Recurrent miscarriage is a condition when there has been three or more successive pregnancy losses. It is different from infertility as, infertility is the inability to conceive. For many cases, the cause of a recurrent miscarriage has not always been found. A number of factors can cause recurrent miscarriages of which some are treatable.It may not always be possible to identify a cause for recurrent miscarriage in a couple, even after extensive research and treatment procedures. Some of the common causes of recurrent miscarriage are described below:
1. Chromosomal abnormalities: Incompatible chromosomes can result into pregnancy losses. When an egg and a sperm meet, of which one of them is faulty, they can't line up properly resulting into chromosomal abnormality. Such conditions lead to miscarriages.
2. Uterine abnormalities or Incompetent cervixes: Miscarriages occur if the uterus is abnormally shaped since the embryo is not properly implanted or even if it gets implanted, it may not get sufficient nourishment to survive. If the woman has a weak cervix, it cannot hold the developing embryo, leading to miscarriage.
3.  Immunologic disorders: Under rare cases, the embryo itself is not accepted by the body. Antiphospholipid antibodies are those, which attack self tissues, such as embryos and prevent them from building up. This leads to recurrent miscarriage.
4. Untreated thyroid problems: Conditions such as thyroid or uncontrolled diabetes result in uterine conditions which make it tough for the embryos to survive.
5. Polycystic ovary syndrome: Women with polycystic ovary syndrome tend to have high levels of male hormones which, result in irregular menstruation and ovulation. This can prevent the lining of the endometrium from maturing that is required for holding the embryo.
6. Bacterial infections: There may be presence of a number of microorganisms inside the reproductive tract that may be harmless for the person. But there may be certain bacteria lined up in the reproductive tract, which can prevent development of embryo, thus leading to miscarriages.
7.  Lifestyle: Smoking and drinking are harmful lifestyle habits, which may increase the chance of miscarriage to a great extent. It is always advised to avoid smoking or drinking when you wish to conceive. Other lifestyle conditions, such as working in certain environments like hospital environments, farms, laboratories, etc, may lead to miscarriages; however, the exact reason has not been identified yet.

Reasons For Recurrent Miscarriage

Being a mother is the greatest gift to womankind. Every woman dreams of bearing a child. The feeling of being a mom is beyond any description. For some women, conception becomes a long and painful struggle. The fetus requires a complete 28 weeks to mature. Women who are unable to hold fetus or where fetus ceases to grow to suffer complications. Abortion is a term used for medical termination of pregnancy. It can be induced by drugs or surgery. However, complications can arise within any trimester causing a miscarriage. Miscarriage refers to the loss of a fetus before 20 weeks of pregnancy. A miscarriage is medically known as spontaneous abortion that may occur due to fetal or maternal complaints.

The symptoms of a spontaneous abortion are severe pain, cramps or heaviness in abdomen, fluid or tissues passing from the vagina or vaginal spotting or bleeding. These are warning signs and immediate gynaecologist attention is required in case of any such symptoms.

Let s look at some of the causes of miscarriage:
Faults in the genetic makeup of the fetus or chromosomal abnormalities can cease fetal growth.
Immune system disorders
Infection such as syphilis, rubella, poliomyelitis can lead to fetal death
Trauma and injury due to accidents may cause loss of fetus
Lifestyle factors such as excessive smoking, drinking, drug abuse can lead to fetal death.
Women with fibroids, cysts, menstrual issues or uterine abnormalities have a tendency for recurrent abortions.
Women with hormonal imbalances also tend to suffer miscarriages.

Homeopathy, with its holistic systems approach, provides highly individualised treatment for recurrent abortions. This all natural treatment targets the symptoms of the disease in totality. Homeopathic treatment of miscarriages goes beyond treating complications in conception and aims to restore uterus health and hormonal balance. It also deals with psychological symptoms like mood swings, irritability, anger, depression and fear that become associated due to recurrent failures in pregnancy. Morning and evening sickness can also be effectively managed through homeopathic medication.

Apart from this, homeopathy effectively combines a preventive and curative approach to treatment. It ensures that the patient is treated for the miscarriage and her health be restored for further conception.

Arnica is a well-known remedy for miscarriages in case it happens due to falls, lifting weights or violent concussion. If given in time, it may reduce the chance of miscarriage.
Caulophyllum: deals with the tendency of miscarriage due to weakening of uterine tissues.
Crocus Sativa: Deals with the tendency of abortion in Ist or 2nd month and issues like mood swings, violence, repentance and sadness.
Erigon: effective remedy for irritability, abortion due to exercise and profuse bleeding.
Sepia: Deals with morning sickness, depression, the tendency to abort in 5th to 7th month.

These and many other remedies are available for effective and long term treatment. Remember to consult a qualified homeopathic doctor for the same.

Homeopathy Remedies to Restoring Fertility After Miscarriage

The most devastating period for any pregnant women is a miscarriage. This normally happens because of genetic abnormality noticed in the fetus caused due to tripling of a chromosome. This is also called  spontaneous abortion  because the body rejects the random genetic abnormality. Apart from this, there are many other reasons for miscarriage namely blood clotting, deshaped uterus, uterine fibroids, unhealthy cervix and so on. Now, this could lead you to the next question - What can we do to prevent miscarriage?

Time to meet the gynecologist:
When there is tripling of chromosomes or genetic mismatch, the body actually rejects the fetus, thereby preventing birth of an unhealthy baby. But, if the miscarriage repeats several times, then you have to meet your gynecologist for further tests and appropriate medical intervention.

Symptoms of miscarriage:
In the normal course, when miscarriage occurs, the women would experience back pain or vaginal bleeding or blood in the vaginal mucus or cramping or abdominal pain. Ironically, sometimes the miscarriage may happen without any of these symptoms. It would get noticed only during routine scanning. However, in the normal course, the chance of a miscarriage is highest before the 12th week. But if miscarriage happens after the 12th week and before the 24th week, then it is called spontaneous abortion. Thereafter, it is known as a  still born  baby.

However, there are some steps that can help women prevent a miscarriage. These steps are briefly explained here.

Nicotine retards growth of fetus and it is for this reason the couple should shun smoking, months before they plan pregnancy. This change in lifestyle has remarkable effects in preventing miscarriage. Similarly, caffeine can also be the cause of miscarriage. Therefore, women should regulate their intake of coffee as per the advice given by the gynaecologist.
Women suffering from chronic ailments like lupus, problems with thyroid, epilepsy and such other ailments are prone to a miscarriage. Similarly, it is also advisable that women should get tested for STD/HIV because these ailments can cause a miscarriage. Women suffering from such ailments should be under constant medical care.
In addition to these, the women should take food rich in vitamins, proteins, Omega-3 and fibres. Further, they should also do physical exercises as per the instructions given by the gynaecologist. One should drink enough water so as to keep oneself sufficiently hydrated. Women must practice meditation, which helps in reducing stress.
The causes of a miscarriage are many; women should discuss about the issues relating to a miscarriage with their gynaecologist. This helps them take appropriate preventive steps against this unwanted situation.

Miscarriage - Can You Prevent it?

If you lose a baby before 24 weeks of pregnancy, it is called a miscarriage. If this happens in the first 3 months of pregnancy, it is known as an early miscarriage. Unfortunately, early miscarriages are common, with 10 20 in 100 (10 20%) pregnancies ending this way. Late miscarriages, after 3 months of pregnancy but before 24 weeks, are less common: 1 2 in 100 (1 2%) pregnancies end in a late miscarriage. When a miscarriage happens three or more times in a row, it is called recurrent miscarriage. Recurrent miscarriage affects 1 in 100 (1%) couples trying to have a baby.

Why does recurrent miscarriage and late miscarriage happen?

Sometimes there is a reason found for recurrent and late miscarriage. In other cases, no underlying problem can be found. Most couples are likely to have a successful pregnancy in the future, particularly if test results are normal.

There are a number of factors that may play a part in causing recurrent and late miscarriage:

Age, the older you are, the greater your risk of having a miscarriage. If the woman is aged over 40, more than 1 in 2 pregnancies end in a miscarriage. Miscarriages may also be more common if the father is older.
Antiphospholipid syndrome (APS- a syndrome that makes your blood more likely to clot) is uncommon but is a cause of recurrent miscarriage and late miscarriage.
Thrombophilia (an inherited condition that means that your blood may be more likely to clot) may cause recurrent miscarriage and in particular late miscarriages.
Genetic factors, about 2 5 in 100 couples (2 5%) with recurrent miscarriage, one partner will have an abnormality on one of their chromosomes (the genetic structures within our cells that contain our DNA and the features we inherit from our parents). Although this may not affect the parent, it can sometimes cause a miscarriage
Weak cervix is known to be a cause of miscarriage from 14 to 23 weeks of pregnancy. This can be difficult to diagnose when you are not pregnant. It may be suspected if in a previous pregnancy your waters broke early, or if the neck of the womb opened without any pain.
Developmental problems of the baby may lead to a miscarriage but are unlikely to be the cause of recurrent miscarriage.
Infection that makes you very unwell can cause a miscarriage. Milder infections that affect the baby can also cause a miscarriage. The role of infections in recurrent miscarriage is unclear.
An abnormally shaped uterus may contributes to recurrent miscarriage or late miscarriages. However, minor variations do not appear to cause miscarriage.
Diabetes and thyroid problems can be factors in miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control.
It has been suggested that some women miscarry because their immune system does not respond to the baby in the usual way. This is known as an alloimmune reaction. There is no clear evidence to support this theory at present. Further research is needed.
Are there any other risk factors?

Being overweight increases the risk of miscarriage. Smoking and too much caffeine may also increase the risk. Excessive alcohol is known to be harmful to a developing baby and drinking five or more units a week may increase the risk of miscarriage.

The chance of a further miscarriage increases slightly with each miscarriage. Women with three miscarriages in a row have a 4 in 10 chance of having another one. This means that 6 out of 10 women (60%) in this situation will go on to have a baby next time. 

Why are investigations helpful?

Finding out whether there is a cause for your recurrent miscarriage or late miscarriage is important as your doctor will be able to give you an idea about your likelihood of having a successful pregnancy. In a small number of cases there may be treatment available to help you.

What investigations might be offered?

Blood tests:

For APS- APS is diagnosed if you test positive on two occasions 12 weeks apart, before you become pregnant again.
For thrombophilia- If you have had a late miscarriage you should be offered blood tests for certain inherited thrombophilias.
To check you and your partner s chromosomes for abnormalities. You may be offered this test if your baby has been shown to have abnormal chromosome
Tests for abnormalities in the baby You should be offered tests to check for abnormalities in your baby s chromosomes. This is not always possible but may help to determine your chance of miscarrying again. If you have had a late miscarriage you may also be offered a postmortem examination of your baby. This will not happen without your consent and you will have the opportunity to discuss this with your health team beforehand.

Tests for abnormalities in the shape of your uterus. You should be offered a pelvic ultrasound scan to check for any abnormalities in the shape of your uterus. If an abnormality is suspected, further investigations may include a hysteroscopy (a procedure to examine the uterus through a small telescope which is passed through the vagina and cervix) or a laparoscopy (a procedure in which a surgeon uses a fine telescope to look inside the abdomen and pelvis).

Tests for infection. If you have had a late miscarriage, tests such as blood samples and vaginal swabs may be taken at the time to look for any source of infection.




What are my treatment options?

Treatment for APS

If you have APS and have had recurrent miscarriage or a late miscarriage, treatment with low-dose aspirin tablets and heparin injections in pregnancy increases your chance of having a baby. Aspirin and heparin make your blood less likely to clot and are safe to take in pregnancy.

Having APS means you are at increased risk of complications during pregnancy such as pre-eclampsia, problems with your baby s growth and premature birth. You should be carefully monitored so that you can be offered treatment for any problems that arise.

Treatment for thrombophilia

If you have an inherited tendency to blood clotting (thrombophilia) and have had a miscarriage between 12 and 24 weeks of pregnancy, you should be offered treatment with heparin. At present there is not enough evidence to say whether heparin will reduce your chance of miscarriage if you have had early miscarriages (up to 12 weeks of pregnancy). However, you may be still offered the treatment to reduce the risk of a blood clot during pregnancy.

Your doctor will discuss what would be recommended in your particular case.

Referral for genetic counselling

If either you or your partner has a chromosome abnormality, you should be offered the chance to see a specialist called a clinical geneticist. They will discuss with you what your chances are for future pregnancies and will explain what your choices are. This is known as genetic counselling.

Monitoring and treatment for a weak cervix

If you have had a miscarriage between 14 and 24 weeks and have a diagnosis of a weak cervix, you may be offered an operation to put a stitch in your cervix. This is usually done through the vagina at 13 or 14 weeks of pregnancy under a general or spinal anaesthetic. Your doctor should discuss the surgery with you.

If it is unclear whether your late miscarriage was caused by a weak cervix, you may be offered vaginal ultrasound scans during your pregnancy to measure the length of your cervix. This may give information on how likely you are to miscarry. If your cervix is shorter than it should be before 24 weeks of pregnancy, you may be offered an operation to put a stitch in your cervix.

Surgery to the uterus

If an abnormality is found in your uterus, you may be offered an operation to correct this.

Hormone treatment

Taking progesterone or human chorionic gonadotrophin hormones early in pregnancy has been tried to prevent recurrent miscarriage. More evidence is needed to show whether this works.

Immunotherapy

Treatment to prevent or change the response of the immune system (known as immunotherapy) is not recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and may carry serious risks (including transfusion reaction, allergic shock and hepatitis).

What if no cause is found?

Where there does not appear to be a cause for recurrent miscarriage or late miscarriage, there is currently no evidence that heparin and aspirin treatment reduces the chance of a further miscarriage. For that reason this treatment is not recommended in these circumstances.

What does this mean for us in the future?

You and your partner should be seen together by a specialist health professional. Your doctor will talk to you both about your particular situation and your likelihood of having a further miscarriage and a successful pregnancy. If a cause has been found, possible treatment options will be offered to you to improve your chance of a successful pregnancy.

For couples where no cause for recurrent miscarriage has been found, 75 in 100 (75%) will have a successful pregnancy with this care. It is worth remembering that the majority of couples will have a successful pregnancy the next time even after three miscarriages in a row.

Recurrent And Late Miscarriage - Tests & Treatment For Couples!

What is recurrent miscarriage?

If you have three or more miscarriages in a row, doctors call it recurrent miscarriage. If you have experienced recurrent miscarriage, your GP or midwife will refer you to a gynaecologist. Your gynaecologist will try to identify the reason for your losses.

Having miscarriage after miscarriage may leave you feeling utterly drained of hope. At times, it may be hard to keep trusting in the future. This experience affects every aspect of a woman s life from her mental and emotional health to her physical health and social well-being. 

If you can, try to draw comfort from the fact that most women who experience recurrent losses do go on to have a baby. This is especially the case if tests can find no reason for the losses. Six out of 10 women who have had three miscarriages will go on to have a baby in their next pregnancy.

Treatment of Recurrent Pregnancy Loss

Treatment for anatomic abnormalities of the uterus involves surgical restoration through removal of local lesions such as fibroids, scar tissue and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.

A thin endometrial lining has been shown to correlate with compromised pregnancy outcome. Often times this will be associated with reduced resistance to blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil (Viagra), Terbutaline and possibly aspirin.

Sildenafil (Viagra) Therapy Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.

Terbutaline this is a medication that relaxes the muscle in the uterine wall and so permits improved hormone delivery to the endometrium. The use of Terbutaline will often cause an increase in heart rate. It should not be prescribed to women who have irregular heart beats (arrhythmias), and women who have decreased cardiac reserve.

Aspirin this is an antiprostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81mg orally, daily from the beginning of the cycle until ovulation.

Selective Immunotherapy Using Intralipid, heparin, aspirin and corticosteroid

Many causes of pregnancy loss or failure can be treated with immunotherapy comprising combinations of aspirin and heparin and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate increased NKa. Achievement of optimal success with Intralipid/corticosteroid therapy requires that the treatment be initiated well before ovulation takes place (about 7-14 days prior to anticipated implantation). Given the fact that only 10-15% of natural cycles (with or without the use of insemination and/or fertility drugs) will result in a pregnancy, it follows that repeated administration of Intralipid will be required in most cases before a pregnancy will occur. IVF achieves pregnancy rates that are often 2-3 times higher. This often makes IVF a treatment of choice in cases of immunologic recurrent pregnancy loss.

Role of IVF

Preimplantation genetic diagnosis (PGD) a procedure whereby the embryo can be tested for genetic or structural chromosomal abnormalities requires the use of IVF to select the best embryo(s) for transfer to the uterus. In cases of structural chromosomal (translocations) egg or sperm donation is often another option worth considering.

In those cases where due to intractable anatomical or alloimmune dysfunction IVF repeatedly is unsuccessful or is not an option, Gestational Surrogacy might represent the only recourse other than adoption.
If a couple with Recurrent Pregnancy Loss is open to all of the diagnostic and treatment options referred to above, a live birth rate of 70%   80% is ultimately achievable.

Recurrent Miscarriage - How to Deal With It?

Do you know about the various signs and symptoms that indicate a miscarriage? Miscarriage refers to pregnancy, which ends on its own, within 20 weeks of gestation. Miscarriage is a matter of great loss and grief for pregnant women. It accounts for being the most common form of pregnancy loss. According to studies, almost 10% to 25% of pregnancies result in a miscarriage. Chemical pregnancies are likely to be responsible for almost 50% to 70% of miscarriages.

Causes of miscarriage

The causes of miscarriage vary from one woman to another and in many cases the exact cause is not identified.
During the first trimester of pregnancy, chromosomal abnormality is the most common cause of miscarriage. It signifies some problem with your baby s chromosomes. Most cases of chromosomal abnormalities occur because of damaged eggs and sperm cells.
A certain problem which appears after the zygote goes through divisional procedures may also be responsible for a miscarriage.
Other causes for miscarriage include the following:

Hormonal imbalance, maternal health complications, and infections
Several habits such as smoking, malnutrition, excessive caffeine consumption, drug abuse, and exposure to toxic substances
Maternal age
Maternal trauma
When implantation of the egg in the uterine lining occurs improperly
Warning signs of miscarriage
There are several warning signs of miscarriage. The most important of them are as follows:

Back pain, which can vary from being mild to fatal. This pain can be even worse than menstrual cramps.
Loss of weight
Discharge of mucus that is whitish pink in color
True contractions are likely, in which pain occurs after every 5 to 20 minutes.
Bright red or brown bleeding with or without the presence of cramps may indicate a miscarriage.
Passage of tissue with a cloth material from your vagina.
Sudden reduction in the signs and symptoms of pregnancy
Chances of miscarriage
There are certain factors, which indicate whether you are likely to have a miscarriage. They are as follows:

Increase in your maternal age increases the chances of a miscarriage.
Women who are in between the age of 35 to 45 are at a higher chance of miscarriages than women who are relatively young. In women above the age of 45, the chances of miscarriage are maximized.
A woman having a miscarriage in the past has more chances of having another miscarriage.
In case you experience some or any one of these symptoms, it is important for you to seek professional health care as you need to evaluate whether you are having a miscarriage or not.


How To Know If You Are At Risk Of Having A Miscarriage?

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