What is Recurrent Pregnancy Loss?
Recurrent pregnancy loss is defined as a woman losing two or more consecutive pregnancies. It usually occurs in the first trimester of pregnancy, but in rare cases it can occur later in life.
Recurrent pregnancy loss is rare, and the rate of a woman having two consecutive miscarriages is estimated to be less than 5%. Moreover, even if no underlying cause can be identified, the mother-to-be has a high chance of having a successful pregnancy without requiring any special treatment. Approximately 65 out of 100 women with unexplained recurrent pregnancy loss will have a successful next pregnancy.
Approximately half of miscarriages are due to chromosomal abnormalities, which are abnormal numbers of chromosomes formed during fertilization of the embryo. Such genetic problems occur by chance. There is no medical condition that causes them. However, the likelihood of this problem increases with age.
In some rare cases, one of the partners may have a genetic disorder associated with chromosomal diseases. Therefore, it is important to have chromosome analysis of both couples with recurrent pregnancy loss.
Common Causes of Recurrent Pregnancy Loss
Genetic Factors
- Genetic abnormalities in the egg or sperm cell are common causes of recurrent pregnancy loss.
- Genetic abnormalities can prevent the normal development of the embryo and naturally cause miscarriage.
Anatomical Problems
- Anatomical defects such as congenital deformities in the uterus or those that may occur over time due to abortion, infections, severe intrauterine adhesions (Asherman Syndrome) can increase the risk of pregnancy loss.
- A septum, a partition in the uterus, or other abnormalities in the uterus can be the cause of recurrent miscarriages.
- Conditions such as polyps in the uterus or submucous myomas that push on the uterine wall, which can prevent the embryo from attaching to the uterus.
Hormonal Imbalances
- Abnormalities in hormone levels can prevent the pregnancy from continuing.
- Progesterone deficiency in particular can be the cause of recurrent miscarriages.
- It is suggested that polycystic ovary syndrome may also play a role in recurrent miscarriages.
Systemic diseases in the mother
- Thyroid disorders
- Diabetes
Autoimmune diseases
- Immune system diseases, conditions such as antiphospholipid syndrome can cause recurrent pregnancy loss.
- These diseases can cause the body to reject the embryo or cause a miscarriage.
Infections
- Some infections, especially those affecting the inside of the uterus, can increase the risk of pregnancy loss.
- Early detection and treatment of these infections will increase the chance of a healthy pregnancy.
Thrombophilic Conditions
- Thrombophilic conditions can affect placental circulation by increasing blood clotting and can cause recurrent pregnancy loss.
What Tests Should Be Performed to Diagnose Recurrent Miscarriages?
Blood Tests
- Hormone Levels: Measurement of hormone levels, especially progesterone, estrogen, and thyroid hormones.
- Antiphospholipid Antibody Tests: Performed to determine antiphospholipid syndrome.
- Thrombophilic Panel: Performed to investigate blood clotting disorders.
Genetic Tests
- Karyotype Test: Performed to determine genetic abnormalities in egg or sperm cells.
- Genetic Evaluation of Embryo: Performed to evaluate the genetic structure of the embryo obtained through artificial reproductive techniques.
Intrauterine Imaging
- Ultrasound: Performed to detect anatomical abnormalities or structural problems in the uterus.
- Hysteroscopy: A minimally invasive surgical procedure that can be used to view the inside of the uterus and thus detect and treat conditions such as polyps, submucous myomas, deformities (intrauterine septum), and adhesions that may be present in the uterus.
Immunological tests
- Antinuclear Antibody (ANA) Test: Performed to determine autoimmune diseases.
- Antiphospholipid Antibody Tests: Performed to determine antiphospholipid syndrome.
Infection Tests
- Blood Tests: Performed to detect infections such as Toxoplasma, Rubella, Cytomegalovirus (TORCH).
- Vaginal Culture: Performed to determine intrauterine infections.
Endometrial Biopsy
- Examination of the intrauterine tissue is performed to evaluate endometrial abnormalities.
Prevention and Treatment of Recurrent Miscarriage
Preventive Measures
Healthy Lifestyle: Healthy lifestyle habits such as a balanced diet, regular exercise, and not smoking can reduce the risk of recurrent miscarriage.
Drugs and Alcohol: It is important for women planning a pregnancy to limit their use of medications and alcohol consumption.
Genetic Counseling: Genetic counseling for couples who have had recurrent miscarriages in the past can help identify possible genetic causes.
Medical Treatments
Hormonal Therapy: Progesterone supplements can be used to prevent recurrent miscarriages.
Anticoagulant Therapy: Anticoagulant medications can be used to prevent blood clots in women with thrombophilic conditions.
Surgery: Surgical interventions such as uterine septum surgery can be performed to correct anatomical abnormalities.
Immunologic Treatments: Immunologic treatments can help reduce the risk of recurrent miscarriage in women with immune system diseases.
Psychological Support
Emotional Support: Couples experiencing recurrent miscarriages should access support systems that will help them cope with this difficult process by providing emotional support.
Psychotherapy: Counseling or therapy can help couples cope with this experience and prepare for future pregnancies.
