Recurrent Pregnancy Loss

By Rafat Abbasi, MD

Infertility is defined as the inability to conceive after one year of unprotected intercourse. However, couples who experience pregnancy loss are also unable to complete a family. Recurrent pregnancy loss is a form of reproductive failure. It is defined as three or more consecutive losses. Most losses occur in the first trimester.
The incidence of spontaneous miscarriage is about 15-20%. Early losses that occur even before a missed period may be as high as 30-50%. In women who have a history of two or more previous losses the risk increases to about 40%. The risk of miscarriage is increased with advancing maternal age. Evaluation should be instituted after 2 losses especially in the infertility population.
Causes of recurrent
pregnancy loss include
Anatomic factors
Genetic problems
Hormonal abnormalities
Immunologic problems
Hematologic problems
Infectious agents
Environmental effects
(In about 50% of patients, no cause may be found.)
The diagnostic workup must be systematically completed, as several factors could be causing miscarriages. A complete exam, blood tests and X-ray studies may be required to ascertain the cause(s) of pregnancy loss. Grieving for the loss is important. Psychologists who specialize in grieving should be involved to counsel the patient and give support.
Lifestyle changes are important. Dealing with stress and using adjunctive treatments such as acupuncture have shown positive results. Smoking and excessive caffeine intake should be discouraged. The use of recreational drugs should be avoided.
Additionally, some studies have documented the impact of paternal age as well on pregnancy loss. Occupational exposure to environmental toxins has been linked to poor sperm quality. Advanced paternal age is also associated with chromosome defects and several birth defects.
In summary, it is important to offer these couples the benefit of a complete evaluation coupled with emotional support.