A discussion on recurrent miscarriage: part 1

Suffering from a miscarriage can have a devastating impact on couples, and repeated miscarriages can leave some couples feeling hopeless. In the first article of a two-part series, leading consultant gynaecologist Mr Laxmikant Chaudhari explores the prevalent causes of recurrent miscarriage, how they can be identified and how to address them.

What are the common causes of recurrent miscarriage, and how can they be identified and addressed?

Recurrent miscarriage, typically defined as the loss of three or more consecutive pregnancies before 20 weeks of gestation, can have various causes. Identifying and addressing these causes may involve a thorough medical evaluation. It is important to note that specific recommendations and treatments may vary based on individual circumstances, and consulting with a healthcare professional is crucial. Some common causes and potential approaches include:

Chromosomal abnormalities

Identification: Chromosomal abnormalities in the embryo are a frequent cause of miscarriage. Karyotyping, a genetic testing method, can be performed on the products of conception to determine if chromosomal issues are present.

Addressing: In cases of chromosomal abnormalities, counselling and genetic testing may be recommended. In some cases, assisted reproductive technologies such as in vitro fertilisation (IVF) with preimplantation genetic testing (PGT) can be considered to select embryos with normal chromosomes.

Uterine abnormalities

Identification: Structural issues with the uterus, such as septum, polyps, or fibroids, can contribute to recurrent miscarriages. Diagnostic tools like hysteroscopy or imaging studies may help identify these abnormalities.

Addressing: Surgical procedures can sometimes correct uterine abnormalities. In some cases, assisted reproductive technologies may be recommended.

Endocrine and hormonal factors

Identification: Hormonal imbalances, thyroid disorders, and conditions like polycystic ovary syndrome (PCOS) can contribute to recurrent miscarriage. Blood tests can help identify hormonal irregularities.

Addressing: Treatment may involve hormone replacement therapy or medications to regulate hormonal imbalances. Managing conditions like PCOS through lifestyle changes or medications may also be considered.

Immunological factors:

Identification: Some autoimmune disorders and immune system abnormalities have been associated with recurrent miscarriage. Specialised blood tests can help identify immune-related factors.

Addressing: Treatment may involve immune-suppressing medications or other interventions based on the specific immune-related issues identified.

Thrombophilic disorders

Identification: Blood clotting disorders, such as antiphospholipid syndrome, can contribute to recurrent miscarriage. Blood tests can help diagnose these disorders.

Addressing: Treatment may involve blood-thinning medications (anticoagulants) to reduce the risk of blood clot formation during pregnancy.

Lifestyle factors

Identification: Smoking, excessive alcohol consumption, and certain medications can increase the risk of recurrent miscarriage.

Addressing: Lifestyle modifications, such as quitting smoking and moderating alcohol intake, are important. Reviewing and adjusting medications with the guidance of a healthcare provider is also essential.

It is crucial for individuals experiencing recurrent miscarriage to consult with a reproductive specialist or a healthcare team specialising in fertility and recurrent pregnancy loss. A comprehensive evaluation can help identify the underlying causes and guide appropriate interventions tailored to the individual's situation.

Are there specific tests or screenings available to assess the risk of recurrent miscarriage?

Recurrent miscarriage, defined as the occurrence of three or more consecutive pregnancy losses, can be a complex and emotionally challenging situation. When it comes to assessing the risk of recurrent miscarriage, healthcare providers typically conduct a series of tests and screenings to identify potential underlying causes. However, it's important to note that in some cases, the cause may remain unknown.

Here are some common tests and screenings that may be recommended:

Thyroid function tests: Thyroid disorders, such as hypothyroidism or hyperthyroidism, can contribute to miscarriages. Testing thyroid function can help identify and manage these conditions.

Antiphospholipid antibody syndrome (APS) testing: APS is an autoimmune disorder that can cause blood clots, potentially leading to recurrent miscarriages. Blood tests can detect the presence of antiphospholipid antibodies.

Hormone level testing: Evaluating hormone levels, including progesterone and oestrogen, can help identify hormonal imbalances that may contribute to recurrent miscarriage.

Blood clotting disorders testing: Some clotting disorders, such as Factor V Leiden or protein S deficiency, may increase the risk of blood clots and recurrent pregnancy loss.

Hysterosalpingography (HSG) or hysteroscopy: These procedures can help identify structural abnormalities in the uterus, such as polyps, fibroids, or a septum, which could contribute to recurrent miscarriages.

Genetic testing: Genetic tests can be conducted to identify if any genetic abnormalities in either partner which may contribute to recurrent miscarriage.

Endocrine and autoimmune testing: Conditions such as diabetes, lupus, and other autoimmune disorders may be associated with an increased risk of recurrent miscarriage. Testing for these conditions can be part of the evaluation.

Chromosomal analysis (karyotyping): This test examines the chromosomes of both partners to identify any chromosomal abnormalities that could lead to recurrent miscarriages.

It's important to work closely with a healthcare provider or a reproductive specialist who can tailor the testing based on individual circumstances. The choice of tests may vary depending on the specific medical history, age, and other factors of the individuals involved. Additionally, addressing lifestyle factors such as smoking, alcohol consumption, and maintaining a healthy weight can also be important in the overall management of recurrent miscarriage.

*Disclaimer: This information is based on the doctor's personal opinion.

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