Women’s Health with Minoos Hosseinzadeh, M.D. Recurrent Pregnancy Loss: When Women Should become Concerned about Miscarriages
Recurrent pregnancy loss (RPL) is typically defined as the occurrence of two or three or more consecutive pregnancy losses. In women of reproductive age, this generally occurs approximately one percent of the time; but sporadic early pregnancy loss is relatively common and occurs in up to 10-15 percent of all pregnancies. After the second loss, most physicians will work with their female patients to start the work-up for recurrent pregnancy loss.
Maternal age influences the recurrent pregnancy loss rate. In women aged 30 and younger, the rate is 25 percent. In those over 40, the rate is 50-60 percent. The most important thing to remember is that 60-70 percent of women with unexplained RPL will have a successful next pregnancy.
Causes of Recurrent Pregnancy Loss
Recurrent Pregnancy Loss can be the result of several factors. Some of the more common factors that have been implicated in RPL include:
Genetic abnormalities: In 2-4 percent of couples, balanced translocations, which can result in a fetus with an unbalanced chromosomal make-up, can be found. These abnormalities increase the likelihood of the fetus being aborted by the body.
Uterine anatomic abnormalities: Congenital abnormalities of the uterus have often been implicated in second trimester pregnancy loss. Some of the reasons include a septated, bicornuate or didelphic uterus. Other uterine factors include the presence of scar tissue, as well as fibroids, within the uterine cavity. These abnormalities can generally be identified through testing with a fertility specialist.
Autoimmune disorders: Antiphospholipid syndrome is an autoimmune disorder characterized by recurrent pregnancy loss, fetal death and thrombosis, more commonly known as blood clots.
Thrombophilias (clotting disorders): A number of clotting disorders have been implicated in recurrent pregnancy loss. Some of these include mutations in factor V Leiden and the prothrombin gene, but deficiencies in protein C, protein S and antithrombin III, which are anticoagulants, have been found to be contributing factors to RPL.
Hormonal and metabolic disorders: Thyroid disorders, poorly controlled diabetes and polycystic ovarian syndrome increase the risk for miscarriages. Women should work with their physicians to determine an appropriate course of action for establishing and maintaining hormone levels within the body.
Lifestyle factors: Lifestyle factors that have been associated with an increased risk of miscarriage include obesity, caffeine and alcohol consumption and the use of non-steroidal anti-inflammatory drugs. Women should implement doctor-approved exercise regimens to maintain healthy weight, and eliminate intake of caffeine and alcoholic beverages to optimize their bodies for pregnancy.
In addition to the physical stress that a miscarriage exacts on a woman’s body, there is also emotional stress imparted on both the woman and her partner. The best way to avoid both is to work with a fertility specialist that can conduct a proper work-up for recurrent pregnancy loss and institute the appropriate treatment protocols. In some patients, when all of the causes of RPL have been ruled out, it may be recommended that they proceed with in vitro fertilization (IVF), so that Preimplantation Genetic Diagnosis (PGD) may be performed to assess the chromosomal makeup of each of the embryos.
OCPC Readers: Email questions to Women’s Health with Dr. Minoos at DrMinoos@OCPCmagazine.com. ____________________________________________________________________________
Dr. Minoos Hosseinzadeh is a nationally recognized specialist in reproductive endocrinology at the largest and most-established locally-based fertility center in Orange County, Calif., Coastal Fertility Medical Center (http://www.coastalfertility.com). Double-board certified in Obstetrics and Gynecology and Reproductive Endocrinology & Infertility, she is also a member of the American Society of Reproductive Medicine, Society for Reproductive Endocrinology and Infertility, American College of Obstetrics and Gynecology and the Royal College of Physicians and Surgeons. She has presented at several national and international fertility meetings and authored numerous papers on hormone replacement therapy and age-related female infertility.
