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Recurrent Miscarriage – Miscarriages are normal, happening in 15-20% of all pregnancies, typically in the 1st trimester (up to 13 weeks). One or even two miscarriages are not by themselves characteristic of future infertility. In any case, they may leave patients concerned and questioning their capacity to have a live birth1.

Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.

Types of Recurrent Miscarriage

There are numerous reasons for miscarriage, yet they are normally divided into two categories: early and late.

Recurrent early miscarriage (within the first trimester) is mostly because of hereditary or chromosomal issues of the embryos, with 50-80% of unconstrained losses having anomalous chromosomal number. Basic issues of the uterus can also play a part in early miscarriage.

Recurrent late miscarriage can be the consequence of uterine variations, immune system issues, an incompetent cervix, or premature labor.

Causes of Recurrent Miscarriage

Known causes of recurrent miscarriage include the following:

Genetics: A genetic issue with a developing embryo or a genetic condition that influences one or both the two parents may cause recurrent miscarriages.

Conditions influencing the uterus: The cycle of implantation is hormonally managed and requires a synchronized communication between the embedding embryo and the lining of the woman’s uterus (endometrium). Factors that change this relationship cause pregnancy loss.

Antibodies including lupus anticoagulant (LAC), anticardiolipin antibodies (ACA), and beta-II-glycoprotein antibodies are believed to promote miscarriage by causing clotting in the early placental circulation or by preventing optimal implantation. Treatment involves the use of low dose aspirin and other anti-clotting medications.

Other causes include:

  • Environmental factors
  • Infections
  • Hormonal disorders
  • Clotting disorders
  • Male factors

Diagnosis

Depending on the cause diagnosis for recurrent miscarriage can be done by the following:

Testing for uterus problems-
  • Hysterosalpingogram (HSG)
  • Hysteroscopy
  • Transvaginal Ultrasound
  • Endometrial Biopsy
Blood Tests-
  • Lupus Anticoagulant Antibodies
  • Anticardiolipin Antibodies
  • Prothrombin time and Activated Partial Thromboplastin Time
  • Thyroid Panel

Fetal Tissue Karyotyping

Treatment

Although the diagnosis can be frustrating, treatment options to lower the risk of miscarriage are available. These options include:

  • Ovulation induction.
  • Progesterone therapy.
  • Low dose aspirin.
  • Injectable blood thinners.
  • Antibiotics for presumed chronic inflammation of the uterus.
  • In vitro fertilization.
  • Pre-implantation Genetic Testing for Aneuploidy (PGT-A).
  • Intracytoplasmic sperm injection (ICSI) with the assistance of the ZyMotTM device.