Repeated (Recurrent) Miscarriage

Repeated Miscarriage

What is Repeated (recurrent) Miscarriage or Pregnancy loss?

A Miscarriage or a Pregnancy loss is defined as a baby inside the womb getting terminated before 24 weeks of pregnancy. Two or more miscarriages makes a woman at higher risk of another pregnancy loss. Three or more losses are called ‘Recurrent Pregnancy Loss’ or ‘Repeated (Recurrent) Miscarriage’.

Around 10% women globally at least have one pregnancy loss. Globally in studied populations, recurrent miscarriage is unexplained almost 50% of the times.

However, at Akruti IVF Centre, we provide detailed information and diagnostics to provide an explanation and treatment algorithm for every individual couple to reduce their risk of miscarriage and improve chances of having a healthy baby.

With a customized treatment plan, at Akruti IVF, more than 80% woman with previous multiple pregnancy losses end up with a successful live birth!

Let’s learn the various diagnostics for evaluating Repeated (Recurrent) Miscarriage or pregnancy loss risk.

1. Genetic Evaluation:

  • Genetics plays a large part in determining if the fetus is viable. If the embryo has abnormal number of chromosomes it is not viable for birth and terminates on its own.
  • The most basic test done is Parental Karyotyping, meaning checking the Chromosome arrangement and its normalcy in the couple. Please read more about Genetic Karyotyping here

2. Advanced parental Age:

  • Advanced Maternal Age is a risk factor for recurrent miscarriages if previously this risk was not observed at a younger age (Eg: 1 normal pregnancy and willful termination and next history of recurrent losses after age of 33 years in female)
  • Increasing female age increases the chances of egg formation with abnormal number of chromosomes leading to pregnancy losses due to chromosomal abnormality. Since this cannot be assessed before embryo formation, the currently highest validated method is to conduct Pre-Implantation Genetic Testing for Aneuploidy (abnormal chromosomal arrangement) . Please read more about Pre-implantation Genetic Testing here.
  • PGT identifies normal chromosome arrangement and number embryos allowing to reduce the risk of recurrent miscarriage. In vitro fertilization is required to create multiple embryos at blastocyst level for accessing the PGT Test.

3. Advanced Paternal (father) Age :

  • Advanced age of the male partner can also lead to abnormal chromosome complement in embryos and in many cases when the woman’s egg reserve is depleted but the male has sperm available, age of the male partner plays a large role in normal embryo formation.

4. Size and Shape of The Womb (Uterus) :

  • When the size or shape of the womb is abnormal enough to not allow a normally growing embryo to become a fully grown fetus, at most times, Surgical correction of the Uterus ( the womb) is the answer.
  • Some abnormal uterus shapes that can lead to repeated miscarriages are :
    • Unicornuate Uterus : Having only 1 side of uterus normal
    • Bicornuate Uterus
    • Septate Uterus
  • Common Names Used are :
    • Retroflexed uterus
    • Tilted uterus
    • Backward uterus
    • Retroverted uterus
    • Tilted womb

5. Weak Cervix :

  • Cervix weakness can lead to miscarriage in third to sixth month of pregnancy.
  • No reliable tests can inform which patient is at highest risk for cervical weakness. Normally a previous history of cervical weakness leading to pregnancy loss leads to procedure known as cervical tightening or cervical cerclage in consequent pregnancy and leads to successful birth 92% of the time in the ongoing pregnancy.

6. Polycystic ovaries :

  • Polycystic Ovarian Disorder leads to a condition where the Polycystic ovaries are bulkier and larger than normal ovaries. These ovaries produce many follicles but many times ovulation is abnormal, absent or delayed. These women have hormonal imbalance and nearly 50% women with PCOS also have repeated pregnancy losses.
  • A common culprit is having higher androgen production and reduction of androgens either via long term usage of appropriate medication or laproscopic ovarian diathermy has led to significantly increased number of children born for women with PCOS.

7. Infections :

  • Vaginal infection can lead to a serious uterine infection and increases risk of having miscarriage in fourth to sixth month. There is also increasing information that confirms infections without any symptoms in the Womb known as chronic endometritis can lead to repeated miscarriages or implantation failure.

8. Immune reasons :

  • Various auto-immune diseases like Rheumatoid arthritis, having higher range of lupus antibodies, other antibodies that can lead to pregnancy losses are anti-nuclear antibodies (ANA) and antibodies against DNA histone protein ( anti-ds-DNA).
  • Anti- phospholid syndrome is one of the highest risk factors for repeated pregnancy loss and testing for aPL antibodies is routine at Akruti IVF Centre due to the high risk of miscarriage even during natural pregnancies apart from IUI or IVF pregnancies.

9. Blood conditions:

  • There are certain hereditary genes that create abnormalities in blood clotting . The disorder is termed as thrombophilia. In cases recurrent miscarriage is unexplained in spite of all above testing, the genetic expert at Akruti IVF may order Genetic testing to understand your risk of blood clotting disorder and plan your Clinical treatment accordingly.

10. Diabetes and thyroid problems :

  • Uncontrolled diabetes can be a reason for recurrent miscarriage.
  • There is also now evidence that clinical hypothyroidism and subclinical hypothyroidism with high level anti TPO antibodies can lead to pregnancy losses.
  • At Akruti IVF, we review all blood work of patients and order blood draws based on individual patient’s risk factors to customize treatment respective of their case.