Recurrent Pregnancy Loss

Recurrent pregnancy loss refers to the loss of two or more pregnancies. Although miscarriages are common, it is important to look for an underlying problem if a woman experiences more than one loss.

There are a number of reasons why a miscarriage happens and some of the causes are more likely depending on when the miscarriage occurs. For those which occur in the first trimester the recognized causes are a chromosomal imbalance in the embryo (aneuploidy), uterine malformation or fibroids and antiphospholipid antibody syndrome (APA). Aneuploidy is the most common reason for a miscarriage but should be considered the diagnosis only after the other causes are ruled out.

Aneuploidy is a term which means that an embryo contains an abnormal number of chromosomes – either too many or too few chromosomes. This originates as a result of a chromosomal imbalance in either the egg or sperm which created the embryo. Many eggs and sperm form with an abnormal chromosome count and the percentage of abnormal eggs released increases with age. As a result, miscarriages increase with maternal age. Infrequently, individuals may carry their own chromosomes in a way that increases the number of abnormal eggs or sperm they make. A karyotype, or chromosomal analysis, done through a simple blood draw can identify the presence of this unique situation.

Further evaluation is focused on the other causes of miscarriage and entails a uterine evaluation through pelvic ultrasound, sonohysterography or hysterosalpingram and blood work looking for evidence of APA.

It is important to note that research has revealed that a woman’s chance of a successful pregnancy does not decrease even after three losses if an evaluation does not identify a specific cause. For those with an identifiable problem there are treatments available to correct and improve the chance of a healthy, full term baby.

The significant loss which is experienced by those who have a miscarriage or miscarriages is under-recognized. Many individuals never discuss their loss. It is important to receive the support that you need both medically and emotionally. The medical evaluation described above can be completed in one or two office visits. In addition, there are support groups and counselors who specialize in reproductive care.