A few months after Mrs. A’s first child was born, she wanted to be pregnant again; she wanted her children to be close in age, so they could share clothes, go to school at the same time, and so she could go back to pursuing a career within ten years. When her son was six months old, she discovered she was pregnant.
But before was eight weeks pregnant, she had a miscarriage. If she hadn’t been trying to conceive, she probably wouldn’t have even noticed that her period was late! At the clinic, her obstetrician’s reassured her and informed her that around 15 percent of confirmed pregnancies, and up to half of all pregnancies end in miscarriage during the first trimester.
The obstetrician also reassured her that the miscarriage wasn’t as a result of something she had done or hadn’t done, that it was “just one of those things.” She was comforted when I informed that most of the time miscarriage are a one-time occurrence. But you may never know why you miscarried. Well, she did get pregnant again, about three or four months later. Her second baby was born a month after her brother’s second birthday.
What is a recurrent miscarriage?
A miscarriage is recurrent when you have three or more miscarriages in a row. Miscarriages are more common than we think. If you have a menstrual cycle that is somewhat regular, it might be a bit easier to spot it. Like in the case above if she were not actively monitoring her cycle, she would have put it off for a late period, rather than a miscarriage. Recurrent miscarriages is a common cause of infertility, and there are various reasons, and more often than not, there is a solution. Your Gynecologists will try to identify the cause of the losses. In about half the cases, tests can find no reason for the losses. The good news is most women who experience recurrent losses do go on to have a baby. Draw comfort from this fact – six out of 10 women who have had three miscarriages will go on to have a baby in their next pregnancy.
Is recurrent miscarriage common?
About one woman in 100 experiences a recurrent miscarriage. Frustratingly, it is often unclear why it keeps happening to some women. But some problems that cause some women to miscarry again and again can be identified. Some clinically confirmed pregnancies also end in miscarriage; however, it is estimated that more than half of all conceptions will end within the first 12 weeks of pregnancy.
Do you know up to 50% of the time, the woman doesn’t even realize that she was ever pregnant?
The risk of miscarriage increases with the number of previous pregnancy losses but is typically less than 50%.
What causes recurrent miscarriage?
A couple of health conditions may lead to miscarriage. Some of the problems are not scientifically proven or fully understood how or why they play a part. Conditions that are known to cause recurrent miscarriage include but not limited to:
- Antiphospholipid syndrome (APS), is a blood clotting problem also known as sticky blood syndrome or Hughes syndrome. APS is a problem that makes your blood clot when it shouldn’t. APS may stop a fertilized egg from implanting in the womb or block the placenta preventing the exchange of blood, nutrients or waste between mother and child.
- Some other inherited blood-clotting disorders such as thrombophilia are similar to APS but is something you are born with rather than acquire. Thrombophilia means that your blood may be more likely to clot than normal. Thrombophilia could cause recurrent miscarriage either due to inadequate blood supply to the pregnancy or inflammation
- Genetic problems. You or your partner may have missing or duplicated genetic information on one of your chromosomes. This abnormality may not cause a problem until it is passed on to your baby.
- Problems with your womb (uterus) or cervix. You may have a womb that has an abnormal shape, or a weak cervix. Apart from being born with an abnormally shaped uterus, some women may develop abnormalities such as Asherman syndrome, in which adhesions and scarring form in the uterus after uterine surgery. Fibroids and polyps may interfere with implantation too.
- Infections such as bacterial vaginosis infections increase the risk of late miscarriage and premature birth.
- Hormonal problems such as polycystic ovaries, uncontrolled type 2 diabetes and thyroid diseases have all been linked to recurrent miscarriage.
Most pregnancy losses result from random events that may arise from the egg, the sperm, or the early embryo. Aging may also have an effect, the older you are, the more likely you are to experience a miscarriage. Your baby’s father’s age may also increase the risk of miscarriage. For women age of 35 years and above, the number of your eggs and their quality starts to decline more quickly. This reduction could make the genetic material in your eggs more likely to go wrong, and this may or may not increase the likelihood of a miscarriage.
Despite knowing possible causes, it often turns out that a reason for recurrent miscarriage eludes us. For unknown cases, make the lifestyle changes your doctor recommends and follow your treatment regiments.
What You Can Do
Improve your lifestyle by eating healthy, exercising moderately and use dietary supplements wisely. Get your diabetes or thyroid conditions under control. Test for and treat infections with antibiotics and prevent it from recurring. Adopt positive stress coping abilities.
Test and treat APS, the next time you’re pregnant. Your doctor will offer you blood-thinning medicines such as aspirin and heparin to treat APS. Omega 3 fish oil and some dietary supplements may also help blood thinning.
An ultrasound scan may show the abnormality that’s been making pregnancy difficult; fortunately, surgery can correct some of these defects. Abnormalities of the womb is an uncommon condition.
Cervical cerclage is a minor surgery performed to support the cervix carried out about the 13/14 week of gestation. If you have a suspected weak or short cervix, you may be offered extra scans in your next pregnancy. An incompetent or short cervix is presumed if in a previous pregnancy, your waters broke early, or if your cervix opened painlessly. Speak with your doctor who will explain the pros and cons to this procedure.
Endometrial biopsy is used to assess if your uterine lining is getting thick enough for the fertilized egg to implant. Treatment is the use of hormones such as progesterone.
Sometimes, though, tests don’t provide answers; you could see it as a reason for better luck next time because a lot of women who have unexplained recurrent losses have a healthy baby eventually with the right support, love, and care.
Even if you or your partner has a chromosome problem causing miscarriages, you still have chances of a healthy baby if you just keep trying; this is because some problems are not transferred every time you conceive. Every couple is different. And try to modify your lifestyle as well as follow your treatment plan.
It can be very hard if you’re feeling so knocked back by all your losses that you’re not sure if you can face losing another baby.
Recurrent miscarriage is a common cause of infertility. Managing it is a big challenge for both patient and doctor. There has been a wide range of research from cause to management. More often than not, the cause of recurrent miscarriage can only be identified approximately 50–60% of the time. But the good news is with proper support, self-care and lifestyle modifications, you can conceive.
There is a tremendous psychological impact of recurrent miscarriage. Psychological support and counseling are crucial to the successful treatment. Therefore, couples with unexplained recurrent miscarriage should seek appropriate emotional support and reassurance.
Lifestyle management may be our best solution even though generally speaking; there is no scientific proof that environmental factors, obesity, stress, and occupational factors are related to pregnancy loss; but it’s best to err on the side of caution.
Many investigations such as genetic thrombophilia screening do not have substantial evidence, so it is not routinely performed. No form of immunotherapy is recommended until further evidence is available. Lifestyle management may just be our best solution.
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