“The unborn life never arrived in your arms but it will never leave your heart”.
Easier said than done, ‘the sun will rise and you can restart the process’. But is it that easy? The pain, agony and distress a woman goes through when she unexpectedly miscarries her baby? No, it’s definitely not! A duration of too many centuries is even less to define what it feels to be pregnant and to define the battles associated with motherhood. Most women don’t even know about what miscarriage exactly is when they miscarry their baby. Things get more complicated and life gets more messy when miscarriages become recurrent and tend to happen more often.
What is a recurrent miscarriage?
Recurrent miscarriages or recurrent pregnancy losses are defined as the loss of two or more pregnancies before 20 weeks of gestation. About 15% of all pregnancies end up as a miscarriage and a common cause of secondary infertility. Secondary infertility is described as the inability to get pregnant or carry a pregnancy to term before the birth of the baby. Most miscarriages tend to happen before 12 weeks of gestation or the 1st trimester of pregnancy. Pregnancy loss prior to the first trimester is commonly caused due to chromosomal abnormalities in the developing embryo.
Symptoms of miscarriage: –
It is important to consider the symptoms of miscarriage to prevent your body from a major harm. A major number of miscarriages take place before the 12th week of pregnancy. Some women experience miscarriage at the earliest stage of pregnancy. Thus, women should be aware of early symptoms of miscarriage at least until she reaches the sixth week of pregnancy.
Common signs and symptoms of a miscarriage can be:
- Abdominal discomfort
- Continuous vaginal spotting or heavy bleeding
- Abdominal cramps or pain
- Pain in lower back
- Fluid or tissue passing from vagina
In case a fetal tissue has been passed from the vagina, women need to keep it in a clean container and bring it to their fertility clinic for analysis.
It is important to note that pregnancies are still possible for most women who have experienced vaginal spotting or bleeding in the first trimester.
In many cases there are chances that women may not feel any symptoms of miscarrying the baby. It is also known as missed abortion. Common missed miscarriage symptoms are:
- Feeling like you are not pregnant anymore
- Continuous vaginal bleeding
- Abdominal cramps
- Discharge of fluid or tissue
Causes Of Recurrent Pregnancy Loss: –
Usually, miscarriages take place after the 11th or 12th weeks of pregnancy. The miscarriage feels like a heavy period flow but its way more than that. Below are some of the prominent causes of recurrent miscarriages.
- Genetic Factors
Genetic factors account for 50-60% causes of recurrent miscarriages in women. Genetic mutations in the parents or in the embryo may result in recurrent miscarriages. Often parents are asymptomatic carriers of such genetic mutations, which when passed down to the offspring could result in lethal conditions or implantation failure. Abnormalities in the genetic material of the embryo may lead to implantation failure or further 1st trimester miscarriages. These defects are usually seen in the oocyte and are less common due to sperm maturation. Errors during cell division, creation and maturation of the oocyte are generally responsible for such first-trimester pregnancy losses.
In most cases, larger chromosomal deletions or duplications or aneuploidies may be responsible for the miscarriages. Genetic testing helps in the identification and further prevention of such defects in later pregnancies.
- Uterine problems
Uterine problems are another major factor that contributes to the cause of recurrent miscarriage. The integrity of the uterus and endometrium that is prepared for implantation of the embryo is dependent on hormone cycles as well as the absence of structural anomalies. Hormones such as progesterone which is released by the ovaries in the second half of the cycle are important for implantation and maintenance of the pregnancy. Any changes in these levels could lead to miscarriages.
For implantation to occur it is important that the uterus is of normal shape and constitution. Abnormalities such as uterine polyps, fibroids and other defects could result in recurrent loss of pregnancies.
- Immunological conditions
Immunological conditions involving certain antibodies such as Lupus Anticoagulant, Anticardiolipin Antibodies and beta-II Glycoprotein are known to be the cause of miscarriages due to clotting in the placenta which inhibits proper implantation. With proper treatment, this can be overcome to prevent miscarriages in future pregnancies.
- Environmental factors
Environmental factors often play an important role in recurrent miscarriages. Factors such as smoking, alcohol consumption and caffeine consumption often lead to loss of pregnancy. It is recommended by Gynaecologists that women who are planning a pregnancy or are pregnant should refrain from smoking and alcohol consumption. Most pregnant women are advised to drink up to 2 cups of coffee per day to limit their caffeine intake. Other than these, strenuous physical exercise may also contribute to miscarriages. Women are also advised to refrain from rigorous aerobics or other cardio exercises during the first trimester of pregnancy.
Many infections such as Mycoplasma, Toxoplasma, and Chlamydia are known to cause recurrent miscarriages. Screening through blood cultures or endometrial biopsy can help detect the same.
- Hormonal disorders
Disorders affecting the endocrine system are also known to adversely affect an ongoing pregnancy. Conditions such as uncontrolled diabetes or thyroid hormone disorders may cause recurrent miscarriages. PCOS is also a hormonal disorder wherein different hormones in the female body get affected which leads to infertility in most cases. In women who do get pregnant have a high risk of undergoing a miscarriage.
- Clotting disorders
The tendency to form blood clots or thrombophilia during pregnancy is known to cause miscarriages. These blood clots usually go and block the blood flow to and from the placenta. This further results in foetal growth restriction, foetal death, pregnancy-induced hypertension and placental separation. Clotting disorders usually cause second and third-trimester pregnancy losses and are rare in the first trimester of an ongoing pregnancy.
- Male factors
Often malefactors such as sperm DNA fragmentation lead to pregnancy loss. A semen analysis along with a special sperm DNA fragmentation test can help identify the problem. For such couples, ICSI (Intracytoplasmic sperm injection) along with IVF (in-vitro fertilisation) can help overcome such problems.
The loss of pregnancies is a difficult time for both partners and many women undergoing multiple such losses may need further diagnosis and treatment to overcome this problem.
Diagnostic tests for Recurrent Miscarriages: –
Gynaecologists may recommend several tests to determine the cause of the recurrent miscarriages so as to help the couples plan their future pregnancies.
A karyotype test is one of the most common genetic tests suggested to couples having recurrent pregnancy losses. This test helps to identify balanced chromosomal translocations in the parents which may cause chromosomal anomalies in the foetus thus resulting in a miscarriage.
A hysterosalpingogram is a specialised radiological test that uses X-ray contrast dye to check the uterus and fallopian tubes for abnormalities or blockages.
- Blood hormone levels
Blood tests to check the levels of different hormones such as Estrogen, Progesterone, Prolactin and Thyroid Stimulating hormone helps to identify the cause of miscarriages
- Saline Sonohysterogram
This test uses sterile water in the uterine cavity and through a transvaginal ultrasound is able to detect any abnormalities in the uterus such as fibroids and polyps.
- Glucose screening
Glucose screening involves testing the female partner for high levels of blood glucose which would result in uncontrolled diabetes and thus could be responsible for recurrent miscarriages
- Vaginal Ultrasound
This test uses high-frequency sound waves to check for abnormalities in the uterus, ovaries and fallopian tubes
- Endometrial biopsy
This test involves the biopsy and further testing of endometrial tissue to check for the presence of infections that could be causing the miscarriages
- Antiphospholipid Antibody testing
This testing involves the detection of Antiphospholipid Antibodies which could cause the immune system to attack the ongoing pregnancy and cause miscarriage.
- Ovarian Reserve testing
This test helps to determine the quality and quantity of the eggs in the ovaries of a woman to identify if depletion of the ovarian reserve is the cause of pregnancy loss
- Sperm DNA fragmentation testing
This test helps to determine if sperm quality and fragmentation of the sperm DNA is the cause of recurrent pregnancy loss.