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Is miscarriage of a sign of infertility?

Is miscarriage of a sign of infertility?

Kindara | April 9, 2021 |
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Miscarriage, the spontaneous loss of pregnancy before 20 weeks, is, unfortunately, a common experience. About 10 to 20 percent of pregnancies end in miscarriage, and chemical pregnancies, those that end very early (before the egg implants in the uterus) may account for up to 70 percent of all conceptions (1, 2). 

One miscarriage is already one too many, but what if you miscarry more than once? Does having multiple miscarriages point to a bigger issue? Here's what you need to know about when to ask for help. 

When should you see a doctor? 

Whereas one miscarriage is often the result of a chromosomally abnormal embryo failing to progress, more than one in a row may indicate that something else is going on (3). Dr. Kimberly Langdon, a retired OB/GYN in the Midwest with 19 years of clinical experience, recommends seeing a doctor after every pregnancy loss to be sure the tissue has passed, and  for a physical exam and testing if you've had more than 2 miscarriages after 11-12 weeks of pregnancy, or 3 or more miscarriages before 10-12 weeks. Three miscarriages in a row before 20 weeks is known as recurrent pregnancy loss or RPL (4). 

Why does Repeat Pregnancy Loss (RPL) happen? 

Before we get into the nitty gritty of RPL's causes, keep in mind that most people who suffer recurrent miscarriage do go on to carry a pregnancy to term. According to the American Society for Reproductive Medicine, women with RPL have a 60-80% chance of carrying a pregnancy to term (5). 

There are a number of reasons for recurrent pregnancy loss (RPL). Many (60%) are due to genetic abnormalities, such as an additional chromosome, a missing chromosome, and there's no medical cause behind these — frustratingly, they just happen (6). Balanced chromosome translocation is one genetic situation that can lead to recurrent miscarriage (7). It occurs when part of a chromosome breaks off and reattaches in another location, so two chromosome sections have switched places. This can result in either extra or missing chromosomal material, and depending on which genes are affected, a miscarriage. One in 500 people (both men and women) are carriers for balanced translocation, and while there's no cure for it, a blood test on both partners can ascertain if it's what's behind recurrent pregnancy loss. 

As you get older, however, there is a greater possibility of genetic abnormality. In a study of 43 women over age 35 with RPL, fetal chromosomal abnormalities were responsible for the majority of miscarriages (8). 

Uterine structural problems account for about 15% of all recurrent miscarriages (9). Issues include untreated inflammation, fibroids, polyps, poor blood supply, and an irregular shape (10). A septate uterus, the most common uterine anomaly, is a condition in which the uterus is separated by a wall of tissue running vertically down the middle, dividing it into two cavities(11). While some women with septate uteruses may have normal pregnancies, it does come with a higher risk of miscarriage and premature birth (12). If you've already had multiple miscarriages, you may have scarring and adhesions in the uterus, also known as Asherman's syndrome. Asherman's Syndrome can reduce the size of the uterus, and can result in very light or no periods, cramping, and miscarriage, but some folks who have it also have no symptoms (13). 

Weakened cervical muscles, or an "incompetent cervix," can also lead to recurrent miscarriages (14). 

Infections such as herpes, chlamydia, German measles, ureaplasma parvum and cytomegalovirus are also causes of RPL, as well as medical conditions that interfere with hormone production like diabetes, polycystic ovary syndrome, and untreated thyroid conditions. Antiphospholipid syndrome is an autoimmune disorder in which your immune system mistakenly creates antibodies against substances which cause blood clotting. If untreated, it can result in miscarriage (15). 

How is Repeat Pregnancy Loss (RPL) diagnosed and treated? 

The resolution of recurrent pregnancy loss depends on the cause of it. Unfortunately, in 50 to 75 percent of cases of RPL, doctors can't figure out the exact source, but don't let that stop you from talking to your health care provider and pursuing testing and treatment (16). 

Methods for diagnosing RPL include a physical exam, blood tests, an ultrasound, genetic screenings, and hormone testing. Your doctor may advise making changes to your lifestyle, such as losing weight, reducing and/or ceasing your exposure to toxins such as nicotine, and curbing your use of alcohol and caffeine (17, 18). 

An endometrial biopsy may be done to see what, if anything, is happening with your uterus and if it's capable of sustaining a pregnancy. Your doctor may recommend a hysterosalpinogram,, which provides a view of your reproductive organs so that any structural issues and conditions (like scar tissue and fibroids) can be seen. A hysterosalpinogram can also be used to document the process of tubal flushing, a procedure in which liquid is passed via pressure through the fallopian tubes to assess whether or not they're open. Blocked fallopian tubes can be an obstacle to conception, but it depends what they're blocked by; if it's mucus, adhesions,  or some kind of cell debris, tubal flushing may clear them out. A 2015 study indicated that when tubal flushing is done with an oil-soluble liquid, it may increase the chances of pregnancy in those with blocked fallopian tubes (19). 

Managing your mental health during multiple pregnancy losses is essential. You deserve to receive care from an empathetic health care professional, and to be supported by those around you. Don't hesitate to ask for help. Taking care of yourself should always be number one. 

Tired of another month gone by without a positive pregnancy test? Priya Fertility System Now Available

About the author

Chanel Dubofsky's writing on gender, reproductive health, popular culture, and religion can be found in New York Magazine, Lilith, Rewire, Modern Fertility, Cosmopolitan, and others. She lives in Brooklyn, New York. Follow her on Instagram at cdubofsky

References +
2

What is a Chemical Pregnancy? (2020, May 22). Retrieved March 1, 2021 from //www.whattoexpect.com/pregnancy/chemical-pregnancy/

6

Repeated Miscarriages. (2020, April). Retrieved March 1, 2021 from https://www.acog.org/womens-health/faqs/repeated-miscarriages

9

Recurrent Pregnancy Loss. (n.d.). Retrieved March 1, 2021 from https://fertility.wustl.edu/getting-started-infertility/multiple-miscarriages/

10

Recurrent Pregnancy Loss. (n.d.). Retrieved March 1, 2021 from https://www.uclahealth.org/obgyn/recurrent-pregnancy-loss

12

Septate Uterus. (n.d.). Retrieved March 2, 2021 from https://www.childrenshospital.org/conditions-and-treatments/conditions/s/septate-uterus

13

Asherman's Syndrome. (2017, June 29.). Retrieved March 3, 2021 from https://my.clevelandclinic.org/health/diseases/16561-ashermans-syndrome

14

Multiple Miscarriage. (n.d.). Retrieved March 3, 2021 from https://resolve.org/infertility-101/medical-conditions/multiple-miscarriage/

15

Antiphospholipid Syndrome. (n.d.).  Retrieved March 3, 2021 from https://www.mayoclinic.org/diseases-conditions/antiphospholipid-syndrome/symptoms-causes/syc-20355831

16

Diagnosing Recurrent Miscarriage. (n.d.). Retrieved March 3, 2021 from https://nyulangone.org/conditions/recurrent-miscarriage/diagnosis

17

Recurrent Pregnancy Loss. (n.d.)  Retrieved March 2, 2021 from (https://www.yalemedicine.org/conditions/recurrent-pregnancy-loss

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