Recurrent Pregnancy Loss
Recurrent pregnancy loss is classically defined as the occurrence of three or more consecutive pregnancy losses; however, the American Society of Reproductive Medicine (ASRM) has redefined recurrent pregnancy loss as two or more pregnancy losses. A pregnancy loss is defined as a clinically-recognized pregnancy involuntarily ending before 20 weeks.
Recurrent Pregnancy Loss Causes
Most pregnancy losses result from chromosomal, or genetic, abnormalities, and are random events.
The abnormality may come from the egg, the sperm, or the early embryo. Approximately 15% of all clinically recognized pregnancies end in miscarriage; however, it is estimated that at least 40-50% of all conceptions will end within the first 12 weeks of gestation.
Advancing maternal age is associated with an increased risk of miscarriage, which is thought to be due to poor egg quality leading to chromosomal (genetic) abnormalities. Sometimes, the mother or father themselves may have a slight irregularity in their genes, but the offspring could be more severely affected and thus result in miscarriage.
Sometimes, there could be an abnormality in the uterus that leads to miscarriage. The miscarriage may be due to poor blood supply to the pregnancy or inflammation. Some women may be born with an irregularly shaped uterus, and some women may develop abnormalities with their uterus over time (i.e. fibroids).
A woman’s immune system may also play a role in recurrent pregnancy loss. Hormone abnormalities may also impact pregnancy loss, including thyroid disease and diabetes. Abnormalities in a mother’s blood clotting may also affect pregnancy loss.
Recurrent Pregnancy Loss Testing
Recurrent Pregnancy Loss Treatment
The treatment recommendations for patients with recurrent pregnancy loss are based on the underlying cause of recurrent pregnancy loss.
Unexplained Recurrent Pregnancy Loss
Over one-half of patients with recurrent pregnancy loss will have unexplained recurrent pregnancy loss, which means that no specific cause could be identified in the work-up. There is no universal recommendation for treatment of these patients. Despite this, the overall chance of pregnancy is good, more than 50%, without any intervention at all.
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