Recurrent Miscarriage - Why?

Why Does This Keep Happening?

A woman who experiences recurrent miscarriages generally has two questions that plague her mind: Why does this keep happening? What can I do about it? Neither of these question have easy answers, or even answers that are truly satisfying. While there has been some progress in terms of learning more about recurrent pregnancies, they continue to remain a mystery in most cases, with reasons seemingly elusive.

Defining Miscarriage

A miscarriage is the loss of a pregnancy before the 20th week of gestation - although some doctors put the timing at 23 weeks. When a woman loses a pregnancy three times consecutively, then she is having recurrent miscarriages, a very perplexing and distressing situation for both the woman and her partner.

Some statistics indicate that one in 100 women has recurrent miscarriages, about three times more than what may happen by chance. It follows then, that there must be a specific reason for the loss of pregnancy. Yet, for many of these women no underlying problem can be identified in spite of careful investigations by doctors and specialists. It really does appear to be chance. If a couple has the will and determination to keep trying, there is still a possibility for a successful outcome in the future.

Some Possible Reasons for Miscarriage

There are a number of factors that are considered when a woman has recurrent miscarriages. Not all of them are the sole reason, many factors come into play. Some of the possibilities that could be at least partially involved follow.

· Age is definitely a factor. The older a woman is, the more likely a miscarriage will occur, especially since aging affects the viability of the eggs. Also, the more miscarriages a woman has, the higher the chances for another.

· Abnormal chromosomes account for about five in 100 miscarriages and are the prevalent cause of pregnancy loss in the first trimester.

· The most common reason for miscarriage is an abnormality in the embryo. However, the more miscarriages a woman has, the less likely this is the cause.

· The presence of antiphospholipid antibodies (aPL) in the blood has been noted in women experiencing recurrent miscarriages. 15 in 100 such women have aPL antibodies whereas less than two in 100 of women with normal pregnancies have aPL in their blood.

· Irregularities in the structure of the womb may account for 37 out of 100 miscarriages in women. Serious anatomical abnormalities that remain untreated are a likely cause of miscarriage or early birth.

· A weak cervix has been attributed to many miscarriages, although it is hard to prove that is what happened. Since there is no reliable test, the numbers can't really be proven.

· Infections in the bloodstream are a known cause of miscarriage. The possibility of miscarriage increases significantly if bacterial vaginosis (BV) is contracted. BV infections cause miscarriage in the fourth to sixth month of gestation. BV is hard to track in the body, which is why it isn't treated early enough.

· As long as diabetes and thyroid conditions are kept in control they do not pose a threat for recurrent miscarriages. Both are implicated in single miscarriages and can, if left untreated, be a cause for additional miscarriages.

· Although there is no clear support for some possible reasons for recurrent miscarriage, there continues to be a link between such health issues as blood conditions, primarily thrombophilia (blood clots); alloimmune reaction, when the immune system does not respond properly to the baby; PCOS; and hyperprolactinemia, a case where too much prolactin is produced in the woman's body.

Isn't There Any Way of Knowing Why?

There are some ways to address some of these concerns and possibly get some answers as to why there are recurrent miscarriages.

· Proper prenatal care has been shown to help prevent miscarriage

· A pelvic ultrasound or transvaginal ultrasound can screen for uterine, ovary and fallopian tube irregularities and structural problems with the uterus.

· Genetic screening by way of blood tests (karyotyping) often uncover chromosomal abnormalities.

· Embryonic abnormalities can be discovered by blood samples of the embryo and/or placenta after a miscarriage.

· Testing can be done for bacterial vaginosis. Although the baby may not survive an infection, antibiotics and proper treatment can help ensure a safe, healthy future pregnancy.

· Treat aPL with low-dose aspirin and low-dose heparin injections. The combination of the two drugs has shown to be effective.

· Treatment can be administered for thrombophilia which can reduce the risk of blood clots.

· A vaginal ultrasound can identify a weak cervix and a stitch can be put into the cervix to help strengthen it during pregnancy.

· Hormone treatments of hCG and progesterone in early pregnancy may help prevent a miscarriage.

It may be that the doctor cannot identify a reason for recurrent miscarriage, nor be able to tell what will happen with another, subsequent pregnancy. However, the good news is that even if there is no reason that is evident, there is still a three out of four chance for a healthy birth.

Miscarriage affects both partners in a relationship. There are ways of dealing with the aftermath that help couples get back on track again. Learn more about them here.

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