Early pregnancy loss, or miscarriage, occurs in approximately 15-20 percent of all pregnancies. The incidence increases with advanced maternal and/or paternal age and can be as high as 40 percent when a woman reaches age 40. When two or more consecutive miscarriages occur, the condition is termed recurrent pregnancy loss. The risks of losing a subsequent pregnancy after 2, 3, or 4 consecutive losses are 24%, 30%, and 40% respectively. Often, a cause for repeated miscarriage can be identified at IVF New Jersey and infertility treatment sought either prior to or during a subsequent pregnancy. Therefore, it is important that a couple seek the care of a reproductive endocrinologist for infertility treatment prior to initiating another pregnancy.
Recurrent Pregnancy Loss/Miscarriage Causes
Couples suffering from recurrent pregnancy loss/miscarriage often feel frustrated and helpless from the repeated ups and downs of becoming pregnant and then experiencing a loss. Nevertheless, it is important to undergo a thorough investigation to rule out treatable causes. Fortunately, even if no treatable causes are uncovered, greater than 70 percent of pregnancies in women with recurrent pregnancy loss/miscarriage problems will result in a live birth. The evaluation of recurrent pregnancy loss can be divided into four categories:
Approximately 70 percent of recurrent pregnancy loss/miscarriages are due to random genetic errors in the fetus. Normally, an embryo results from the union of a sperm and an egg (gametes). Both gametes contain 22 autosomes and one sex chromosome each, resulting in 46 total chromosomes when combined. When an extra chromosome exists, it is called a trisomy, and represents the largest group of genetic abnormalities resulting in recurrent pregnancy loss/miscarriages. When a chromosome is missing, it is termed monosomy. Monosomy X, also known as Turner’s syndrome, represents the most common single genetic abnormality resulting in miscarriages. These genetic errors increase in frequency as a woman’s egg supply and quality decrease (a natural impact of aging) therefore blood tests for hormonal evaluation of ovarian reserve (FSH, AMH, etc.) may provide insight to the likelihood of recurrence.
On the other hand, irrespective of age, embryos can be genetically abnormal as a result of a pre-existing genetic defect in either one of the parents. In about 4% of couples a genetic defect can be detected in one of the parents through a simple blood test called karyotype. Most commonly, a balanced translocation is discovered; this occurs when a portion of one chromosome has moved to a different chromosome leaving one chromosome with too much genetic information and the other lacking genetic information. Because there is a full complement of genetic material, the parent is completely normal. The problem arises when that parent tries to pass on this genetic information via their gametes (egg or sperm). When the chromosome pair is separated, the resulting gamete will either have too much or too little genetic material. The embryo created from that egg or sperm will most often be abnormal and result in a miscarriage.
Tissue collected from a miscarriage, either by the patient or during a dilation and curettage (“D and C”), can be sent for genetic analysis of the fetal chromosomes. This is known as a tissue karyotype. When a normal karyotype results, a genetic error cannot explain the pregnancy loss. It is therefore important to seek infertility treatment. At IVF New Jersey, our fertility specialists can search for other possible causes of miscarriage in order to prevent them from recurring in subsequent pregnancies. If you have experienced recurrent pregnancy loss/miscarriage and you are seeking infertility treatment, contact IVF New Jersey today.
Abnormalities in a woman’s uterus can lead to an increased risk of recurrent pregnancy loss/miscarriage. These abnormalities can be present at birth and are known as congenital anomalies. There are also abnormalities that can present later in life, such as fibroids or uterine polyps. The uterus develops as two halves growing toward the midline where they fuse together. If one side fails to develop, then a unicornuate uterus exists. Usually, only one fallopian tube is present and the uterus is significantly smaller than normal. If the two uterine halves fail to fuse in the midline, then a bicornuate or uterine didelphys exists. Lastly, if the fibrous tissue present at the fusion site of the two uterine halves fails to resorb, then a uterine septum exists. This leads to a less favorable site for implantation and a high risk of pregnancy loss/miscarriage. When fibroids or endometrial polyps are present within the uterine cavity, they can act as an inflammatory entity and adversely affect the implantation of an embryo. All of these anomalies are easily diagnosed when a woman seeks infertility treatment and receives a radiological procedure known as a hysterosalpingogram (HSG), where the course of radio-opaque dye through the cervix, uterus, and fallopian tubes is observed under fluoroscopic (X-ray) view. Once diagnosed, many of these abnormalities can then be corrected by a skilled reproductive surgeon using operative hysteroscopy. If you are interested in infertility testing and treatment for recurrent pregnancy loss/miscarriage, contact our infertility specialists in New Jersey.
Certain endocrinological disorders, such as hypothyroidism, hyperthyroidism, hyperprolactinemia, and diabetes, when not adequately treated, can lead to increased risks of congenital anomalies in the fetus as well as a higher chance of recurrent pregnancy loss/miscarriage. It is important to diagnose and treat these disorders, often months prior to attempting to conceive. Occasionally, inadequate progesterone secretion can lead to a luteal phase defect. This can be diagnosed by a serum progesterone level after ovulation takes place. Once diagnosed, patients may receive the infertility treatment of progesterone supplementation, or superovulation with Clomid®. For help with recurrent pregnancy loss/miscarriage in New Jersey, contact our infertility specialists.
Immunological Causes and Thrombophilias
There are certain conditions that make a woman more susceptible to forming blood clots. The most studied and proven immunological cause of recurrent pregnancy loss/miscarriage is antiphospholipid antibody syndrome (APS). This syndrome is characterized by the production of antibodies which abnormally increase the formation of blood clots. These blood clots can then travel to the placenta and adversely affect placental blood flow. The use of both aspirin and heparin to reduce the ability to form blood clots is a common and often rewarding treatment of this condition. Other conditions collectively known as thrombophilias are inherited defects in coagulation often leading to a hypercoagulable state. There is significant controversy regarding how some of these conditions could be associated with a higher risk of early pregnancy loss/miscarriage. It is not known at this time if the use of blood thinners such as those used to treat antiphospholipid syndrome will benefit these women.
If you have endured recurrent pregnancy loss/miscarriage, you may wish to seek out infertility testing and treatment. Contact the experts of IVF New Jersey.