlying cause. Our fertility center performs a variety of tests on the father, the mother, and the fetal tissue. Be aware, however, that for 60-70% of women, testing does not reveal a cause of miscarriage. Testing involves:
- Blood tests for diabetes, insulin resistance, autoimmune diseases, and diseases related to the pituitary and thyroid glands.
- Ultrasound and hysterosalpingiogram for anatomical testing.
- Chromosome testing for products of conception after multiple losses (DNA analysis).
- Blood clotting studies, especially for people with family history of venous thrombo-embolism.
Random chromosomal abnormalities of the embryo is a factor in 75% of all first trimester losses. For these couples, a karyoptype test can check for a balanced translocation, which indicates chromosome problems. Selecting a chromosomally normal embryo may increase your chances of live birth. This is done through Colorado in vitro fertilization (IVF) where the woman’s eggs and the man’s sperm are combined in the laboratory. Resulting embryos can be tested for chromosomal problems that cause miscarriage.
Around 15% of all repeated miscarriages are related to uterine structural problems. These abnormalities (anomalies) of the uterus are often congenital (something you are born with), such as a double uterus, a septate uterus (divided by a wall), or other malformation.
Some uterine abnormalities form during the woman’s life, such as polyps and fibroids. These growths occur anywhere in the uterus, and may affect pregnancy. In addition, scarring in the uterus can lead to miscarriages. These problems are treated with surgery, which increases your chances of a healthy pregnancy.
Endocrine and Autoimmune Disease Issues
Endocrine problems warrant investigation include diseases of the pituitary and thyroid glands, polycystic ovarian syndrome, and diabetes mellitus. Luteal phase defect (LPD) suggests problems with hormones, which can result in miscarriage. Treatment for LPD is ovulation induction and stimulation medications, such as clomiphene citrate (Clomid). In addition, progesterone therapy is popular for helping maintain the uterus lining (endometrium).
Immunological problems develop when the mother produces antibodies that cause blood vessel clotting, which harms the developing fetus. If the fetus does not receive nutrients, it can die in utero, which leads to miscarriage. Several blood tests are used to detect this problem, and it is easily treated with aspirin or heparin.