The most common complication of pregnancy is miscarriage during the first trimester of pregnancy, which affects about 15 % of pregnancies. Most women after miscarriage have a normal pregnancy, however, sometimes the miscarriage is repeated, causing anxiety and frustration for the couple.
In this article we explore what repeat miscarriages are, what causes them and what treatment options exist.
Understanding repeat miscarriages
The World Health Organization defines repeat miscarriage as the repeated loss of three or more pregnancies before 20 weeks. It is an infertility problem that affects about 1% of couples trying to conceive and has a strong emotional impact.
There are multiple causes that can lead to miscarriage and sometimes there may be several risk factors in the same couple. Possible causes include genetic alterations such as chromosomopathies, anatomical factors such as uterine anomalies, cervical insufficiency or uterine fibroids, endocrine factors such as luteal defects, diabetes, or thyroid alterations, urinary or vaginal infections or thrombophilia such as antiphospholipid syndrome. It should be noted that the cause of miscarriage is often unknown.
Description of tests that can help identify the cause of repeated miscarriages
When a couple has repeated miscarriages, it is advisable to look for an underlying cause. This should be done by taking a detailed medical history, including family and personal history of both partners, as well as obstetric and gynecological history, and by performing a complete physical examination and gynecological examination.
In addition, other diagnostic tests can be performed:
- Transvaginal ultrasound: allows determining whether there are abnormalities in the uterine morphology or endometrial cavity. This study can be completed with other imaging tests such as hysteroscopy or pelvic nuclear magnetic resonance.
- Genetic testing: determining the karyotype of both partners can help detect chromosomal abnormalities.
- Blood tests: should include a complete blood count, assessment of kidney and liver function, and endocrine tests with assessment of progesterone, thyrotropin, and prolactin concentrations.
- Serology: to detect possible infections.
- Special coagulation studies: the determination of antiphospholipid antibodies, anticardiolipin antibodies and lupus anticoagulant allows the detection of thrombophilia.
Treatment options
Once the underlying cause of repeated miscarriages has been identified, there are some treatment options.
When genetic alterations are present, one option is to opt for in vitro fertilization (IVF) with Preimplantation Genetic Diagnosis (PGD). This allows embryos without chromosomal abnormalities to be selected, increasing the chances of success. If healthy embryos are not obtained after PGD , gamete or embryo donation can be used.
The administration of anticoagulants such as heparin and acetylsalicylic acid is the treatment used in cases of thrombophilia. These drugs at low doses have been associated with reduced gestational losses and high rates of healthy infants. However, these treatments may increase the risk of complications during the third trimester so increased vigilance during pregnancy is necessary.
In the case of morphological abnormalities, there are surgical procedures that can correct them to improve the chances of pregnancy, while treatment for women with endocrine disorders may consist of drugs that regulate hormone concentrations. Finally, when the cause of miscarriages is an infection of the reproductive tract, it must be treated to eliminate it before attempting a new pregnancy.
Repeated miscarriages are a complex and frustrating infertility problem that requires a comprehensive and personalized study. Faced with this problem, it is of great importance that couples seek support and specialized advice. At Barcelona IVF we offer a detailed and personalized assessment to find the most appropriate treatment.
