No matter how far along you are in your pregnancy, learning that you have lost your baby can be devastating. When it happens more than once, it can be even more discouraging. You may wonder if you’ll ever hold your baby in your arms.
You aren’t alone.
Recurrent pregnancy loss is when a woman experiences two or more clinical losses before 20 weeks gestation. While up to 50% of recurrent pregnancy losses do not have a clear cause and treatment, there is hope for women who have experienced multiple losses. In fact, there is still a 60-80% chance of conceiving and carrying a baby to full term, even after three losses.
Let’s take a look at what we know about recurrent pregnancy loss, ways to prevent miscarriages, and where you can find support as you seek answers.
How Common are Miscarriages?
Early pregnancy loss, or miscarriage, happens in about 9-12% of pregnancies that have been clinically confirmed by an ultrasound before 20 weeks gestation. The rate of early miscarriages can be as high as 26% for pregnancies that are considered biochemical, that is, the pregnancy was diagnosed only with a urine or blood pregnancy test or not diagnosed at all.
In women 40 and older, however, the rate of miscarriage increases dramatically. Up to 50% of women over 40 experience miscarriage.
When it comes to multiple miscarriages, less than 5% of women under age 35 experience two or more clinical losses, and less than 1% experience three or more.
Causes of Miscarriages
Age & Chromosomal Abnormality
The most common cause of recurrent pregnancy loss is chromosomal abnormalities in the developing embryo due to the age of the mother or father. As people age, the quality of the egg and sperm degrades, resulting in genetic abnormalities that can lead to spontaneous miscarriage.
Treatment: Unfortunately, there is no treatment for aging. However, using donor sperm for intra-uterine insemination (IUI) or donor eggs and/or sperm for in-vitro fertilization (IVF) can be an option. Assisted Reproductive Therapy (ART) can be used to test embryos so that only healthy embryos, free of genetic defects, are transferred.
About 18% of recurrent pregnancy losses can be traced to a uterine abnormality. Abnormal uterine shapes include uterine septum, bicornuate uterus, unicornuate uterus, and didelphic (double) uterus.
The woman may have a septate uterus (or uterine septum), which means a septum, a thin tissue or membrane, divides the uterus. This is the most common uterine abnormality. When a fertilized egg implants on the septum, it doesn’t have enough blood supply to grow properly. A septate uterus can be diagnosed by magnetic resonance imaging (MRI), ultrasound, or hysteroscopy.
Treatment: Septate uterus is treated with an outpatient surgery that cuts or removes the septum. If left untreated, the risk of another miscarriage or preterm labor remains high (67%, according to one study).
Another anatomical cause for miscarriage is uterine fibroids. Uterine fibroids, or leiomyomas, are small tumors or bumps that grow in the uterus. They are usually benign (not cancerous). Fibroids may be diagnosed during a pelvic exam, ultrasound, MRI, hysterosonography, hysterosalpingography, or hysteroscopy.
Treatment: Fibroids can be treated with medication that includes either hormonal or non-hormonal methods. If you have more severe symptoms, surgery may be recommended.
Some medical conditions, such as thyroid disease, diabetes, blood clotting disorders, immune system disorders, hormonal disorders, and other metabolic disorders, can increase the risk of multiple miscarriages. These disorders could include antiphospholipid syndrome (APS), an immune system disorder that increases your risk of blood clots, and polycystic ovarian syndrome (PCOS), a hormonal imbalance that can also cause other fertility problems.
Treatment: If you have a thyroid condition or diabetes, adjustments can be made to your medication to help prevent future miscarriages. Blood clotting disorders can also be treated with medications such as Lovenox, Heparin, or aspirin, which are designed to thin the blood to prevent clots. Progesterone supplementation, including Prometrium or progesterone suppositories, may be helpful in addressing hormonal issues.
Obesity, using illegal drugs, drinking alcohol, smoking cigarettes or marijuana, and even drinking too much caffeine (over 300mg/day, the equivalent of one large energy drink) can all increase your risk of miscarriage.
Treatment: Your OBGYN can connect you to resources so you can make the lifestyle changes you need to prepare your body for a healthy pregnancy.
Diagnosing Recurrent Pregnancy Loss
Blood tests are typically the most cost-effective and least invasive testing options. For that reason, you will most likely undergo a number of blood tests to determine what may be causing your multiple miscarriages.
To determine if you have APS, your OBGYN would run three lab tests:
- beta 2 glycoprotein
- lupus anticoagulant
- and cardiolipin antibody.
A test for diabetes would include the hemoglobin A1C test. A snapshot of your current hormone levels could be taken by testing your TSH and prolactin. If you have a family history of clotting disorders, you may have additional blood tests drawn.
Your uterine cavity can be evaluated by a physical exam, hysterosalpingogram, hysteroscopy, or saline-infused sonohistogram (SIS). Sometimes, but not often, an MRI will be used to get a picture of your uterus.
Chromosomal testing can be done on both partners. If the male is found to have a translocation of chromosomes that are then passed on to the embryo, IVF and ART can be used to find an unaffected embryo. If a dilation and curettage (D&C) procedure was done after a miscarriage, the tissue could be tested for chromosomal disorders.
Couples who are diagnosed with genetic disorders may be referred to a genetic counselor.
What if the cause is “unexplained?”
Unfortunately, even after all of these tests have been done, sometimes we simply can’t explain why a pregnancy ended in loss — up to 50% of recurrent pregnancy loss cases remain unexplained. Unexplained losses can be the hardest of them all, because if you don’t know the “problem,” it’s easy to think there isn’t a solution.
Many women still blame themselves, even after they have done everything they could to be healthy and take care of their baby. However, miscarriages are not because of something you are doing wrong. And there really is hope: even after three miscarriages, there is still a 60-80% chance of conceiving and carrying to full term.
When to ‘Try Again’
After a pregnancy ends, you might want to try to conceive again as soon as possible. If you didn’t have a D&C procedure, it is safe to have intercourse as soon as you feel up to it. If you did have a D&C or another procedure like a myomectomy to remove fibroids, you may be instructed to not have intercourse for at least two weeks.
Your body will need some time to “reset” hormonally to prepare for another baby. You will know if your body has “reset” by testing your beta HCG levels. A blood test after a miscarriage will determine your beta HCG level. Once that number is essentially zero, you can start trying to conceive again the following cycle.
However, while your body may be ready to conceive, it’s important to be sure that you are mentally and emotionally ready to try to conceive. Talking to other people who have experienced pregnancy loss can be very helpful. Ask your OBGYN for recommended support groups.
At Madison Women’s Health, we will do everything we can to help you carry and deliver a healthy baby. Our OBGYNs and nurses care about you, your partner, and your dreams to hold your child in your arms. We are with you every step of the way.
Vicki Slager-Neary, OBGYN, WHNP, A.P.N.P, has been serving women in the Madison area as board-certified Women’s Health Nurse Practitioner since 2016. She has provided patient care for over 17 years as a nurse in the Emergency Department, Labor and Delivery, Fertility, and OBGYN. Vicki has extensive experience working in Reproductive Endocrinology and Infertility for the past 10 years. Her areas of special interest include preconception counseling and treatment, contraception, and pregnancy. Vicki has a wide variety of experience managing infertility conditions including PCOS, amenorrhea, recurrent pregnancy loss and unexplained infertility.