miscarriage - Recurrent Pregnancy Loss

Miscarriage occurs in 15 to 25% of pregnancies. The rate of miscarriage risk increases markedly when a woman passes the age of 40, approaching 50% probability in some studies. Most miscarriages are due to chromosomal abnormalities, but other causes may be related to anatomic, hormonal, infectious, or immunological abnormalities. Spontaneous abortion is the technical name for miscarriage. Recurrent miscarriage is usually defined as at least three miscarriages with no more than one pregnancy extending into the third trimester. When a couple presents with this history, the physician attempts to identify any abnormalities that may be causing the frequent losses. A direct cause is found less than half the time these evaluations are performed. Fortunately, couples with such unexplained recurrent miscarriage usually have a high chance of a successful subsequent pregnancy. If the woman does get treated for recurrent miscarriage and subsequently gets pregnant, it is difficult to know whether the treatment was responsible for the pregnancy's success. Unfortunately, few studies have been well done on this subject, and many of the suggested treatments are expensive and experimental. Common tests performed on a couple who have experienced recurrent miscarriages include checking their chromosomes (karyotypes), checking a woman's uterine anatomy (hysterosalpingogram), evaluating common hormonal problems (thyroid, prolactin, glucose), checking for infections (chlamydia and mycoplasma), and checking for common immunologic problems (antibody testing). Treatment can vary in complexity, ranging from taking a baby aspirin each day or undergoing an out-patient surgical procedure to remove a fibroid (hysteroscopic myomectomy) to undergoing complicated immunotherapy.