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?

Miscarriage refers to the spontaneous loss of the fetus before one completes the 20th week of pregnancy, taking into account the period from the conception to gestation.  It usually happens in the first trimester of the pregnancy; that is within the seventh and the twelfth week of conception. Recurrent miscarriage is when one suffers from multiple miscarriages in a row.

Possible Causes:

Abnormally-shaped Uterus: Some miscarriages, particularly late ones, are thought to happen because the uterus (womb) has an abnormal shape.
Polycystic Ovary Syndrome (PCOS): Women with this condition have many small cysts in their ovaries.They also tend to have hormonal problems, including high levels of insulin and male hormone in the blood, which can lead to recurrent miscarriage.
Infection: Some serious infections can cause or increase the risk of single miscarriages. These include toxoplasmosis, rubella, listeria and genital infection. But it is not clear whether infection plays a role in recurrent miscarriage.
Diabetes and Thyroid Problems: Uncontrolled diabetes and untreated thyroid problems can cause miscarriage. But well-controlled diabetes and treated thyroid problems do not cause recurrent miscarriage.
Risk Factors:
Your risk of recurrent miscarriage is higher if:

you and your partner are older; the risk is highest if you are over 35 and your partner over 40; 
you are very overweight. Being very underweight may also increase your risk.
Each new pregnancy loss increases the risk of a further miscarriage. But even after three miscarriages, most couples will have a live baby next time.

Testing After Recurrent Miscarriage:

If you have had three miscarriages in a row, you should be offered tests to try to find the cause. This should happen whether or not you already have one or more children. Testing is not usually offered after one or two early miscarriages (up to 14 weeks) because these are often due to chance. But you might be offered tests after two early miscarriages if you are in your late 30s or 40s or if it has taken you a long time to conceive.
If you had a late (second trimester) miscarriage, where your baby died after 14 weeks of pregnancy, you should be offered tests after this loss.

You can opt for blood tests to check for sticky blood syndrome or APS. Tests would look for antibodies that would help treat the condition. Antibodies are chemicals produced by the body to combat infections.
Get an examination done should the doctor suspect chromosomal abnormalities and in case it is diagnosed, both of you can consult a clinical genetics specialist for genetics counseling.
Your doctor will recommend an ultrasound scan to trace any type of abnormality that may make a pregnancy futile, for instance, a short or a fragile cervix.
Your hopes:

It is natural to pin your hopes on testing as the answer to your problems. But there are three reasons why it may not be the answer you re looking for:

A cause may not be found; when this happens your miscarriages are called  unexplained 
Even if a cause is found, it may not be treatable;
Treatment may not lead to a successful pregnancy. This can happen if a pregnancy miscarries for a different reason than the one being treated.

Understanding Miscarriages

Recurrent pregnancy loss is termed as the occurrence of three or more miscarriages. Recently, the American Society for Reproductive Medicine has altered the definition and limited the number of miscarriages to two. A pregnancy loss can only be termed so if the pregnancy is clinically recognized and is ends involuntarily before 20 weeks. The pregnancy loss must be identified by a registered doctor to term it as pregnancy loss.

What are the major causes of Recurrent Pregnancy Loss?
There could be a lot of reasons behind recurrent pregnancy loss. Most of the pregnancy failure happens from reasons such as abnormalities of the genes, chromosomes and other random events. It is estimated that close to 15 percent of the pregnancies end up in miscarriages. While 30-60 percent of the pregnancies expire within the first 12 weeks, fifty percent of the women are believed to be not aware of the pregnancy in the first place. The risk of miscarriage, however, is less than 50 percent.

An advanced maternity age is another crucial factor towards recurrent 2pregnancy loss. The risk of miscarriage dramatically increases among these women owing to their poor quality of egg, abnormalities in the chromosome etc. At a time, it has been observed that either the father or the mother might have irregularities in the gene leading to early miscarriage.

An abnormality in the uterus might also be a reason for a miscarriage. Poor blood supply and inflammation of the uterus are two of the topmost reason for miscarriages among many women. While some women born with a defective uterus, some develop uterus anomalies due to lifestyle and unhealthy life practices.

Last but not the least, a woman s immune system might also play a pivotal role towards a miscarriage. Certain hormonal irregularities, diabetes and thyroid diseases might lead to a miscarriage. Then there are the environmental factors such as stress, occupational factors, lifestyle practices etc that contributes towards a miscarriage.

What are the tests conducted?
To evaluate the exact reason for repeated miscarriages, a doctor performs a detailed physical and surgical examination. Some other areas where a doctor sneaks into include family history, genetic history etc. A karyotype test might also be prescribed in case a doctor feels the need of doing so. The uterus cavity and the uterus are closely monitored to understand any potential lack in the anatomy. This is followed by a list of imaging tests that a doctor might prescribe. These include MRI, X-ray, hysteroscopy etc.

What are the treatment options?
The treatment options are decided based on the finding of the tests. Sometimes plain medicines along with antibiotics can cure the condition, while sometimes surgery might be required to fix any potential threat within the uterus. In any case, the probability of future pregnancy after treatment goes as high as 77 percent.


Recurrent Pregnancy Loss - Things You Should Avoid!

What is Miscarriage?

Miscarriage is defined as the spontaneous loss of the foetus before it is able to survive on its own outside the womb. Miscarriage usually occurs within the first trimester of the pregnancy. It is a very common complication in early pregnancies.

Miscarriage can be a common complication, but it can have devastating effects on the minds of the parents.

Signs and Symptoms of Miscarriage:

The most common visible signs are slight to heavy bleeding from the vagina. But the other common symptoms are:

Dizziness, light-headedness

Discharge from the vagina

Tissue discharge from the vagina

Cramping and pain in the abdomen

It is advised to go visit your doctor if you experience any of the above signs and symptoms.

What causes a miscarriage?

Chromosomal Abnormalities: A lot of miscarriages are caused due to mismatched chromosomes. Some women who have experienced miscarriage over two times may learn through tests that there are chromosomal abnormalities that may not affect them but prevent them from getting pregnant.

Abnormalities in the Uterus: Sometimes, the uterus may be too hostile to house a foetus. It can be a genetic disorder or a non-genetic disorder like fibroids or cysts that can lead to a spontaneous abortion.

Hormones: Low levels of progesterone in the body can lead to problems with implantation of the foetus.

Obesity: Studies have shown that every 1 in 4 women who are obese before the conception lose the foetus to spontaneous abortion.

Drugs and Toxins: Consuming alcohol or smoking during the pregnancy is seen to increase the risk of miscarriages manifold. Also, women who are exposed to toxins present in plastic such as Bisphenol A are seen to undergo miscarriage more often than women who are not exposed to such toxic substances. Coffee can be consumed in moderate levels during pregnancy.

Infections: Infections including Mycoplasma can infect the uterine lining and unknowingly cause complications such as miscarriage. Women who have undergone multiple gynaecologic procedures are seen to be at increased risks.

Diabetes: When the diabetes becomes uncontrolled, it can increase the risks of miscarriage.

7 Most Common Causes Of Miscarriage

Miscarriages are quite common these days. Couples who experience miscarriage have to go through an emotional trauma. They feel frustrated because of doubts and many unanswered questions along with the emotional trauma they face. While some women feel that they are a failure after experiencing a miscarriage, some others feel extremely guilty about it. Therefore, it is very important for couples to know about miscarriage. 

Here are the six most frequently asked questions about miscarriage that you must know:

How common is it for a miscarriage to happen?

This is definitely one of the most asked questions about miscarriage. According to most doctors, miscarriage is quite common. Unfortunately, one in four pregnancies can end in miscarriage. Therefore, everyone knows someone who has suffered a miscarriage.

What can be the symptoms of miscarriage?
This is the 2nd most common question asked about miscarriage. The symptoms of miscarriage vary from person to person. For most women, the symptoms noticed are bleeding and pain. As the pregnancy advances, more pain and more bleeding are noticed. The pains are similar to extremely bad menstrual cramps. However, doctors also agree that if a woman experiences some bleeding, it doesn t always imply that a miscarriage can happen.

What are the causes of miscarriage?
A woman s age is linked to miscarriage. If a woman is over 35, the risk of miscarriage rises. This is because cells do not divide properly as women age. The DNA of a man can also play a role in miscarriage.

How do doctors treat miscarriage?
About 75 % of miscarriages occur after the embryo gets embedded into the uterus. No treatment is required for this kind of miscarriage. Most miscarriages happen during the first 12 weeks of pregnancy. These miscarriages can be resolved through medication or surgery. The miscarriages that occur after the 12 weeks can be extremely traumatic for women.

What is the biggest misconception of miscarriage?
The most common misconception of miscarriage is that it can happen due to activities like exercise and sex.

What can be done to prevent a miscarriage?
People often ask this question to their doctors. Although there is no particular way to prevent a miscarriage, people should maintain a healthy lifestyle during pregnancy. Obesity, smoking and drug use can enhance the risk of miscarriage, and hence they should be avoided. 

Aforementioned are the six most asked questions about miscarriage. You should always talk to your doctor, if you face any complications or problems during pregnancy. It is important to clear your doubts about miscarriage. You should also try your best to maintain a healthy lifestyle.

Miscarriage - 6 Common Questions That Are Asked?

It's normal to be concerned with your fertility after early miscarriage. Many couples want to try to conceive again right away, while others need time to heal. Ultimately, though, fertility following a miscarriage is an issue of concern for most couples.

Once you are ready to start trying for a child again, there are a number of things you can do to increase your chances of having a successful pregnancy.

Rest and Recuperate- Many women want to hurry and start trying to get pregnant again right away after their miscarriage. This is a perfectly normal response, but may not be the best way to guarantee a healthy pregnancy. Give your body a chance to rest so your menstrual cycle can get back to normal. You also want to give yourself plenty of time for your mental balance to return so you are ready to take on the trials of trying to become pregnant. Be gentle and give yourself time to rest and focus on taking care of your physical and emotional needs until you are ready to try again.
Change Lifestyle- Eliminating unhealthy habits can help increase your chances of conceiving later. Eliminate drug or alcohol use and quit smoking before you start trying for pregnancy. Cutting down or eliminating caffeine can also help you conceive a healthy pregnancy.
Eliminate Stress- Eliminating stress can also make conceiving easier. Stress can reduce fertility levels, making it harder to get pregnant. Practicing meditation, yoga or taking time to relax after dealing with tough issues in your life can make it much easier to conceive.
Eat Healthy- Eating a healthy diet is also essential to having a healthy pregnancy. This can also help women manage the depression caused by their miscarriage. Getting a variety of vitamins and minerals and cutting down on saturated fats and processed foods can help you get pregnant and maintain a healthy pregnancy.
Take Fertility Drugs or Therapies- There are various fertility drugs and therapies on the market today. Your doctor will prescribe different medications based on your overall health and age.
Use an Ovulation Predictor- An ovulation predictor can help you map out your cycle. This will allow you to determine which days in your cycle will be the most likely for you to conceive. 
Support the Uterus and Liver- Performing a fertility cleanse after your period has stopped can help support the uterus and liver, promoting overall fertility health. Sometimes stagnant blood can get left behind after your period which can cause discomfort or health issues. Following a fertility diet to help rid your body of the excess blood and hormones in your system can help your conceive more easily.
Massage the Uterus- When you have stopped bleeding after your miscarriage, performing a uterus massage can help your body relax. This massage will help bring fresh blood to the area and soothe the body so you can relax. 
If you have been having trouble conceiving it may be time to talk to a fertility expert. Your doctor can perform fertility tests on you and your partner to determine if there are any underlying issues present. Then you can work together to determine if any additional medical treatment is necessary to help you get pregnant.

Ways to Increase Fertility after Miscarriage

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