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Overview

Recurrent Pregnancy Loss: Treatment, Procedure, Cost And Side Effects

What is Recurrent Pregnancy Loss? How is the Recurrent Pregnancy treatment done ? Who is eligible for the treatment of Recurrent Pregnancy ? Who is not eligible for the treatment? Are there any side effects? What are the post-treatment guidelines? How long does it take to recover? What is the price of the treatment in India? Are the results of the treatment permanent? What are the alternatives to the treatment?

What is Recurrent Pregnancy Loss?

Recurrent Pregnancy Loss is a situation wherein there have been 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period for a woman. Recurrent Pregnancy Loss can occur in women for a variety of reasons. The various reasons can be genetic factors, due to auto immune reaction, due to infections, due to endocrine factors, and other unexplained factors which can be thrombophilias, environmental factors etc. The treatment varies depending on the factor of the recurrent pregnancy loss and shall differ according to the severity.

From various studies it is found that the major reasons impacting the recurrent pregnancy losses are as follows:

  1. Approximately 2% to 4% of RPL is associated with a parental balanced structural chromosome rearrangement,
  2. Anatomic abnormalities account for 10% to 15% of cases of recurrent pregnancy loss and are generally thought to cause miscarriage by interrupting the vasculature of the endometrium, prompting abnormal and inadequate placentation. Some of these abnormalities are congenital uterine anomalies, intrauterine adhesions, and uterine fibroids or polyps.
  3. The endocrinologic disorders account for approximately 17% to 20% of recurrent pregnancy loss. Some of these include Luteal phase defect (LPD), polycystic ovarian syndrome (PCOS), diabetes mellitus, thyroid disease, and hyperprolactinemia.
  4. Certain infections, like Listeria monocytogenes, Toxoplasma gondii, rubella, herpes simplex virus (HSV), measles, cytomegalovirus, and coxsackieviruses, are known or suspected to play a role in recurrent pregnancy loss.
  5. Inherited/acquired thrombophilias, Autoimmune infections, environmental factors like drinking and smoking, lifestyle stress etc. also result in recurrent pregnancy loss.

The treatment for the recurrent pregnancy loss can involve a range of options including careful monitoring and pre-natal care, surgery, hormone therapy, antibiotics and the use of procedures such as in vitro fertilization etc. and it depends on the patient condition and the factor responsible for the recurrent pregnancy loss.

How is the Recurrent Pregnancy treatment done ?

The treatment for the recurrent pregnancy loss varies from situation to situation of the patient and on the causing factor. The patient reports the doctor who then carries out numerous examinations to diagnose the root cause of the disease. The examinations may include, blood tests for antibodies test, glucose screening, hormone levels etc, urine test, genetic profiling, CT-scan, ultrasound etc. After the examination the available options includes the following:

  1. Lifestyle change: One of the most easily corrective reasons is lifestyle change. Drinking excessive alcohol or smoking and lack of proper vitamins and exercise can be one of the major reasons for the miscarriages. So, this can be treated simply by avoiding drinks and smoking and having a balanced diet and proper workout schedules.
  2. In Vitro Treatment: If the reason is some complications related to the uterus reshaping then the mode of treatment includes two methods. One is the In Vitro Treatment with a pre-implantation genetic diagnosis that is the profiling of the embryo prior to the implantation. It is similar to prenatal profiling. In the process of In Vitro Treatment the female is given drugs so that she produces multiple eggs per month. These eggs are taken out of her body and freeze. Then the male sperms are collected in the form of semen. Both the eggs and the sperms are together fused in the laboratory to form a zygote. When the embryo is clinically checked completely then it is transferred to the womb surgically.
  3. Hysteroscopy : This is a minimal invasive surgery in which all the equipment’s and tiny camera for the surgery are inserted through the vagina only. A hysteroscopy passed through the vagina to repair the inside of the uterus. General anaesthesia is administered to the mother and then the hysteroscopy is inserted into the uterus with the NaCl solution or the Sorbitol solution. After the inspection of the uterine cavity, several other instruments are also inserted through the hysteroscopy to help treat the fibroids, heavy menstrual bleeding and polyps that may affect the positioning of the baby in the uterus.
  4. Medication: Various medications are provided based on the condition like:
    • Women with diseases like thyroid dysfunction, blood pressure misbalance or diabetes have to take proper medications to keep the levels within range.
    • Women with PCOS are required to be administered Metformin drug regularly so that the harm to the embryo is least. If women have some endometric infections then the required antibiotics are administered for the underlying infection.
    • Mothers who have issues like thrombophilia can be administered aspirin and heparin in small quantities only. A drug is being worked upon by the companies named NT 100 which is proven to help in conceiving after multiple miscarriages. The drug NT 100 is administered orally or through injections to the mothers twice a day or as prescribed by the physician according to the severity of the miscarriage. The results are visible after regular intake in about 10 to 15 days.
    • In the rarest of rare case of the luteal phase defect which is treated by giving progesterone supplementations.
  5. Genetic counselling: In very rare cases of about 5% couples with recurrent pregnancy loss, one of the parent suffers from a translocation(rearrangement) in their chromosomes. If at the time of fusion this imbalance occurs then the foetus is likely to miscarry. The Genetic Counselling is the best solution for this.

Who is eligible for the treatment of Recurrent Pregnancy ?

Pregnant women may have a miscarriage once or twice in multiple pregnancies. These miscarriages may happen for several reasons. Having a miscarriage once does not mean that the mother will surely have another pregnancy loss if she gains a baby again. If the woman has consecutive miscarriages within 18 to 20 weeks of conceiving for about two to three consecutive times then they should diagnose the cause and get treatment of recurrent pregnancy loss.

Who is not eligible for the treatment?

Womens who are able to get pregnant with no issues and are thus not having any pregnancy loss especially the consecutive pregnancy loss are not eligible for the treatment.

Are there any side effects?

Different treatments may have different side effects as well. Consumption of the drugs for treatment may lead to common everyday problems like aching bones and muscles, diarrhea, constipation, hair loss, headaches nosebleeds and tiredness in the body. At times some severe side effects are also seen like irregular heartbeat, bloody urine, bloody vomit and bruising.

Hysteroscopy may not have any major concerns but it may leave pain in the vagina for a few hours and may widen the hole. The blood-thinning medicines will increase the chances of serious bleeding problems like stomach ulcers and may lead to heavy loss of blood even in minor cuts.

In case of In Vitro Fertilizations, some complications like that of multiple births that may occur due to multiple transfers or spread of some infectious diseases through the birth canal like Hepatitis or AIDS may occur. Also, rare risk of Ovarian Hyperstimulation Syndrome may occur. Other side effects include bloating, cramping, constipation, breast tenderness, pelvic pain, vaginal bleeding, blood in urine and mood swings.

What are the post-treatment guidelines?

All the surgical treatments require a proper bed rest of about a week or maybe more. A good nutritious diet must be taken for the health and well being of the mother and the baby. Also, there must be a reduction in the physical and mental exertion on the body because it may affect the hormones injected into the body and may nullify their effect.

How long does it take to recover?

The treatment recovery time varies from the patient condition to condition and differs from the mode of the treatment opted for the patient. Surgeries are mostly a one-day procedure so the recovery time is about a week or a fortnight. This time is just the time taken by the physical cuts and stitches to recover. The effects of the hormones ingested will take about three to four months to be back to normal. Proper water intake and light workout sessions with some meditation for peaceful body and mind will also aid to the recovery. Some medications like NT100 if taken in large quantities for a long time may give a permanent effect on the body and may not revert back to the original conditions. In such conditions, consultation with a doctor is a must.

What is the price of the treatment in India?

The cost of the NT 100 drug is about 4000 rupees for a packet which is quite expensive. Also, the drug has to be administered for about 3 to 4 months so will be a little too much for a common person to spend on. The cost of hysteroscopy ranges from 54,000 to 2,45,000 depending upon the complexity of the operation and the deformation in the uterus.

For a single session of IVF Treatment, the average cost is approximately Rs.2,50,000. Though the cost is not fixed it may go up higher to about Rs. 4,50,00 for a single cycle. Also, the costs of the treatment will also have additional charges of blood tests and pregnancy tests to be done worth Rs.70,000 to Rs. 90,000. In India, Mumbai has the highest cost of the IVF treatment with a basic cost of 2,00,000 to 3,00,000 and the least being in Kolkata of about 65,000 to 80,000. If the couple requires donor eggs or donor embryos the costs can be added up with about 30,000 to 55,000.Even when in 6 couples, 1 couple requires IVF then too the costs are very high for the general public to afford.

Are the results of the treatment permanent?

The results of surgeries are found to be quite everlasting in IVF treatments but in the case of hysteroscopy are not sure to be permanent because uterus may again get deformed in childbirth or polyps and fibroids may grow again. As far as the intake of drugs is concerned their effects remains until a limited time span of intake and then get back to normal again.

What are the alternatives to the treatment?

The alternative to all these surgeries and expensive treatments that can loosen your pockets is adoption. Adoption may not only give the couple a child but a kid his parents back. This is also an ecologically sustainable way that will help to maintain the overall world population.

After critically analyzing the causes, treatments and alternatives of recurrent pregnancy loss it is clear that the treatment requires the women who is trying to conceive to be cautious, maintain god health diet and have moral support. Such recurrent losses can be stressful and can leave a trauma. It may add to a lot of physical exertion on the body of the mother too. The alternative of adoption is a way better method as it gives an orphan a family and a couple a child.

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MBBS,MS - Obstetrics and Gynaecology
Gynaecology
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