Recurrent Pregnancy Loss: Causes and Treatments
For those looking to grow their family, pregnancy loss can be devastating and concerning. However, one miscarriage doesn’t necessarily indicate that something is wrong. Between 15-25% of pregnancies end in miscarriage, and many women are able to have successful pregnancies after a loss without intervention.
Recurrent pregnancy loss, on the other hand, can indicate the need for specialized testing and treatment. Learn about recurrent pregnancy loss, its causes, and treatment options that can improve the chances of successful pregnancy.
What is Recurrent Pregnancy Loss?
When a woman has 2 or more miscarriages before the pregnancies reach 20 weeks, this is considered recurrent pregnancy loss (RPL).
A miscarriage is classified as the loss of an implanted pregnancy. Implanted pregnancies are diagnosed through ultrasound during or after the first 5-6 weeks of pregnancy.
Biochemical pregnancies, which are seen through blood or urine tests before implantation occurs, can also end in loss. While diagnosis of RPL typically includes implanted pregnancies, a woman experiencing multiple biochemical pregnancy losses should still consider testing.
What Causes Recurrent Pregnancy Loss?
Recurrent pregnancy loss can be traced to a variety of causes. Identifying the underlying reason(s) helps in creating a treatment plan that leads to successful pregnancy.
Genetic Factors
Sometimes, one or both partners may carry a genetic variation or abnormality that increases the risk of pregnancy loss. Examples include:
Balanced translocation: a chromosomal abnormality that occurs when 2 chromosomes break and exchange segments
Aneuploidy: a genetic disorder characterized by an abnormal number of chromosomes in an embryo
Aneuploidy is common in recurrent pregnancy loss. The majority of miscarriages that happen in the first 10 weeks can be traced to aneuploidy.
Immunological Factors
Some autoimmune conditions can lead to miscarriage. For example, antiphospholipid syndrome (APS) is a rare autoimmune disorder that causes an increased tendency to form abnormal blood clots in the body. This can cause complications and pregnancy loss.
Endocrine Issues
Balanced hormone levels are critical for successful pregnancy. Hormonal imbalances that impact pregnancy outcomes include:
Thyroid dysfunction
Elevated prolactin levels
Overt diabetes (poorly controlled diabetes)
Structural Factors
Anything that structurally sits in the way of an embryo’s continued development can also lead to pregnancy loss or complications. Structural issues that can occur in the uterus include:
Uterine anomalies: malformation of the uterus
Uterine septum: a band of fibrous tissue that divides the uterus into 2 parts
Hydrosalpinx: fluid accumulation in the fallopian tubes
Fibroids and polyps: growth of muscle (fibroid) or lining (polyp) of the uterus that can interfere with implantation
Sperm Viability
Pregnancy loss is not always tied to egg quality, uterine health, or other health factors related to the partner who carried the pregnancy. Sperm quality is equally important. Abnormalities or sperm defects can contribute to recurrent pregnancy loss.
Testing for Recurrent Pregnancy Loss
The factors above often go undetected until pregnancy loss occurs. If you’ve experienced 2 or more pregnancy losses, different types of testing can help to uncover and treat the root cause.
Genetic Testing
Genetic testing is commonly used to improve pregnancy outcomes. Preimplantation Genetic Testing for Aneuploidy (PGT-A) can be used during IVF to reduce the chances of implanting aneuploid embryos.
Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR) can screen for embryos that have chromosomal rearrangements if either partner carries a balanced translocation.
Sperm Analysis
Sperm testing can identify abnormalities in sperm count and quality that could impact chances of successful pregnancy. A sperm DNA fragmentation index (DFI) evaluates sperm samples for DNA damage, which can occur as a result of health conditions or lifestyle factors.
Immunological and Hormonal Testing
Blood tests can check for many autoimmune or thyroid disorders, such as APS, diabetes, and other endocrine issues.
Uterine Imaging
Imaging is often used to detect uterine abnormalities like fibroids and polyps. Your doctor may recommend a pelvic ultrasound, hysterosalpingography (HSG), or hysteroscopy to diagnose structural factors that can cause pregnancy loss.
Treatment Options for Recurrent Pregnancy Loss
Once the reason for recurrent pregnancy loss has been found, a treatment plan can be made to improve chances of successful pregnancy. Treatment for RPL is tailored to address specific issues found through testing.
Treatment might include:
Surgery: If structural factors are found, surgery may be recommended. Issues like uterine septum, polyps, and fibroids can be resolved through minor procedures. Addressing these structural factors can help with embryo implantation.
Medical management: Hormonal issues and autoimmune disorders can often be treated or regulated with medication to improve the chances of carrying a pregnancy to term.
IVF with genetic testing: If chromosomal abnormalities are found, IVF with PGT-A testing can reduce the rate of miscarriage. This allows doctors to choose healthy (euploid) embryos, decreasing time to conception and reducing the risk of aneuploidy.
Lifestyle changes: In some cases, lifestyle factors for both partners can contribute to pregnancy loss. Smoking, alcohol use, recreational drug use, dietary factors, and exposure to toxins can be detrimental to the success of a pregnancy. Read about lifestyle changes that improve fertility.
Testing and treatment doesn’t completely eliminate the chances of miscarriage. But detecting and treating underlying issues greatly improves a person’s ability to carry a pregnancy to term.
Grow Your Family With Beverly Hills Reproductive Center
Many people go on to have healthy pregnancies after recurrent pregnancy loss with the right care.
If you’ve experienced recurrent pregnancy loss, consult with a fertility specialist who can guide you through testing and treatment options. Request a consultation with Dr. Lina Akopians to take the next step towards growing your family.