RECURRENT MISCARRIAGE TREATMENT

Recurrent Miscarriage Treatment

Most pregnancy losses are random events resulting from result from chromosomal, or genetic, abnormalities. The abnormality may come from the egg, the sperm, or the early embryo. Approximately 12-15% of all clinically recognized pregnancies end in miscarriage; however, it is estimated that at least 30-40% of all conceptions will end within the first 12 weeks of gestation.

Risk factors include advancing maternal age, parental chromosomal abnormalities, uterine anomalies, (congenital or acquired) Immunological issues, hormonal abnormalities (including thyroid disease and diabetes) and lastly blood clotting disorders (thrombophilias).

Generally speaking, environmental factors, stress, and occupational factors do not seem to be related to pregnancy loss.

Testing

First, your fertility specialist will take a detailed medical, surgical, family, and genetic history and perform a physical examination. Testing includes karyotype analysis of both partners. Evaluation of the uterine cavity, including a/an ultrasound, saline ultrasound, hysterosalpingogram X-ray, occasionally, MRI (magnetic resonance imaging), and/or hysteroscopy (to look inside the uterus).

Antiphospholipid antibodies, anticardiolipin antibody and lupus anticoagulant, if present indicate presence of antiphospholipid syndrome, which may be related to pregnancy loss. This testing is also done if there is a personal history of blood clots associated with risk factors such as surgery, bone fractures, or prolonged immobilization, or if a patient has a parent or sibling with a disorder of excessive blood clotting.

Hormonal testing includes Thyroid function tests, thyroid antibodies serum prolactin, AMH, FSH and LH (ovarian reserve).

Treatment

The treatment is based on the underlying causes. Whatever the results of workup the chance for a successful future pregnancy is high: 75% if the no abnormalities detected, and 71% if an abnormality was found.

Individuals in whom a karyotypic (a chromosomal or genetic) abnormality is found are often referred for genetic counseling. The Genetic counsellor can discuss what the genetic abnormality is and the likelihood of having a chromosomally normal or abnormal pregnancy in the future. Options include CVS, Amiocentesis after getting pregnant to determine chromosomes or In vitro fertilization (IVF) with preimplantation genetic diagnosis (PGD) can also be done.

If uterine abnormality is found, surgery may be performed depending on the defect. If antiphospolipid syndrome is diagnosed, certain medications that reduce blood clot formation may be given. If thyroid dysfunction or diabetes are diagnosed, appropriate management must be offered to normalise the hormonal profile.

Unexplained Recurrent Pregnancy Loss

Very Frustrating to the couple when no cause is found and happens in 50% of the cases.Various treatments may be offered to these patients, but 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 other than TLC and lots of emotional support.