Recurrent Pregnancy Loss

Studies have concluded that about half of all first trimester miscarriages are the result of chromosomal abnormalities. They are related to the age of the woman and are more likely to occur with advancing maternal age.Increased DNA damage in the sperm may also be a contributing factor. Further research is needed in this area. We offer testing for the Sperm DNA Fragmentation at our clinic. For details kindly write to us at reachus@corionfertilityclinic.com

There are several hormonal imbalances that can contribute to miscarriage rates. These can be evaluated with simple blood tests and treated if present.

Several blood disorders have been implicated in recurrent miscarriages. Women with abnormal blood clotting may be predisposed to early or late miscarriage.

Recurrent Pregnancy Loss is defined as:

Two or more failed Clinical pregnancies as documented by ultrasonography or histopathologic examination i.e. Recurrent Pregnancy Loss testing.

Three consecutive Recurrent pregnancy losses, which are not required to be intrauterine.

A clinical pregnancy is a pregnancy that is confirmed by both high levels of hCG (the pregnancy hormone) and ultrasound confirmation of a gestational sac or heartbeat (fetal pole). These are the different methods of Recurrent Pregnancy Loss Testing. Recurrent Pregnancy Loss Treatment in India is widely available.

Recurrent Pregnancy Loss Testing includes the following:

Diagnostic Evaluation of Recurrent Pregnancy Loss

Parental Karyotype , Pre- genetic testing

HSG or Office Hysteroscopy or Saline infusion Sonohysterography

Hormonal Testing – Thyroid , Prolactin and diabetes

Infection – Chronic endometritis / Cervicitis

Autoimmune – Antiphospholipid antibody / anticardiolipin antibody / Lupus anticoagulant / thrombophilia.

Male Factor – High sperm DNA fragmentation

All or some of the above Recurrent Pregnancy Loss Testing may be required.

Following are the causes of Recurrent Pregnancy Loss

• Genetic – Approximately 2% to 4% of RPL is associated with Chromosome abnormality. Additional structural abnormalities associated with RPL include chromosomal inversions, insertions, and mosaicism. Single gene defects, such as those associated with cystic fibrosis or sickle cell anemia, are seldom associated with Recurrent Pregnancy Loss.
• Anatomic – Anatomic abnormalities account for 10% to 15% of cases of Recurrent Pregnancy Loss . These include congenital uterine anomalies, intrauterine adhesions, and uterine fibroids or polyps.
• Endocrine – Luteal phase defect (LPD), polycystic ovarian syndrome (PCOS), diabetes mellitus, thyroid disease, and hyperprolactinemia are among the endocrinologic disorders implicated in approximately 17% to 20% of Recurrent Pregnancy Loss.
• Infection – Certain infections are known or suspected to play a role in sporadic spontaneous pregnancy loss. However, the role of infectious agents in recurrent loss is less clear, with a proposed incidence of 0.5-5.0%. The infection increases the chances of Chronic endometritis / cervicitis.
• Immunlogic – There may be abnormalities within immunologic mechanisms that could lead to both sporadic and recurrent pregnancy loss. One specific autoimmune disorder, APS ( anti-phospholipid antibody ) requires particular attention as it has been clearly linked with many poor obstetric outcomes, including Recurrent Pregnancy Loss.
• Thrombotic – Both inherited and combined inherited/acquired thrombophilias are common, with more than 15% of the white population carrying an inherited thrombophilic mutation.
• Environmental – Sporadic loss and/or Recurrent Pregnancy Loss are linked to occupational and environmental exposures to organic solvents, medications, ionizing radiation, and toxins (tobacco , alcohol and caffeine ) have been suggested.
• Unexplained – When all known and potential causes for RPL are accounted for, almost half of patients will remain without a definitive diagnosis. The optimal management of these patients is often as unclear as the etiology of their Recurrent Pregnancy Loss.

Recurrent Pregnancy Loss testing and Treatment in India has the following options:

Surgeries for Recurrent Pregnancy Loss Treatment

Surgery like hysteroscopic resection of fibroid , septum , adhesions and polyps.

Recurrent Pregnancy Loss treatment using Blood-thinning medicines

Women with autoimmune or clotting (thrombophilia) problems may be treated with low-dose aspirin and heparin. These medicines can be taken during pregnancy to lower the risk of miscarriage.

Recurrent Pregnancy Loss treatment by Correcting other medical problems

Treating medical conditions such as diabetes, thyroid dysfunction, or high prolactin levels can improve the chances of having a healthy, full-term pregnancy.

Recurrent Pregnancy Loss treatment using Genetic screening

In about 5% of couples with RPL, one of the parents has a rearrangement (translocation) of their chromosomes. If one parent has a translocation, this can cause fetuses with chromosome imbalances that are more likely to miscarry. The parents’ blood can be studied (karyotyped) to see if they have a translocation. If a chromosomal problem is found, the doctor might recommend genetic counselling. While many couples with translocations eventually conceive a healthy pregnancy naturally, your doctor might suggest fertility treatments, such as in vitro fertilization (IVF). During IVF, eggs and sperm are mixed outside of the body in a laboratory. After IVF, before the embryos are returned to the uterus, they can be tested (preimplantation genetic screening). This allows embryos without translocations to be chosen to increase the chance of a healthy pregnancy.

Recurrent Pregnancy Loss treatment by Lifestyle Choices

Stopping cigarette smoking and stopping illicit drug use (such as cocaine) will lower the risk for miscarriage. Limiting alcohol and caffeine intake may also help. Healthy weight loss might also help pregnancy outcomes. There is no proof that stress, anxiety, or mild depression causes RPL. However, these are important problems that go along with RPL. Psychological support and counseling can help couples cope with the emotional pain of miscarriage and create a healthy environment for a pregnancy.

Other Recurrent Pregnancy Loss treatments

There is no proof that intravenous (IV) infusions of blood products (such as intravenous immunoglobulin [IVIG]) or medicines (such as soybean oil infusion) decrease the risk of miscarriage.

Therapies for Recurrent Pregnancy Loss Treatment depending upon the etiology

Genetic – Genetic counselling , IVF with pre-genetic testing  OR Donor gametes.

Anatomic – Hysteroscopic resection of septa , polyps , adhesions and fibroid

Endocrine –  Thyroid hormone replacement , diabetes management , progesterone supplementation.

Infection – Antibiotics to treat endometritis / cervicitis

Immunologic / thrombotic – Low dose aspirin OR low molecular weight heparin

Environmental – Avoid exposures ( tobacco , alcohol and caffeine ) , supplementation with multivitamins and folic acid.

What are the recurrent pregnancy loss Testing and Treatments in India?

Recurrent Pregnancy Loss testing and Treatment in India has the following options:

Surgeries for Recurrent Pregnancy Loss Treatment
Surgery like hysteroscopic resection of fibroid , septum , adhesions and polyps.

Recurrent Pregnancy Loss treatment using Blood-thinning medicines

Women with autoimmune or clotting (thrombophilia) problems may be treated with low-dose aspirin and heparin. These medicines can be taken during pregnancy to lower the risk of miscarriage.

Recurrent Pregnancy Loss treatment by Correcting other medical problems

Treating medical conditions such as diabetes, thyroid dysfunction, or high prolactin levels can improve the chances of having a healthy, full-term pregnancy.

Recurrent Pregnancy Loss treatment using Genetic screening
In about 5% of couples with RPL, one of the parents has a rearrangement (translocation) of their chromosomes. If one parent has a translocation, this can cause fetuses with chromosome imbalances that are more likely to miscarry. The parents’ blood can be studied (karyotyped) to see if they have a translocation. If a chromosomal problem is found, the doctor might recommend genetic counselling. While many couples with translocations eventually conceive a healthy pregnancy naturally, your doctor might suggest fertility treatments, such as in vitro fertilization (IVF). During IVF, eggs and sperm are mixed outside of the body in a laboratory. After IVF, before the embryos are returned to the uterus, they can be tested (preimplantation genetic screening). This allows embryos without translocations to be chosen to increase the chance of a healthy pregnancy.

Recurrent Pregnancy Loss treatment by Lifestyle Choices

Stopping cigarette smoking and stopping illicit drug use (such as cocaine) will lower the risk for miscarriage. Limiting alcohol and caffeine intake may also help. Healthy weight loss might also help pregnancy outcomes. There is no proof that stress, anxiety, or mild depression causes RPL. However, these are important problems that go along with RPL. Psychological support and counseling can help couples cope with the emotional pain of miscarriage and create a healthy environment for a pregnancy.

Other Recurrent Pregnancy Loss treatments
There is no proof that intravenous (IV) infusions of blood products (such as intravenous immunoglobulin [IVIG]) or medicines (such as soybean oil infusion) decrease the risk of miscarriage.

The cost of Recurrent Pregnancy Loss treatment varies from Rs 2,00,00 – 4,00,000.