Recurrent Miscarriage

Suffering one miscarriage can be extremely upsetting. Experiencing multiple miscarriages can be utterly devastating. Emotionally taxing and challenging for both partners, having multiple miscarriages can signify a possible fertility problem. However, with the proper care, it is possible to conceive and carry a child to term successfully.

What is Recurrent Miscarriage?


Miscarriage refers to the spontaneous loss of a pregnancy up to the 20th week of gestation (after this time, it is known as a stillbirth). In women with recurrent miscarriage, pregnancy loss occurs 3 or more times in a woman under 35 and 2 or more times in women over the age of 35. The possibility that a woman who has experienced one miscarriage will go on to have multiple miscarriages is around 1%.

Reasons Behind the Abortions


Pregnancy involves many factors that govern the growth and development of the foetus into a healthy child. Sometimes small factors, like the shape of the uterus, environmental factors, blood group of the parents or just the presence of some infection, may result in uterine conditions that are unfavourable for the child and lead to miscarriage.

Causes of recurrent miscarriages may be:

Chromosomal – Many infertility specialists have recognised some chromosomal anomalies as the universal reason for recurrent miscarriages, though these abnormalities are uncommon. Anomalies may be present in the father or the mother’s chromosome and, in spite of fertilisation, symptoms of miscarriage appear due to the presence of an abnormal chromosome in the embryo, making it impossible for the embryo to develop further.

Structural Cause – In some women, the muscle composition or the blood supply in the uterus is abnormal, which results in recurrent pregnancy loss. These abnormalities may occur due to the following reasons:

  • The uterus shows fusion and is not of the proper shape
  • The presence of fibroids, polyps or scar tissues that decrease the blood circulation
  • Structural abnormalities of the vagina and cervix due to DES, a particular oral oestrogen drug, exposure. The use of this fertility drug has now been stopped.
  • Abnormal cervix function that dilates very early during pregnancy.

Hormonal Cause – The hormone progesterone plays a very important role during pregnancy. One of the first major functions of this hormone is to encourage the uterine cells to build an environment friendly for the embryo so that it can easily implant. Even later, progesterone is continuously required in sufficient quantities for the development and culmination of pregnancy.

When you have a limited amount of progesterone in the body, this may lead to fertility problems and in milder conditions the failure of the embryo to implant on the uterine wall and thus recurrent miscarriage. This defect is also known as luteal phase defect as it is actually the luteal phase (the time between ovulation and your next period) when the progesterone presence is most important.

Immunological Cause – When the immune system is not operating correctly, it can make it difficult to sustain a pregnancy. In some cases, the immune system may malfunction and destroy important tissue inside the uterus, thereby causing a miscarriage. Other instances, a dysfunctioning immune system will recognize a developing foetus as a harmful foreign body. This triggers an immune response that ends in miscarriage. In particular, anti-phospholipid syndrome is commonly associated with recurrent miscarriages.

Other Causes – Some other reasons of pregnancy termination may be:

  • Exposure to radiations like X rays, or industrial or chemical toxins
  • Presence of a systemic disease in the mother, like diabetes
  • Addiction to drug, cigarettes or alcohol
  • Use of certain drugs that may be harmful to the foetus

Investigation and Treatment


Before treatment can be given, a proper investigation will need to be conducted to determine precisely why you have had repeat miscarriages. Once the cause has been ascertained, an appropriate treatment can be recommended to improve your chances of conception.

Some of the methods used to investigate and treat the reasons for pregnancy loss are:

  • Hysterosalpinogram (HCG) or hysteroscopy is used to determine the shape of the uterine cavity and whether it has any fusions or presence of scar tissues. The procedure may be repeated a few times to completely remove the adhesion on the uterus. After each operation, the patient is given a high dose of oestrogen for the re-growth of the endometrium and there is a 60% to 80% chance of normal pregnancy.
    However, certain disadvantage of this technique include the risk of pelvic infections, and radiation exposure. That is why many doctors suggest that women with recurrent miscarriages get a thorough ultrasound of the pelvic region done to understand the exact condition and the shape of the uterus.
  • An endometrial biopsy test may be performed when an hormonal imbalance is suspected. Once the inadequate level of progesterone is confirmed, a patient may be given progesterone or hCG supplements.
  • Women showing signs of an autoimmune disorder are tested by a coagulation based test or a direct antibody test. Common treatments for anti-phospholipid syndrome include the use of low dose of aspirin, starting before pregnancy; prednisone, which suppresses the immune system; heparin and injection of immunoglobin. The dosage depends on the severity of the condition.

Women who are found to have a structural defect may only require surgery to correct the anomaly and increase their chances of maintaining a pregnancy. If a chromosomal problem is suspected, couples will be advised to seek the help of a genetic counsellor, who can perform genetic testing to identify the precise problem.

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