Recurrent Miscarriage

If you have had a recurrent miscarriage, your obstetrician will conduct a number of tests to figure out any underlying cause. The doctor will ask for your and your spouse’s medical history, conduct a pelvic exam and ask you to get blood tests done. Based on the results of these tests, the cause behind recurrent miscarriage can be understood and then treated. The causes can vary from person to person. The following are some of the leading causes of recurrent miscarriage as noted by a 2009 study published in the journal Review in Obstetrics & Gynecology.

There are a number of factors which can put you at an increased risk of recurrent miscarriage. These risks include:

• If you get pregnant at an older age (above 35 years).
• If you have chronic conditions like diabetes, high blood pressure, etc.
• If you have endocrine diseases like hypothyroid, PCOS, etc.
• If you have uterine abnormalities or growths, like fibroids.
• If you have cervical issues like a weak cervix.
• If you smoke, drink alcohol or use illegal drugs before and during pregnancy.
• Obesity as well as being underweight (malnourished) increase the risk of recurrent miscarriage.
• Prenatal genetic tests like amniocentesis increase the risk for miscarriage - the reason for this is not known.

Read more: Can I still get pregnant if I have PCOS?

Diagnosing any underlying causes is the first step towards proper treatment. While these test can help to determine the underlying causes in some women, it must be noted that some patients don't get a definitive diagnosis despite getting all the tests - in nearly 50% of recurrent miscarriage cases, the underlying causes cannot be identified with certainty.

The following tests and exams are done to diagnose the causes behind recurrent miscarriage:

• Medical history: Your doctor will first take a complete medical history from you and your spouse. This will include all the infections and diseases you have each had, if either or both of you have had any surgeries done, and what diseases run in the family (from heart disease to thyroid problems and diabetes).
• Genetic testing: A test that includes the karyotype analysis, or the analysis of genetic or chromosomal makeup, of both parents will be done. The purpose of this test is to find out if there are any genetic abnormalities that the parents are passing on to the foetus, which may be leading to the complications.
• Pelvic exam: The uterus and uterine cavity of the mother also needs to be examined to understand if there are any anatomical abnormalities that are making the woman’s body reject consecutive foetuses. An ultrasound, X-ray, MRI and hysteroscopy can be recommended to delve deeper into this, in addition to a physical pelvic exam by a doctor.
• Antiphospholipid test: Antibodies related to antiphospholipid syndrome will be tested in the antiphospholipid test to find out if the mother has inherited thrombophilias or abnormally increased blood clotting. The anticardiolipin antibody and lupus anticoagulant will be particularly tested. (Read more: lupus anticoagulant test and cardiolipin antibodies test)
• Hormone function test: Thyroid function and thyroid antibodies will be tested to see if hormone secretion is taking place normally. The production of hormones like progesterone, prolactin, etc., will also be tested.
• Ovarian reserve test: This test evaluates how well a woman’s ovaries are functioning. Poor quality ovaries can produce eggs which have abnormalities, and can, in turn, lead to recurrent miscarriage.

The treatment of recurrent miscarriage depends on the diagnosis of any underlying causes. No matter what the diagnosis, treatment for recurrent miscarriage has a high success rate.

Separately, according to the American College of Obstetricians and Gynecologists, 65% of women whose tests did not identify an underlying cause were still able to get pregnant and deliver a healthy baby without any treatment.

In women who have identified causes behind recurrent miscarriage, the following treatments might be suggested by their doctor:

• Genetic counselling for karyotype abnormalities.
• In vitro fertilization (IVF) with a pre-implantation genetic diagnosis: the fertilized egg is tested for genetic abnormalities before being implanted in the mom-to-be's uterus.
• Surgery to correct uterine abnormalities like septate uterus. In septate uterus, a membrane made of muscle and fibres divides the uterus into two parts.
• Medications like heparin and low-dose aspirin to reduce risks related to thrombophilia and antiphospholipid syndrome may be prescribed.
• Medications to treat or manage thyroid dysfunctions may be prescribed, based on the diagnosis.
• Medications to treat diabetes are prescribed for women with high blood sugar levels.

Read more: How to get pregnant if you have a thyroid problem