Having a miscarriage can be devastating to prospective parents. Sadly, 15% (or more!) of pregnant people suffer recurrent loss of pregnancy. When this happens, it can tax the emotional and mental health of all involved.
Many women who suffer multiple miscarriages seek out the expert counsel of Dr. Steve Rad, a double-board certified Obstetrician-Gynecologist with sub-specialty training in Maternal-Fetal Medicine.
Dr. Rad understands that 8% of pregnancies are termed high-risk. He’s also aware that even if a pregnancy begins as low risk, it can easily escalate into the high-risk category.
Dr. Rad and his team at the Los Angeles Fetal and Maternal Care have decades of Perinatology experience. They are among the very best high-risk pregnancy specialists in Los Angeles, providing state-of-the-art treatments for those suffering from recurrent miscarriages.
What is the definition of recurrent pregnancy loss?
The American Society of Reproductive Medicine defines recurrent miscarriage as two unsuccessful pregnancies. Pregnancy loss is defined as one ending before 20 weeks of gestation — after either being recognized on ultrasound or identifying pregnancy tissue after the loss.
What are the causes of recurrent pregnancy loss (RPL)?
Of those who suffer miscarriages, as many as 50% of those pregnancies end with no known cause, according to the American College of Obstetricians and Gynecologists.
The good news is that couples that have recurrent miscarriages with no known cause may have a chance of a successful pregnancy with the help of an expert Maternal-Fetal Medicine specialist.
Though recurrent miscarriages are not completely understood by doctors, several risk factors are well-agreed upon. These are:
Maternal age
At 35, women have a 20% risk of miscarriage. At 40 there is a 40% chance. After 45, the risk soars to 80%.
Previous miscarriage
People who’ve already had two miscarriages run a higher risk of miscarriage.
Anatomical problems
Sometimes a uterus isn’t the correct shape for pregnancy, or a patient may have an abnormal cervix. Other physical barriers to pregnancy include
- uterine septum
- cervical insufficiency
- uterine fibroids
- uterine scarring
These abnormalities can be evaluated with special studies and procedures, such as 3D/4D advanced ultrasound, MRI, hysteroscopy, saline sonogram, and hysterosalpingography (an X-ray of the uterus and fallopian tubes).
Blood clotting diseases
The main blood clotting problem is antiphospholipid syndrome. This condition causes the immune system to mistakenly create antibodies that make blood much more likely to clot. In pregnant women, this can prevent a pregnancy from properly implanting in the uterus, causing a miscarriage.
Hormonal/Endocrine imbalances
Progesterone deficiency, elevated prolactin, and insulin resistance can all contribute to miscarriage.
Unhealthy lifestyle
Smoking, drinking alcohol, or using illicit drugs has a negative impact on the health of mother and child. Women who smoke, drink alcohol, or use illicit drugs during pregnancy increase their risk of miscarriage.
Weight
Being overweight or underweight can increase risk of miscarriage.
Some prenatal tests
While prenatal tests can be important, some – such as chorionic villus sampling and amniocentesis – carry a slight risk of causing a miscarriage.
Genetic conditions
Patients over the age of 35 often produce eggs or sperm with chromosomal abnormalities. Sometimes one or both parents have a genetic condition called translocation, where a piece of one chromosome breaks off and joins another.
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Treatments for recurrent miscarriage
Statistically, half of the patients who undergo blood tests after consecutive pregnancy losses are found to have a physical abnormality. The reasons for early pregnancy loss can usually be discovered by Dr. Rad, who is an expert in these types of abnormalities.
Recurrent miscarriage treatment for anatomic abnormalities
The primary treatment for cervical or uterine abnormalities is a diagnostic and therapeutic hysteroscopy.
To perform a hysteroscopy, the doctor inserts a thin, lit tube (endoscope) through the cervix into the uterine cavity. This procedure allows the doctor to find and treat causes of abnormal bleeding as well as remove polyps, uterine fibroids, uterine septums, and uterine adhesions.
Recurrent miscarriage treatment for genetic abnormalities
If you’re experiencing recurrent pregnancy loss with no obvious cause, we may recommend genetic testing. Both parents undergo chromosomal tests to check for genetic problems that may interfere with the ability to carry a full-term pregnancy. Genetic testing helps doctors identify missing or defective genes. This information helps them understand if a person, their partner, or their baby is likely to have certain medical conditions.
Serious chromosomal problems that affect the chance of normal pregnancy, such as both partners being carriers of an autosomal genetic disease, may necessitate genetic testing on embryos if undergoing in vitro fertilization (IVF). This process is called preimplantation genetic testing for monogenetic disease, or PGT-M (formerly known as PGD).
If undergoing IVF with a fertility specialist after multiple miscarriages, the embryos will be tested and only normal ones will be transferred to the uterus.
Dr. Rad and his team also have a specialized fertility program for women in this unfortunate situation.
Recurrent miscarriage treatment for autoimmune disease
Many times blood clotting problems can spell pregnancy loss. Three tests the doctor can run are for lupus anticoagulant, anticardiolipin antibody, or anti β2 glycoprotein I. If any of these tests turn up negative, the doctor begins treatment for an overabundance of blood clotting.
Blood thinning is usually accomplished using a combination of low-dose aspirin and blood thinner heparin.
Recurrent miscarriage treatment for hormonal imbalance
When a woman has recurrent miscarriages due to a hormonal imbalance, most times doctors can effectively treat the problem.
Low thyroid disorders can be brought back up to a normal range by taking additional thyroid hormones. Or, physicians may treat an overactive thyroid by treating the gland itself.
For insulin resistance, doctors suggest diet and exercise as the first line of defense. If needed they provide insulin-controlling medications.
When prolactin levels are elevated — this is a hormone that causes the breasts to grow and make milk during pregnancy and after birth — medicine can be given that lowers the level.
The good news is that couples that have recurrent miscarriages with no known cause may have a chance of a successful pregnancy
Recurrent miscarriage treatment for lifestyle factors
Treatment for lifestyle factors is very important for all women preparing for pregnancy. Expectant mothers should quit smoking and not subject themselves to second-hand smoke.
Make sure your diet is full of folic acid, iron, calcium, and vitamins D, B, and C, as these are all important for a healthy pregnancy. If you’re worried about your weight, consult with your doctor for healthy ways to lose or gain weight. Having a healthy diet and exercise regimen prior to pregnancy can improve fertility and improve pregnancy outcomes. Some women may need to seek advice from a weight expert if they need further help.
Expectant mothers should abstain from all alcohol and caffeine.
Recurrent miscarriage treatment for unknown causes
For women who suffer from unexplained recurrent pregnancy loss, Dr. Rad and his team have a specialized Recurrent Pregnancy Loss Program. After a thorough consultation and evaluation, the program is customized to your personal medical history.
Oftentimes, these patients require serial ultrasound scans and additional treatments to promote a healthy pregnancy. Treatment may include progesterone, aspirin, Heparin, and an autoimmune protocol, among others. The goal is to improve uterine blood flow and treat any undiagnosed immune or blood problems.
Dr. Rad and his team have extensive personal experience in this area with great success over the years. Each patient is unique and a specialized plan is developed as they work closely on your case.
More about Dr. Rad
Perinatologist Dr. Rad and his world-class Maternal-Fetal Medicine (MFM) obstetrics and gynecology team at Los Angeles Fetal and Maternal Care understand your High-Risk OB and infertility needs before, during, and after birth. We provide compassionate care and help you understand your pregnancy, answer questions, and provide emotional support to safely navigate your pregnancy.
Call us at (844) 473-6100 or schedule your consultation online. We are currently accepting new patients.
We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, Newport Beach, Irvine, and Downtown Los Angeles. We also offer in-home prenatal care and a fly-in program for out-of-town and international patients. Dr. Rad even travels to patients who need him throughout the U.S. and around the world.
If you can’t make it to Dr. Rad, he also offers virtual consultations worldwide.
Call (844) 473-6100 or click here to schedule online
What causes recurrent miscarriages?
Recurrent miscarriages can stem from various factors including:
- Chromosomal abnormalities in the embryo
- Uterine abnormalities such as fibroids or a septum
- Hormonal imbalances like thyroid disorders or PCOS
- Autoimmune disorders such as antiphospholipid syndrome
- Infections like bacterial vaginosis or certain STIs
- Blood clotting disorders such as Factor V Leiden mutation
- Lifestyle factors like smoking, excessive alcohol consumption obesity
Is recurrent miscarriage considered infertility?
Recurrent miscarriage is a distinct condition from infertility, although they can sometimes coexist or share underlying causes. Recurrent miscarriage refers to the loss of two or more consecutive pregnancies before 20 weeks gestation, while infertility is defined as the inability to conceive after one year of regular, unprotected intercourse.
Can endometriosis cause recurrent miscarriages?
Endometriosis is a condition where the tissue that normally lines the inside of the uterus (endometrium) grows outside the uterus. While endometriosis itself doesn’t directly cause recurrent miscarriages, it can potentially contribute to fertility issues. However, not all women with endometriosis will experience fertility problems or recurrent miscarriages.
Can IUI help recurrent miscarriage?
Intrauterine insemination (IUI) is primarily used as a fertility treatment. It does not directly address underlying causes of recurrent miscarriage. In some cases where infertility contributes to recurrent miscarriage, successfully achieving pregnancy through IUI with careful monitoring and support may lead to a healthier pregnancy outcome.
Can IVF help with recurrent miscarriage?
While In vitro fertilization (IVF) itself does not directly address the underlying causes of recurrent miscarriage, it can offer several potential benefits for this challenge. IVF allows for:
- careful selection and screening of embryos before transfer
- preimplantation genetic testing (PGT)
- optimal timing of embryo transfer
Can PCOS cause recurrent miscarriages?
Polycystic ovary syndrome (PCOS) is a hormonal disorder characterized by irregular menstrual cycles, elevated levels of androgens (male hormones), and the presence of ovarian cysts. While PCOS itself does not directly cause recurrent miscarriages, it can contribute to fertility issues that may increase the risk of pregnancy complications, including miscarriage.
How common are recurrent miscarriages?
The prevalence of recurrent miscarriage varies depending on the population studied and the criteria used for diagnosis, but it’s estimated to affect around 1% to 2% of women trying to conceive. While the majority of miscarriages occur as isolated events, experiencing recurrent miscarriages can indicate underlying factors that may require medical evaluation and intervention.
Can fibroids cause recurrent miscarriage?
Fibroids, which are noncancerous growths of the uterine muscle, can potentially contribute to recurrent miscarriage, although the extent of their impact varies depending on factors such as size, number, and location. Small fibroids that do not distort the uterine cavity are generally not associated with an increased risk of miscarriage. However, larger fibroids or those located near the uterine cavity can interfere with implantation or blood flow to the developing fetus, potentially increasing the risk of miscarriage.
