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Treating Recurrent Miscarriage

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A blog by Dr. Daniel E. Stein, RMA of New York, June 1, 2015

While the primary focus of a fertility and reproductive medicine practice is to help women conceive, a large percentage of the care that we provide is dedicated to helping women carry a pregnancy to term and deliver a healthy child. Recurrent miscarriage or pregnancy loss is defined as the loss of two or more pregnancies each up to 20 weeks gestation. These losses occur most commonly during the first trimester.

There are many possible reasons for recurrent pregnancy loss; however a specific cause is not identified in approximately 50% of cases. The most common causes of recurrent loss include:

  • Chromosomal abnormalities in one or both of the parents
  • Anatomic abnormalities of the uterus
  • Cervical incompetence
  • Blood clotting disorders
  • Endocrine (hormonal) disorders (e.g. thyroid disease and diabetes)
  • Infections
  • Stress and environmental factors
  • Autoimmune factors
  • Systemic diseases (e.g. Lupus)

Maternal age is a contributing factor to miscarriage – women in their late thirties and older have significantly higher miscarriage rates than younger women. The reason for advanced maternal age being a factor is that typically women of advanced reproductive age present a greater proportion of eggs that are chromosomally abnormal – such abnormalities have a negative impact upon the development of the embryos. The age of the male partner is also important as sperm, like eggs, can carry genetic abnormalities. Women aged mid to lower thirties with male partners in their mid-forties and older have a higher rate of miscarriages than women of this age range with younger male partners.

Although it is difficult to determine a cause in approximately half of recurrent miscarriages, couples suffering from recurrent pregnancy loss can often be provided with treatments that diminish the risk of miscarriages in subsequent pregnancies. Structural abnormalities of the uterus can often be surgically corrected. Blood clotting disorders, autoimmune factors, and hormone abnormalities can often be treated with medications. While it is not currently possible to alter the chromosomes of the eggs or sperm, it is possible to distinguish chromosomally normal from abnormal embryos. This process, known as in vitro fertilization (IVF) with preimplantation genetic screening (PGS), allows reproductive endocrinologists to select which embryos should be transferred to the uterus and which embryos may be discarded.

While recurrent miscarriages can be emotionally devastating, there is still a great deal of hope for many couples. Even without therapy, the chances of a future successful pregnancy can be as high as 60% depending upon the number of prior pregnancy losses and the cause(s) of these losses. Effective treatments are available for many couples experiencing recurrent miscarriages. With proper prenatal care, diagnosis, treatment and pregnancy support, the potential for building a family remains high.

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