Recurrent miscarriage is typically defined as the loss of two or more consecutive Pregnancies before 20 weeks of gestation. While miscarriage is relatively common—occurring in about 10-20% of all pregnancies—recurrent miscarriage affects approximately 1-2% of couples trying to conceive.
Causes of Recurrent Miscarriage
The causes of recurrent miscarriage can be complex and multifactorial, including:
- Genetic Factors
Chromosomal abnormalities in one of the parents or in the embryo are a common cause. Structural issues like balanced translocations in parents can lead to miscarriages.
- Anatomical Issues
Uterine abnormalities, such as septate uterus, fibroids, or scarring, can interfere with implantation or growth of the embryo.
- Hormonal Imbalances
Conditions like polycystic ovary syndrome (PCOS), thyroid disorders, or luteal phase defects may contribute to pregnancy loss.
- Immune System Disorders
Autoimmune conditions like antiphospholipid syndrome (APS) can cause blood clotting issues leading to miscarriage.
- Infections
Some infections can increase the risk of miscarriage, though this is less common.
- Lifestyle Factors
Smoking, excessive alcohol use, and high caffeine intake may increase risk.
- Unknown Causes
In many cases, no clear cause is identified despite thorough evaluation.
Diagnosis
A thorough workup includes:
- Detailed medical history and physical exam
- Blood tests for genetic, hormonal, and immune factors
- Imaging studies like ultrasound or hysterosalpingography to check uterine structure
- Chromosomal analysis of parents if indicated
Treatment
- Treatment depends on the underlying cause:
- Genetic counseling for chromosomal issues
- Surgery for correctable uterine abnormalities
- Hormonal therapy for endocrine problems
- Anticoagulants like low-dose aspirin or heparin for autoimmune causes
- Lifestyle modifications to reduce risk factors
Supportive care and counseling are also essential, as recurrent miscarriage can be emotionally challenging.
