Common Causes of Recurrent Pregnancy Loss
Recurrent pregnancy loss (RPL) can be defined as two or more consecutive miscarriages. While not overly common, up to 5% of women may experience RPL. While some causes of miscarriages are unavoidable, thorough investigation is important as there are many other causes that can be avoided.
Genetic Abnormalities
Chromosomal imbalances:
Often first trimester miscarriages that are tested will show chromosomal imbalances within the embryo that explain why the pregnancy ceased developing, these imbalances are often unique to each pregnancy and cannot be detected or prevented through testing of the parents.
Over half of first trimester pregnancy losses can be attributed to chromosomal imbalances, unfortunately this type of miscarriage is usually not preventable, as it is the result of the body recognising that the pregnancy would not have resulted in a healthy baby.
Balanced Translocation:
Is a genetic condition where a person possesses all the genetic information required for normal growth of a baby, however some of the genetic material may have broken off one chromosome and attached to another.
This may result in missing genetic information or added genetic information during the growth of the embryo which may ultimately result in miscarriage.
Approximately 4.5% of couples with RPL one or both parents have a balanced translocation.
This can be detected via karyotype blood testing.
While it is still possible to conceive naturally with balance translocation some couples may opt to do IVF and have their embryos genetically tested to prevent future miscarriages.
Uterine structure
It’s important to understand that not all differences in uterine structure lead to miscarriage, some women can go on to have healthy pregnancies without even knowing, however women with recurrent pregnancy loss (RPL) likely have a higher incidence of uterine anomalies than women without recurrent pregnancy loss (4).
If you have experienced RPL it is worth exploring further with your fertility specialist.
Structural abnormalities may include Uterine Septum (where the uterus is separated but an extra growth of tissue down the middle of the uterus) or uterine Didelphys (when two uterus’s form at birth) may limit the space in which the baby has to grow.
Other structure factors that can form overtime may include, Polyps, fibroids, adhesions or scarring while often these are more commonly linked to fertility issues they may lead to miscarriage if they are located in areas that prevent growth or implantation of the embryo.
Autoimmune
Clotting Factors:
Antiphospholipid Syndrome (ANA) is an autoimmune disease that causes your blood cells to bind together more easily preventing proper development of the placenta, it can otherwise be known as “sticky blood syndrome.”
Often ANA will be treated by taking blood thinners or anticoagulant medication.
Hormonal Factors
Diabetes:
Poorly managed diabetes can be associated with RPL (2,4) however well managed diabetes has not been shown to increase risks of RPL (2,3), seeking advice from either a nutritionist or a registered dietician may be helpful in keeping your diabetes under control during pregnancy.
PCOS:
Polycystic ovarian syndrome (PCOS) in itself may not necessarily be a risk factor for RPL. However, factors that are associated with PCOS such as insulin resistance, elevated androgen levels, and obesity may increase the risk of miscarriage particularly if someone has undiagnosed and unmanaged diabetes (4).
Thyroid:
Hypothyroidism (or underactive thyroid when your body doesn’t produce enough thyroid hormone) may be associated with RPL (2).
While there is some debate about what normal TSH levels should be, if you do have thyroid issues or suspect you might have, seeing an endocrinologist can be helpful as thyroid hormone medication may help prevent further miscarriages or issues with fertility.
Hashimoto’s disease is the most common cause of hypothyroidism, in this condition your body attacks its own thyroid hormone, this can be diagnosed by testing for thyroid antibodies.
Male Factor
It’s important to consider both side of the picture when it comes to RPL and fertility. Thorough investigation, including semen analysis and testing for sperm antibodies and DNA fragmentation, is helpful prior to conception and important in RPL.
How we can help
At Natural fertility Geelong our focus is on improving your overall health, utilising Acupuncture and Chinese herbal medicine along with diet and lifestyle advice.
Recent studies have shown that when supportive care was provided for women with recurrent miscarriage there was an increased rate of live births for woman when compared to a control group receiving standard antenatal care (5).
Recurrent pregnancy loss can be a difficult process both physically and emotionally our aim is to provide a safe and supportive environment for couples.
Resources
1. https://www.healthline.com/health/pregnancy/how-to-prevent-miscarriage#causes
2. https://www1.racgp.org.au/ajgp/2018/july/recurrent-pregnancy-loss
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009578/
4. Not Broken, An Approachable Guide To Miscarriage and Recurrent Pregnancy Loss, Lora Shahine
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342918/\
6. https://www.verywellfamily.com/balanced-translocation-and-recurrent-miscarriage-2371840
