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Recurrent Pregnancy Loss Part 1

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A blog by Joseph A. Hill, III, MD, Fertility Centers of New England

The following is based my experience of over almost 30 years as a physician devoted to women’s reproductive health care.

I spent the first 20 years in academic medicine performing both basic and clinically applied research in the areas of infertility and specifically, recurrent pregnancy loss (RPL), also known as recurrent miscarriage.

My comments and opinions are based on both my individual experience as a clinician, a clinical scientist, and as a student of the literature and work of many others in the field of reproduction.

When a baby is desired, success is expected immediately. However, the natural chance of becoming successfully pregnant per month of attempting pregnancy, called fecundity, is only 1 in 5 or 20 percent. Pregnancy loss occurring before 20 weeks of gestation is called a miscarriage or, by its medical term, spontaneous abortion.

Miscarriage is the single most common complication of pregnancy, occurring in 8 percent of pregnancies in women under age 30 and more than 26 percent of pregnancies in women over age 40. The chance of a miscarriage for women between the ages of 30 and 40 is approximately 15 percent.

If a miscarriage has occurred, the chance of a subsequent miscarriage in another pregnancy is not increased unless this was the second or more loss.

Recurrent Pregnancy Loss or RPL is defined as two or more pregnancy losses prior to 20 weeks of gestation. RPL occurs in approximately 1 percent of pregnancies, which happens approximately 30,000 times annually in the United States alone. Studies from large populations of pregnant women indicate that if a woman has had two miscarriages, then the chance of having her third loss is approximately 20 percent. If there have been three prior losses, then the chance of a fourth is only 30 percent, and even if there have been four prior losses, the chance of a fifth spontaneous loss is 40 percent.

So even with four prior losses, the chance of having a successful pregnancy is as high as 60 percent

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