As many of our patients already know, miscarriage is not uncommon: about 1 in 6 initial pregnancies will end in miscarriage. It’s very likely that you or someone close to you has experienced the loss of a pregnancy.
But while one pregnancy loss is heartbreaking enough, 1 in 20 couples with infertility will experience nothing short of a waking nightmare: multiple, recurrent miscarriages.
Recurrent pregnancy loss (RPL) is when two or more first trimester miscarriages occur. Many women feel a misplaced sense of guilt and responsibility for pregnancy loss. Given the emphasis society often places on a woman’s role as caretaker, it’s easy to understand why some are tempted to blame themselves. This misguided thinking becomes easier to justify after multiple losses.
But if there’s one thing you take from this information, it should be this:
There are many reasons why a pregnancy may not make it to term. None of them are caused by anything that you can control — not without medical intervention, anyway.
Let’s explore each of them.
Sometimes, physical aspects of the structure or anatomy of the uterus can lead to miscarriage. These problems can interfere with pregnancy growth in the first trimester, and may play a role in preterm birth or abnormal presentation of the baby at time of delivery.
Some women are born with anatomic problems (congenital), and others acquire them.
There are three different types of congenital problems with the uterus:
Uterine septum: the uterus has a wedge of extra tissue (septum) hanging from the top that divides the uterus into two cavities
Bicornuate uterus: the uterus is heart-shaped and has two conjoined cavities instead of the one single cavity
Uterus didelphys: the uterus is essentially a double uterus with two separate cervices, and possibly a double vagina as well.
More commonly, women aren’t born with anatomic problems, but acquire them later. Acquired anatomic problems include endometrial polyps, fibroids, and intrauterine scar tissue. These problems can also contribute to difficulty getting pregnant.
A major cause of miscarriage is a chromosomal or genetic abnormality with the fetus. In the majority of cases, this is a random event and does not occur over and over again for most couples.
Some problems which may occur include:
Abnormal karyotype. Karyotype refers to the number and structure of chromosomes in an individual. The most common cause of a single miscarriage is a random event between a sperm and an egg which results in an abnormal number of chromosomes in the fetus. This problem becomes more common as women get older. In a small number of couples (about 3%) with recurrent pregnancy loss, either the man or the woman is born with a structural rearrangement of their chromosomes called a balanced translocation. This can be detected through a simple blood test.
Increased sperm DNA fragmentation. The function of sperm is to deliver the man’s DNA into the woman’s egg. All men have some degree of fragmentation in the DNA of their sperm and that is normal. Low levels of DNA breakage can be repaired by the egg. When the DNA fragmentation exceeds a low level, fertility may be compromised. This may lead to both infertility and early pregnancy loss in some couples.
During pregnancy, a mother’s immune system is altered so that the fetus is not rejected by the body and is allowed to grow. Sometimes, there is an imbalance in the way the immune system responds to the pregnancy.
An immune problem known as antiphospholipid antibody syndrome (APS), causes increased risk of blood clots in the body. This disorder can lead to miscarriage in pregnant women. This causes miscarriage in the later part of the first trimester or later in pregnancy.
Abnormal hormone levels can affect the uterine lining. These problems create an environment that may not be best for egg implantation and nourishment.
Women with thyroid and adrenal gland problems and women with diabetes are usually at a higher risk for miscarriage due to hormonal imbalances. Deficiency of Vitamin D has also been associated with reproductive failure.
Fortunately, there’s a lot we can do to increase your chances of carrying a pregnancy to term. But the only way to know what's causing RPL is to see a fertility doctor for an evaluation.
We recommend getting tested after 2 or more pregnancy losses.
Remember, the more information we can gather about the reasons behind the miscarriages, the better we can tailor a treatment and improve your odds of a successful pregnancy.
At CARE Fertility, that information gathering starts with a telehealth consultation to meet each other, discuss your history and learn more about your past losses. Then, you’ll come in for an in-person visit and undergo testing. The tests we’ll recommend will depend upon the timing of your losses in the first trimester.
These tests may include:
Ultrasound, hysterosalpingogram (HSG) and hysteroscopy to check for anatomic or structural problems
Chromosomal or genetic tests, including semen testing for DNA fragmentation
Blood tests to check for hormonal (thyroid and Vitamin D) or immunologic abnormalities
The first step is to understand the underlying reason for the losses with the help of a fertility specialist, who can then personalize your treatment plan.
We know it’s overwhelming, but there is hope and we are here to support you.
To schedule a new patient consultation, fill out the new patient paperwork in the main menu of our website, or call 817- 540- 1157.