Pregnancy loss is devastating for would-be parents, and recurrent pregnancy loss is even more so. Besides the emotional and physical toll, pregnancy loss can be an indicator for other underlying health concerns. This article attempts to explain pregnancy loss and the types of testing available to help you understand the causes and optimise your chance of a healthy pregnancy in future.
Terminology
Pregnancy loss (or 'miscarriage')is generally classified as embryonic (up to 10 weeks of pregnancy) or fetal (losses between 10-24 weeks of pregnancy). Pregnancies of more than 24 weeks that do not result in a live birth are classified as stillbirth.
Recurrent pregnancy loss “RPL” is when a patient has more then two miscarriages, at either embryonic or fetal stage.
Causes of pregnancy loss
There is no single attributable cause of pregnancy loss. Some of the more common causes of RPL include:
Chromosomal abnormalities of the embryo/fetus
This is believed to be the cause of more than 30% of miscarriages, and the risk increases with advanced parental age. Unfortunately, as couples get older, there is a much higher risk of embryos being aneuploid – ie, not having the correct number of chromosomes. Carriers of unbalanced chromosomal translocations also have an increased risk of miscarriage.
Anatomical Factors
Some women have malformations in their uterus, such as bicornuate or septate uteruses. Growths such as fibroids and polyps (which are usually benign), may also cause pregnancy loss.
Antiphospholipid Syndrome
This is an autoimmune disease that can cause blood clots leading to miscarriage. For many patients, their only symptom is pregnancy loss.
Sperm DNA Fragmentation
Up to a third of miscarriages are believed to be caused by sperm abnormalities with higher rates of aneuploidy in older men. As well as age, general health including obesity, factors such as exposure to environmental contaminants, use of recreational drugs, alcohol intake, and smoking can all have an impact on sperm health and increase the risk of pregnancy loss.
Environmental Risks and General Health in Women
As with sperm factors, environmental contaminants, obesity, alcohol intake, smoking and recreational drugs can all have an impact on the quality of a woman’s eggs and increase the risk of chromosomal abnormalities in the embryo.
Endocrine Factors
Conditions such as hyperthyroidism and Polycystic Ovarian Syndrome “PCOS” may increase the risk of miscarriage.
How do we investigate?
The first step is that your doctor will take a full medical history, which includes a discussion on lifestyle and environment. They will review the results of any previous investigations, and order further tests where necessary. For example, they may order a specialist 3-D uterine scan or conduct exploratory surgery to assess whether there are any previously undiagnosed anatomical issues, or karyotype tests to check for unbalanced chromosomal translocations.
After all investigations are complete, you will have a review appointment with your doctor who will then go through your results and discuss any treatment options with you.
What treatments are available for recurrent pregnancy loss?
Depending on your diagnosis, treatment may involve one or more of the following options:
- Medication (for conditions such as antiphospholipid syndrome, thyroid disorders)
- Surgery for uterine malformations, where they can be rectified
- Lifestyle improvements (for environmental factors and sperm DNA fragmentation)
- Genetic testing of embryos “PGT-A” (to screen for aneuploidy)
Next steps and recommendations
Battling RPL is a heart-breaking, challenging process and everyone will handle it differently. For some people, the thought of going through another pregnancy and potential loss might be too much to bear. Others may wish to pause and reset before trying again. Only you know what is best for you.
If you are struggling to get through pregnancy loss, or deciding whether to try again, we recommend having a free of charge chat with our counsellor, or speaking to your support networks if you are comfortable doing so.
In either instance, our advice is to maintain your health - reduce (and preferably cease) alcohol and smoking, take time to relax and exercise, and enjoy time with your loved ones. Try to minimise stress as far as you can.
If you decide that you want to discuss your situation with a doctor and find out what is causing your pregnancy losses, and whether anything might help, please contact us to make an appointment.
