Repeated Miscarriages
Recurrent miscarriage is defined as the loss of three or more pregnancies. Recurrent miscarriage is a heterogeneous condition that has many possible causes; more than one contributory factor may underlie the recurrent pregnancy losses. When a patient experiences several losses of pregnancy consequently, it will make sense to evaluate the female patient with respect to the following possible scenaria:
1- Genetic Factors
All couples with a history of recurrent miscarriage should have peripheral blood karyotyping performed. The finding of an abnormal parental karyotype should prompt referral to a clinical geneticist.
2- Cervical Weakness
This is a known anatomical cause of miscarriage and pregnancy loss may be recurrent. The cervix (or neck of the womb) is normally strong enough to remain closed throughout the course of pregnancy, in spite of the ever-increasing size and weight of the womb contents. In fact, even at term, hormonal changes have to take place whereby specific hormones are released to act on the cervix, making it softer and thinner and allowing it to dilate in labour. With an incompetent cervix, the cervix is anatomically weak, causing the womb to lose its contents - around mid-pregnancy. Typically, miscarriage caused by an incompetent cervix occurs between sixteen and twenty-four weeks of gestation.
3- Endocrine Factors
The term endocrine hormonal factor in infertility refers mainly to the absence of ovulation, which results in disorders of the menstrual cycle (oligomenorrhoea, primary or secondary amenorrhea) and less commonly to the condition of luteinized unraptured follicle. In cases of oligomenorrhoea or amenorrhea satisfactory results can be achieved with conventional ovulation induction methods, avoiding the use of assisted conception techniques.
4- Immune Factors
These can include
- Antithyroid antibodies
- Antiphospholipid syndrome
- Alloimmune factors
5- Infective Agents
TORCH (toxoplasmosis, other [congenital syphilis and viruses], rubella, cytomegalovirus
and herpes simplex virus) screening is unhelpful in the investigation of recurrent
miscarriage.
6- Inherited Thrombophilic Defects
Inherited thrombophilic defects, including activated protein C resistance (most commonly due to factor V Leiden gene mutation), deficiencies of protein C/S and antithrombin III, hyperhomocysteinaemia and prothrombin gene mutation, are established causes of systemic thrombosis.If you have experienced recurrent miscarriages with or without IVF treatment, it is worth investigating the cause prior to attempting yet another IVF treatment. Sometimes, a miscarriage can be prevented by taking small measures, so it makes sense to identify the cause before you make an attempt at IVF treatment.
