By: Harvey J. Stern MD, PhD
The loss of a pregnancy is a very unsettling experience for couples, but when multiple miscarriages occur, the effect is even more devastating. The American Society of Reproductive Medicine (ASRM) defines recurrent pregnancy loss (RPL) as a condition, distinct from infertility, characterized by 2 or more failed pregnancies. Some experts consider 3 or more losses in a woman less than 35 years of age as warranting evaluation. Although about 15% of all clinically identified pregnancies end in miscarriage, less than 5% of women experience 2 consecutive losses and only 1%experience 3 or more. In women who have a history of 2 miscarriages, the subsequent risk of pregnancy loss rises to 25%, while 3 losses raises the risk of a fourth to 33%.
Often, the patient's obstetrician will initiate an evaluation of couples with recurrent pregnancy loss, but frequently, experts in reproductive medicine and medical genetics are also asked to provide consultation to these patients. At GIVF, we offer our experience in reproductive medicine and genetics to couples with RPL and work with their obstetricians to devise an appropriate evaluation and treatment plan.
There are many causes of RPL, and in at least 50% of couples who undergo evaluation, no explanation for RPL is identified. Possible reasons for RPL include:
- Chromosomal abnormalities in embryos from egg or sperm, particularly in women over 40 years of age
- Endocrine (hormonal) abnormalities
- Diabetes and other metabolic disorders
- Anatomical abnormalities of the uterus
- Autoimmune disorders
- Thrombophilias (clotting disorders)
- Sperm chromatin abnormalities
- Possibly some infections, lifestyle factors, or exposure to toxins
The typical evaluation will include a comprehensive medical and family history, physical exam, blood tests for chromosome analysis, measurement of hormone concentrations, autoimmune and thrombophilia testing, semen analysis and bacterial culture of the male and female reproductive tracts. For women, the anatomy of the uterus is evaluated with transvaginal ultrasonography, hysterosaplingography or saline hysterosonography. Any findings in the male can be further evaluated by a urologic specialist.
Testing can take several weeks to complete and, when results are available, the couple returns for a detailed discussion with their physician. All reproductive options are discussed, including assisted reproduction by IUI, IVF or donor gamete where appropriate. A comprehensive medical summary and treatment recommendations are forwarded to the patient's obstetrician.
Most patients do not need IVF and, in many cases, couples can be successful with natural conception. For patients identified with structural rearrangements of the chromosomes, IVF with preimplantation genetic diagnosis has been shown to be very effective. Patients with thrombophilia are often treated with anticoagulation, and surgical correction of structural uterine anomalies is generally possible.
The chance of having a successful full-term pregnancy is dependent to some extent on the number of miscarriages and whether any previous conceptions ended in a live-born child. Other significant prognostic factors include the maternal and paternal ages, presence of polycystic ovaries or other hormonal defects, maternal BMI and lifestyle choices such as smoking and alcohol consumption. In women with RPL without an identifiable cause, approximately 70-75% of women are able to have a successful pregnancy.
By: Harvey J. Stern MD, PhD
The loss of a pregnancy is a very unsettling experience for couples, but when multiple miscarriages occur, the effect is even more devastating. The American Society of Reproductive Medicine (ASRM) defines recurrent pregnancy loss (RPL) as a condition, distinct from infertility, characterized by 2 or more failed pregnancies. Some experts consider 3 or more losses in a woman less than 35 years of age as warranting evaluation. Although about 15% of all clinically identified pregnancies end in miscarriage, less than 5% of women experience 2 consecutive losses and only 1%experience 3 or more. In women who have a history of 2 miscarriages, the subsequent risk of pregnancy loss rises to 25%, while 3 losses raises the risk of a fourth to 33%.
Often, the patient's obstetrician will initiate an evaluation of couples with recurrent pregnancy loss, but frequently, experts in reproductive medicine and medical genetics are also asked to provide consultation to these patients. At GIVF, we offer our experience in reproductive medicine and genetics to couples with RPL and work with their obstetricians to devise an appropriate evaluation and treatment plan.
There are many causes of RPL, and in at least 50% of couples who undergo evaluation, no explanation for RPL is identified. Possible reasons for RPL include:
The typical evaluation will include a comprehensive medical and family history, physical exam, blood tests for chromosome analysis, measurement of hormone concentrations, autoimmune and thrombophilia testing, semen analysis and bacterial culture of the male and female reproductive tracts. For women, the anatomy of the uterus is evaluated with transvaginal ultrasonography, hysterosaplingography or saline hysterosonography. Any findings in the male can be further evaluated by a urologic specialist.
Testing can take several weeks to complete and, when results are available, the couple returns for a detailed discussion with their physician. All reproductive options are discussed, including assisted reproduction by IUI, IVF or donor gamete where appropriate. A comprehensive medical summary and treatment recommendations are forwarded to the patient's obstetrician.
Most patients do not need IVF and, in many cases, couples can be successful with natural conception. For patients identified with structural rearrangements of the chromosomes, IVF with preimplantation genetic diagnosis has been shown to be very effective. Patients with thrombophilia are often treated with anticoagulation, and surgical correction of structural uterine anomalies is generally possible.
The chance of having a successful full-term pregnancy is dependent to some extent on the number of miscarriages and whether any previous conceptions ended in a live-born child. Other significant prognostic factors include the maternal and paternal ages, presence of polycystic ovaries or other hormonal defects, maternal BMI and lifestyle choices such as smoking and alcohol consumption. In women with RPL without an identifiable cause, approximately 70-75% of women are able to have a successful pregnancy.