Repeated (Recurrent) Miscarriages and Further Investigation

Repeated Miscarriages are one of the most disappointing experiences a couple can have when trying for a baby. In most cases, especially if the miscarriages occur during a natural pregnancy, patients may believe that this is a normal phenomenon and they should keep trying. We have treated many patients who had experienced more than 10 miscarriages when trying for a baby without receiving proper support or information from their health care provider.

Repeated miscarriages can be labeled as such if the patient has had three or more consecutive miscarriages. Having had only one miscarriage will not call for additional testing and investigation as that is something a large number of women experience at one point during their lifetime and it has been shown that women who have a single miscarriage will go on to have a healthy full-term pregnancy afterwards. However, if the patient keeps having miscarriages one after another, there is usually a medical condition behind it which needs to be investigated.

One of the first things that needs to be established is when the patient is experiencing her miscarriages. Certain times of gestation may point to different underlying causes behind the patient's miscarriages. If the patient has experienced her pregnancy losses after 12 weeks of gestation, then there is a high likelihood of cervical incompetence as the underlying cause. Cervical incompetence can be diagnosed through testing when the patient is not pregnant or via close monitoring during pregnancy.

When the patient experiences her miscarriages earlier on, during the first trimester, then other possible problems are accentuated. For instance, genetic problems with gametes (sex cells) could be one problem. Also, the couple may have chromosomal problems that show no symptoms but cause problems during reproduction (such as reciprocal translocations). Alternatively, thrombophilic defects that cause clotting problems are one of the main factors behind first trimester pregnancy losses.

A number of precautionary measures can be taken prior to or during your pregnancy in order to minimize the risk of yet another miscarriage. However, the underlying reasons must be well investigated and understood so that appropriate measures can be taken. For more information, please visit our website.

Repeated (Recurrent) Miscarriages Further Investigation

Repeated (Recurrent) miscarriage is defined as the loss of three or more pregnancies. If you have experienced a single pregnancy loss, the odds are, you are not likely to have another miscarriage. However, if miscarriages are recurrent and are experienced in similar time frames of a pregnancy, further investigation will be needed. Recurrent miscarriages can have many possible causes. When a patient experiences several miscarriages, then it will make sense to get evaluated for the conditions below:

1- Genetic Factors
All couples with a history of recurrent miscarriage should have peripheral blood karyotyping performed. The finding of an abnormal parental karyotype will necessitate consultation with a geneticist. Certain genetic abnormalities can be screened for through PGD testing while others might require alternative avenues.

2- Cervical Weakness
This is a known anatomical cause of recurrent miscarriages. The cervix (or neck of the womb) is normally strong enough to remain closed throughout the course of pregnancy, in spite of the ever-increasing size and weight of its contents. In fact, it remains strong throughout pregnancy and near the time of labor, special hormones are released to make it softer so that it is dilated enough for a successful baby delivery. With an incompetent cervix, the cervix is anatomically weak, making it unable to carry the baby. Typically, miscarriage caused by an incompetent cervix occurs between sixteen and twenty-four weeks of gestation.

3- Endocrine Factors
The term endocrine hormonal factor in infertility refers mainly to the absence of ovulation, which results in disorders of the menstrual cycle (oligomenorrhoea, primary or secondary amenorrhea) and less commonly to the condition of luteinized unraptured follicle. In cases of oligomenorrhoea or amenorrhea satisfactory results can be achieved with conventional ovulation induction methods, avoiding the use of assisted conception techniques.

4- Immune Factors
These can include Antithyroid antibodies, Antiphospholipid syndrome, Alloimmune factors. There are tests that can be administered. In some cases, we find that suppressing your immune system response around the time of embryo transfer reduces the likelihood of an implantation failure and a very early miscarriage. 

5- Infective Agents
TORCH (toxoplasmosis, other [congenital syphilis and viruses], rubella, cytomegalovirus and herpes simplex virus) screening is unhelpful in the investigation of recurrent miscarriage. These infection diseases can cause implantation failures, therefore, IVF failures as well as pregnancy losses after implantation has occurred. Having tested for infectious diseases will rule out this possibility.

6- Inherited Thrombophilic Defects
Inherited thrombophilia defects, including activated protein C resistance (most commonly due to factor V Leiden gene mutation), deficiencies of protein C/S and antithrombin III, hyperhomocysteinaemia and prothrombin gene mutation, are established causes of systemic thrombosis. A thrombophilia gene panel needs to be evaluated to make a diagnosis.


www.donasyon.net
www.lowcostivf.net
www.northcyprusivf.com
www.gender-selection-ivf.co.uk
www.egg-donor-ivf.co.uk