For couples who are trying to conceive a baby, the appearance of 2 lines on a home pregnancy test (HPT) represents joyful news signaling the beginning of a couple’s journey to becoming first time parents or increasing their family. When a miscarriage occurs, couples experience shock, disbelief and sadness. Pregnancy loss is far more common than most couples realize with the chances increasing with a women’s age. For women under the age of 30, the risk of pregnancy loss is 9 to 12%. The incidence of miscarriage triples for women after age 35 and approaches 50% per conception for women after age 40. Fortunately, the vast majority of women who experience a pregnancy loss will have a successful outcome with their next conception. However, for approximately 3% of couples, pregnancy loss becomes a recurring problem. For these couples, a double line on the HPT unleashes a roller coaster of emotions including fear and anxiety. Recurrent pregnancy loss (RPL) can affect both childless couples as well as those who have 1 or more healthy children. According to the American Society for Reproductive Medicine, couples who experience 2 or more pregnancy losses should undergo a medical evaluation. Testing can be helpful in elucidating a cause for RPL in up to 50% of couples.
The majority of miscarriages are due to chromosomal abnormalities in the embryo/fetus. Generally, embryos with too many or too few number of chromosomes (aneuploidy) can not develop into a healthy baby and result in abnormalities that lead to fetal death. Most of the time, aneuploidy is a chance event, the frequency of which increases with the advancement of a women’s age and, to a lesser extent, the male partner’s age.
For couples who experience more than 2 pregnancy losses, medical issues may be identified allowing intervention that can lead to a healthy baby. Reproductive Endocrine/Infertility physicians, specialized in the testing and treatment of RPL, can assist patients in identifying potential causes and prescribing treatments to improve a couple’s chance for achieving a successful pregnancy.
Disorders associated with RPL include chromosomal rearrangements that can be passed from the mother or father to their baby that results in the baby having an abnormal amount of genes, blood clotting disorders or antibodies that negatively affect embryo implantation or development of the placenta, abnormalities in the structure or shape of the uterus including the presence of scar tissue, polyps, fibroids or other congenital defects as well as hormonal abnormalities such as poorly controlled diabetes or thyroid disease. Additionally, lifestyle and environmental factors including obesity, cigarette smoking, use of drugs and consumption of alcohol and caffeine have been associated with increased risk for pregnancy loss.
The positive news is that treatments are available to assist couples who are experiencing RPL. For women who have experienced two pregnancy losses, seeking an evaluation can bring them closer to reaching their dream of having a healthy baby.