What You Need to Know About Multiple Miscarriages
Common causes. Helpful tests. Promising treatments.
Early pregnancy loss is so common that many people consider miscarriages to be a part of the reproductive process. But that doesn’t make the loss any easier to bear for couples hoping to raise a family.
When early pregnancy loss occurs not just once—but multiple times—the emotional pain and concern can be even more traumatic. Yet, experiencing multiple miscarriages doesn’t mean that a couple will never be able to experience the joy of parenthood. In fact, with the help of advanced testing and treatments, the majority of couples who have experienced recurrent pregnancy loss will indeed go on to achieve their dream of having a baby.
What is recurrent pregnancy loss?
Recurrent pregnancy loss used to be defined as the occurrence of three or more consecutive miscarriages. However, the American Society of Reproductive Medicine has recently defined repeated miscarriage as the loss of two or more clinically recognized pregnancies before 20 weeks gestation. A “clinically recognized” pregnancy means the pregnancy has been visualized on an ultrasound.
How common are multiple miscarriages?
Studies show that approximately 15 percent of all recognized pregnancies end in a miscarriage. About 5 percent of women will have two consecutive miscarriages, and approximately 1 percent of women will experience recurrent pregnancy loss.
What causes recurrent pregnancy loss?
There are several factors that influence miscarriage rates, including the advancing age of the mother. For example, we know that pregnant women in their 40s will experience a much higher percentage of miscarriages than women in their 20s or early 30s.
Most pregnancy losses result from genetic abnormalities and are random events. The abnormality may come from the egg, the sperm, or the early embryo. Autoimmune, uterine, hormonal and immunological factors have also been linked to miscarriages. Lifestyle factors, such as cigarette smoking and cocaine use, have been reported to increase the incidence of miscarriages as well.
What tests are available to help find the cause of repeated miscarriages?
If you have experienced one or more miscarriages, it is very important to see a doctor. A complete physical examination, including a pelvic exam, will be done. You may also have blood tests to detect problems with the immune system or hormone function. An infertility specialist can also rule out certain anatomic issues associated with miscarriages, such as uterine fibroids.
Genetic screening for both partners may be recommended to help identify potential genetic causes of recurrent pregnancy loss. Approximately 60 percent of early miscarriages are due to chromosomal abnormalities. This usually means the embryo carried an extra chromosome, was missing a chromosome, or had chromosome defects.
The good news is that recent studies show that, depending on the cause and treatment options, the chance for a successful future pregnancy after miscarriage is as high as 60-80 percent.
What treatments are available for recurrent pregnancy loss?
Treatment options are based on the underlying cause of the repeated miscarriages. In the case of uterine fibroids, for example, surgery may be recommended. If testing revealed thyroid dysfunction, diabetes or a clotting disorder, medications will be prescribed.
If you have a chromosomal issue, genetic counseling may be recommended. IVF (in vitro fertilization) with special genetic testing called “preimplantation genetic testing” offers the best chance for a successful pregnancy.
What is preimplantation genetic testing?
Preimplantation genetic testing (PGT) is a micromanipulation technique that allows fertility labs to test embryos from IVF for certain types of genetic conditions. PGT may be done to select unaffected embryos, which increases the odds of having children that will be healthy and have every opportunity to succeed in life.
For those who know that they carry a genetic predisposition for a painful or debilitating disease, such as sickle cell anemia or cystic fibrosis, ensuring that the disease will not be passed on to their children—and their children’s children—can also provide peace of mind.
When should you see a specialist?
In the past, women were advised to wait until they had three or more consecutive miscarriages before making an appointment with a fertility specialist. That is no longer the rule. There’s no reason to wait it out before seeking answers and receiving appropriate treatments that could help you have a baby sooner.
According to the American Society for Reproductive Medicine, you should seek the care of an infertility specialist if you are unable to achieve pregnancy after 12 months of unprotected intercourse. If you are over the age of 35, the time of trying to conceive is reduced to six months. You should also seek the care of a specialist if you have had more than one miscarriage.