Recurrent Miscarriage—defined as two or more consecutive pregnancy losses—affects approximately 1-2% of women. In India, however, the prevalence is reported to be as high as 7.4%. While the experience is psychologically profound, it is important to know that with proper investigation, the chances of a future successful live birth remain very high.

Understanding Risk Factors

We categorize risk factors into two groups: those we can change (Modifiable) and those we must manage clinically (Non-Modifiable).

Essential Investigations

A systematic workup is key to identifying correctable causes:

• Genetic Testing: Parental Karyotyping helps identify balanced translocations. Array CGH is recommended for testing products of conception.
• Anatomical Screening: 3D Transvaginal Ultrasound is the gold standard for detecting uterine defects.
• Thrombophilia (APS): Screening for Antiphospholipid Syndrome (Lupus anticoagulant, Anti-cardiolipin) is mandatory after two losses.
• Endocrine Check: Thyroid (TSH and TPO-antibodies) and Prolactin testing.

Management & Treatment Options

Treatment at Talwar Fertility is tailored to the specific diagnosis:

The Role of Supportive Care

Perhaps the most important “treatment” for unexplained RPL is Supportive Care (Tender Loving Care). Studies show that couples who receive psychological support and frequent monitoring in a dedicated clinic have significantly higher success rates in their next pregnancy.

Adenomyosis is often called the “sister” of endometriosis, where the endometrial glands grow into the muscular wall (myometrium) of the uterus. While it often results in a “globular” or enlarged uterus, accurate diagnosis requires advanced imaging like 3D Ultrasound and sometimes MRI.

3D Ultrasonography & Junctional Zone

3D sonography is a game-changer for identifying the Junctional Zone (JZ)—the inner layer of the myometrium. On a coronal view, we look for:

• An ill-defined or distorted junctional zone.
• Infiltration of the hypoechoic inner myometrium.
• Localised or diffuse thickening of the transition zone (the hypoechoic halo).

Specific Sonographic Signs

At Talwar Fertility & Child Health Centre, we look for these specific “fingerprints” of adenomyosis during your scan:

The Role of Colour Doppler

Unlike fibroids which often have a clear circular blood supply, Adenomyosis shows diffuse hypervascularity throughout the stroma. Colour Doppler helps us identify these intramural cysts and distinguish them from other uterine masses.

MRI: When Do We Need It?

MRI is an excellent confirmatory tool. The key MRI criteria for adenomyosis include:

• Increased JZ Thickness: A junctional zone thickness of ≥12 mm (or 0.15 mm in specific T2 weighted sequences).
• Globular Enlargement: Uterine length often reaching up to 12 cm.
• High Intensity Spots: Diffuse widening of the JZ on T2 weighted images.

Impact on IVF

Adenomyosis can affect embryo implantation. Once we manage the condition and the follicles reach the optimal size (≥2 follicles over 18 mm), we proceed with a carefully timed HCG/GnRH trigger to ensure the best chances for IVF success in a receptive environment.