Recurrent pregnancy loss and miscarriage is a common fertility issue that many couples experience. Physicians Stephen Greenhouse, M.D. and Shruti Malik, M.D. from Shady Grove Fertility’s Fair Oaks location answer some of the most frequent questions about recurrent pregnancy loss and the treatment options available to our patients.
How is recurrent pregnancy loss defined?
Recurrent pregnancy loss is defined as a woman who has had two or more miscarriages either consecutive or interspersed between a live birth.
How common is miscarriage and recurrent pregnancy loss?
Recurrent pregnancy loss is relatively common. Women in their 20s have about a 20 percent chance of a miscarriage while women in their 40s have around a 50 to 60 percent chance of miscarriage. The likelihood of two consecutive miscarriages, which is defined as recurrent pregnancy loss, is less than 5 percent in women under the age of 30 but can rise to 25% in women over 40. In the event this occurs, it’s recommended to seek an evaluation from a fertility specialist.
Does age play a role in miscarriages?
Yes. The most common cause of first trimester miscarriage is a chromosomal abnormality within the embryo. As a woman gets older, her likelihood of having a genetically abnormal embryo increases.
How do we determine the cause of recurrent pregnancy loss?
The first step during the evaluation is to discuss the history of the patient, including the number of miscarriages and other obstetrical information. Following the initial evaluation, we then do a series of tests to determine the underlying causes of the miscarriages. The evaluation may involve:
- Testing the chromosomes of both partners to see if there is any type of chromosomal rearrangement, which is called a balanced translocation
- Testing the uterus to check for abnormalities such as scarring or a condition called a uterine septum
- Hormone testing to look at progesterone levels, thyroid levels, and prolactin
- Clotting or autoimmune testing
Do lifestyle factors have an effect on recurrent pregnancy loss?
Yes. There are certain lifestyle adjustments that can improve the chances of having a successful pregnancy.
- Quit smoking.
- Limit caffeine use.
- Limit alcohol use.
- Maintain a healthy weight.
What treatment options are available to patients who are struggling with recurrent pregnancy loss?
Our physicians base treatment decisions on a patient’s specific diagnosis. In 50 to 60 percent of patients, no specific diagnosis is found. This may be frustrating for patients, but it does not mean there are not treatments available for those patients or they won’t have a successful pregnancy.
One of the things we can do at Shady Grove Fertility is in vitro fertilization (IVF) paired with preimplantation genetic screening (PGS). This is when we biopsy the embryos during the blastocyst stage to look for any chromosomal abnormalities that are likely to result in implantation failure or miscarriage
Because of the higher percentage of abnormal embryos as women age, especially in women who are in their late 30s or early 40s, IVF with PGS may improve pregnancy rates and decrease miscarriage rates from about 50 percent to 8 to 10 percent per cycle.
IVF with PGS may not be the first line of treatment someone will go through when they come to Shady Grove Fertility. A patient’s age and the number of miscarriages they’ve had will determine the level of treatment that is appropriate to give a patient the highest chance of success.
If you would like to learn more about Shady Grove Fertility’s In Vitro Fertilization (IVF) treatment program, Genetic Testing of Embryos, or to schedule an appointment, please speak with one of our New Patient Liaisons at 877-971-7755 or complete this Schedule an Appointment.