What is recurrent miscarriage?

Recurrent miscarriage is a condition that affects approximately 1-2% of couples trying to conceive, making it a significant concern in reproductive health. Recurrent miscarriage, also known as recurrent pregnancy loss (RPL), is defined as the loss of two or more consecutive pregnancies before the 20th week of gestation. This is distinct from isolated miscarriages which are relatively common and often unexplained. On the contrary, recurrent miscarriage is symptomatic of an underlying issue that requires thorough evaluation.

What are the causes of Recurrent Miscarriage?

A number of factors are at play behind recurrent miscarriage and in many cases, multiple issues may be involved. Let’s take a look at some of the primary causes:

• Genetic Factors: Chromosomal abnormalities are one of the most common causes. These may include balanced translocations in one of the parents, which can lead to unbalanced chromosomes in the embryo.
• Anatomical Abnormalities: Uterine abnormalities such as septate uterus, fibroids or intrauterine adhesions can interfere with implantation or foetal development, leading to miscarriage.
• Hormonal and Metabolic Disorders: Conditions such as polycystic ovary syndrome (PCOS), uncontrolled diabetes and thyroid disorders can impair pregnancy progression.
• Immunological Factors: Autoimmune conditions like antiphospholipid syndrome (APS) cause abnormal clotting and can lead to repeated pregnancy loss. Alloimmune causes, though less understood, may also play a role.
• Infections: While acute infections rarely cause recurrent losses, chronic or undiagnosed infections may contribute in some cases.
• Lifestyle and Environmental Factors: Smoking, alcohol use, excessive caffeine intake, obesity and exposure to environmental toxins can increase the chances of recurrent miscarriages.
• Unexplained Causes: Despite extensive testing, about 50% of cases remain unexplained. In these instances, supportive care and monitoring can still lead to successful pregnancies.

What is the diagnosis for recurrent miscarriage?

Diagnosis for recurrent miscarriage usually begins after two or more consecutive losses. It includes the following:

Genetic Testing: Karyotyping of both partners and, if available, the products of conception.

Imaging: Pelvic ultrasound, hysterosalpingography or MRI to detect uterine abnormalities.

Blood Tests: To assess thyroid function, blood sugar levels, antiphospholipid antibodies, and clotting disorders.

Additional Testing: Immunological and hormonal assessments, depending on the clinical presentation.

Management and Treatment

The treatment of recurrent miscarriage varies and is customised according to the identified cause. Treatment options include:

Genetic Counselling: For couples with chromosomal abnormalities, options like in vitro fertilisation (IVF) with preimplantation genetic testing may be advised.

Surgical Correction: Uterine anomalies can often be corrected surgically.

Medical Management: Hormonal therapy, anticoagulants (e.g., aspirin or heparin for APS), or immunotherapy may be considered.

Lifestyle Modification: Weight loss, cessation of smoking and improving overall health can significantly improve pregnancy outcomes.

Supportive Care: In cases with no identifiable cause, psychological support and close monitoring in early pregnancy have been shown to increase live birth rates.

Dealing with recurrent miscarriage

Recurrent miscarriage is no doubt a distressing experience, but advances in diagnostics and treatment offer hope. With appropriate medical care and emotional support, many couples go on to have successful pregnancies. A multidisciplinary approach involving obstetricians, geneticists, endocrinologists and counsellors is often key to effective management of recurrent miscarriages.