Helping Patients Get Through Recurrent Miscarriage

By definition, recurrent pregnancy loss (RPL) is distinct from infertility, but it is still an issue of concern for reproductive specialists. Women who have experienced two or more miscarriages should be examined to see if there is a treatable condition that is preventing pregnancy from progressing to term. Contact Laurence Jacobs, M.D. to find answers about your recurrent miscarriage at our Chicago area offices.

FREQUENCY

According to the American Society for Reproductive Medicine, "Although approximately 25% of all recognized pregnancies result in miscarriage, less than 5% of women under 35 years old will experience two consecutive miscarriages, and only 1% experience three or more." Recurrent miscarriage is more common among women over the age of 35, due to the increased frequency of chromosomal anomalies in the embryo.

TREATABLE CAUSES

It is true that 33 to 50 % of all pregnancies may end in miscarriage simply due to older, poorer quality eggs that predispose to genetic chromosomal abnormalities (aneuploidy – extra or missing chromosomes such as Down Syndrome). However, there are many other treatable causes for recurrent miscarriage [recurrent pregnancy loss (RPL)]:

• Hormonal abnormalities, such as low serum progesterone levels, diabetes or thyroid disease can easily be diagnosed and treated, and will reduce miscarriage risks.

• Uterine anatomical defects can be evaluated by an x-ray called HSG-Hysterosalpingogram or by ultrasound of the uterus called saline infusion sonogram (SIS). Uterine defects, such as submucous (protruding into the cavity) fibroids, polyps, intrauterine adhesions or septum (congenital shape deformity) or double uterus (bicornuate) account for 10 to 15 % of recurrent miscarriages. Most of these above defects can be repaired surgically, usually by hysteroscopy (telescope through cervix into the uterus).

• Genetic chromosomal unbalanced translocations (portion of one chromosome adherent to another) make up only 1 to 2 % of pregnancy losses. This abnormality can be diagnosed by doing a blood test (genetic karyotyping) on the man and woman. Just like miscarriages due to age-related chromosome abnormalities (aneuploidy), miscarriages from chromosome translocations can be prevented by doing In-Vitro Fertilization (IVF) and Preimplantation Genetic Screening  (PGS). PGS involves evaluating the genetics of the embryos on Day 5 of development, so only a few genetically normal embryos are returned to the uterine cavity. PGS can dramatically reduce the incidence of miscarriages in women of advanced age, by eliminating aneuploid embryos, as well as helping those couples with translocation abnormalities. 

• Thrombophilia (an increased tendency to form blood clots in the small blood vessels of the developing placenta) can be another source of problems. Thrombophilia is the opposite of hemophilia (increased bleeding due to a lack of clotting factors). Thrombophilia may be congenital (born with), such as Leiden factor V, anti thrombin III, homocysteine, protein C & S abnormalities, and Prothrombin Gene (factor II), and MTHFR. Most of these congenital thrombophilias can be successfully treated with Heparin/Lovenox® and baby aspirin, as well as folic acid.

• Immune system: Thrombophilia may be acquired due to malfunction of the immune system producing antibodies, such as lupus anticoagulant or anticardiolipin antibodies. Most of these acquired thrombophilias can be successfully treated with Heparin/Lovenox® and baby aspirin or with prednisone and baby aspirin.

Some debatable causes of miscarriage relating to increased natural killer cells (NK) will be mentioned. Some unproven therapies involve administering Leukocyte Immune Therapy (LIT) (white blood cells from your partner or 3rd party strangers) to stimulate the woman to make more 'blocking antibodies' to protect the fetus. LIT has recently been banned by the FDA. Intravenous immunoglobulin (IVIG) therapy is also very controversial since most infertility specialists don't see much benefit; there's a lack of good controlled studies; it's very expensive; and it involves using blood products from so there is a small risk of transmission of hepatitis or HIV from the transfusions. More randomized controlled studies are needed for IVIG therapy. For abnormal NK activation, Intralipid therapy is safe and far less expensive, and generally preferred.  

COPING

Recurrent miscarriage is a stressful and emotionally taxing condition. At our fertility center, we strongly encourage patients to seek some form of emotional support to help them through their experiences. Grief, anger, helplessness, fear, and isolation are all common among patients with this condition. Group support or one-on-one counseling can make a significant difference in a patient's ability to cope. We offer complimentary psychological counseling with our full time staff member.

Read an article about coping with the holidays for fertility patients (PDF)

CONTACT OUR FERTILITY CENTER IN ILLINOIS

If you have been experiencing recurrent miscarriage, contact our fertility center in the Chicago, Illinois area to schedule a consultation.