Recurrent early pregnancy loss

Approximately 15% of all pregnancies between four to twenty weeks of gestation will undergo clinically recognized spontaneous miscarriages. The true early pregnancy loss rate is closer to 50% because of the high rate of unrecognized miscarriages in the two to four weeks immediately following conception. The majority of these very early cases are caused by chromosomal abnormalities in the sperm or the egg.

Habitual abortion is classically defined as three or more consecutive spontaneous abortions in the first trimester. Clinical studies have indicated that the risk of pregnancy loss after three consecutive spontaneous miscarriages is about 30-45%. After three consecutive miscarriages without a live birth, the chance of a successful live birth is about 55-60%. If a woman has had a successful live birth this chance goes up to 70%. However, keep in mind that these numbers are drawn from younger women. Older women have a risk of pregnancy loss that is twice that of younger women.

Clinically determined miscarriages occur only in 12% of women under 20 years old, but the incidence increases to 26% in women in their 30s, and may be as high as 50% in women in their 40s.

There are several factors that may contribute to early or recurrent pregnancy loss. These include genetic factors, environmental factors, endocrine factors, anatomical factors, immunological factors, and infectious diseases.

Women who undergo recurrent pregnancy losses and have had two miscarriages in their first trimester should have the following tests performed:

• A test to evaluate the uterine cavity, which may include a hysterosalpingogram or hysteroscopy.
• A genetic test to determine chromosomal makeup of the parents.
• A test of antibody formation, including lupus anticoagulant and anticardiolipin antibodies (these are antibodies that the body produces which may attack the embryo and cause recurrent miscarriages).
• A general exam by the physician as well as general health screening, including screening for diabetes and thyroid disease, and presence of any kind of infection that may affect the uterus and the fallopian tubes.

Treatment of recurrent miscarriages depends on the cause. At times, recurrent miscarriages may be treated very easily. For example, a patient that has uterine fibroids or uterine scar tissue formation may be treated by an outpatient procedure called hysteroscopy to remove the scar tissue. This procedure may improve the chances of carrying a pregnancy to term from 30% to 70 or 80%. Other treatments may include treatment of metabolic diseases such as diabetes and thyroid, with thyroid medication or insulin; treatment of genetic diseases by performing in vitro fertilization with preimplantation genetic diagnosis; and treatment of antibody formation by using medication such as Aspirin and Heparin.

Back to Infertility