Recurrent Pregnancy Loss – Diagnosis and Treatment in India
Miscarriage is the loss of a pregnancy before viability. Occurring in 15-20% of all pregnancies, it is the most common complication of pregnancy. Studies show that approximately 25% of all women experience at least one miscarriage in their lives. The individual risk may vary depending on age and other factors. Despite its prevalence, many women feel isolated and responsible for the loss of a pregnancy. The unfortunate fact of miscarriages is that the vast majority of them are not preventable because they are due to developmental or genetic problems in the embryo or fetus that cannot be treated.
Recurrent pregnancy loss (RPL) or recurrent miscarriage (RM) affects from 1-5 % of the reproductive age couples. This diagnosis is both emotionally challenging and confusing for most couples, as the definitive diagnosis using conventional evaluations is found in fewer than half of the couples experiencing repeated loss. The distress associated with the experience of recurrent miscarriage often leads patients to unproven testing and treatments. Studies show that women with no identifiable cause have a very good chance of having a successful pregnancy when standard treatments are used. It is our goal to offer scientifically proven testing and treatment for patients with recurrent pregnancy loss in a supportive and productive environment.
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Our center offers a multidisciplinary approach to recurrent miscarriage by performing testing and treatment for genetic, anatomic, hormonal and immunologic abnormalities is performed.
A healthy uterus, or womb, is essential for the success of a pregnancy. Uterine abnormalities can be congenital or acquired as a woman ages. Transvaginal ultrasound can only diagnose a few of the important uterine anomalies, and frequently further testing is required. Testing the uterine cavity can be done with a hysteroscope, a small camera place into the uterine cavity through the cervix. Other testing such as hysterosalpingogram (HSG), saline infused sonogram or MRI can also be used. Our physicians will recommend the tests most appropriate for the condition.
Studies have concluded that about half of all first trimester miscarriages are the result of chromosomal abnormalities. These generally occur on a sporadic basis, meaning that they are random occurrences. They are, however, related to the age of the woman and are more likely to occur with advancing maternal age.
Research suggests that after a couple has had 2 or more unexplained miscarriages, there is a 2-5% risk that one member of the couple is a carrier of a balanced chromosome rearrangement. Chromosomal analysis of the products of conception (the miscarried fetal tissue) and of the woman and her partner may provide additional important information that will affect future reproductive decisions and additional testing recommendations.
Having a single miscarriage is believed to be a mechanism of quality control, and often the result of a pregnancy starting off with an abnormal number of chromosomes. An abnormal number of chromosomes can lead to missing or duplicated genetic information, which may not be compatible with life.
This type of miscarriage or random genetic error usually occurs very early in the pregnancy. Almost half of all losses of early pregnancies (less than 6 weeks in gestational age) are caused by this type of error.
Seeing a specialist for miscarriages is important when:
- Pregnancy tissue from the miscarriage was tested and found to have had a normal number of chromosomes you are over 35 years of age
- You are having difficulty conceiving again, and or
- One or more of the pregnancy losses took place after 10 weeks gestational age
Your doctor IVF-ICSI CENTER Delhi will likely test for some or all 5 of the main causes identified by scientific studies to date, and include:
- Hormonal (Endocrine)
- Structural (Anatomical)
- Clotting issues which may affect the placenta, specifically Inherited thrombophilias (or clotting disorder); or Acquired thrombophilias (Antiphospholipid syndrome)
In approximately 3% of couples with recurrent pregnancy loss, one partner is carrying a structural abnormality in their chromosomes (genetic material) which then can be passed on to a pregnancy. We can examine your chromosomes by taking a blood sample from you and your partner. If an abnormality is found, we will arrange a consultation with a genetics specialist who can provide you and your partner with further information on how this may affect future pregnancies.
This refers to measuring the levels of several hormones that we know to play a role with fertilization and pregnancy. We will screen for thyroid problems, prolactin (milk producing hormones) as well as male and female hormones that may give us information on how your menstrual cycle is functioning.
Approximately 20% of couples with recurrent miscarriage are found to have a problem with development of the lining of the uterus (endometrium). This is called a luteal phase deficiency (LPD). This development is controlled by the hormones estrogen and progesterone.
The optimal way to find out if the hormones are working together correctly is to take a sample of the lining called an endometrial biopsy (EB). It is very important that you use some form of birth control or abstain from intercourse during the cycle in which the EB is done. This test is scheduled during the latter half of your cycle, between day 21 – 23.
Types of procedures we may order to assess the uterine cavity:
- Pelvic ultrasound (abdominally and vaginally) This is often the first step, and will be done at the time of your initial clinic visit. Please arrive to the appointment with a partially full bladder, at the end of your consultation, you will have the ultrasound.
- Hysterosalpingogram (HSG) This is often referred to as the “dye tests”. A small amount of dye is inserted into the uterus through a cannula and an x-ray is taken. The x-ray shows the shape of inside of the uterua as well as the fallopian tubes. This test is done between day 6-10 of your menstrual cycle.
- Hysteroscopy A small telescope is placed into the cervix into the uterus. This is hooked up to a TV monitor so that you and your doctor can see the inside of your uterus. This can be done at any time in your menstrual cycle as long as you are not bleeding or pregnant.
- Sonohysterogram This test is similar to the HSG but an ultrasound is used instead of x-rays. Saline is inserted into the uterine cavity through a small plastic tube and a 3D ultrasound details the uterine cavity, and if needed, the patency of the tubes.The ultrasound probe is placed in the vagina to visualize the uterus on a TV monitor.
What happens if all my tests are normal?
Approximately 40% of couples with recurrent miscarriage do not have a genetic, endocrine, anatomical, or autoimmune factor. If all of the standard tests are normal, the couple is classified as having unexplained recurrent miscarriage. You and your doctor together will decide what course of treatment is indicated here.
A large part of our recurrent pregnancy loss program involves very close and early pregnancy monitoring. Studies have shown this management does significantly improve your chances to take home a baby.