When people hear the word “infertility” they often assume a woman is unable to get pregnant.
But there is another kind of infertility that is just as heartbreaking if not more so: recurrent miscarriage.
Recurrent miscarriage, also known as recurrent pregnancy loss, is defined as having two or more clinical pregnancy losses (spontaneous miscarriages) before 20 weeks of gestation. These women are able to get pregnant, but not able to stay pregnant.
Losing pregnancy after pregnancy can be emotionally devastating, but the important things to know are that it is not your fault and there is help.
The most common causes of recurrent miscarriage are:
Aneuploid embryo. An aneuploid embryo is an embryo that does not have the correct number of chromosomes (embryos with 46 chromosomes–the correct number– are called euploid embryos). Most aneuploid embryos are not viable, meaning they cannot survive to develop into a healthy fetus. This is a common occurrence that often happens before a woman even knows she’s pregnant, however the prevalence of aneuploid embryos increases as a woman ages. About 60% of miscarriages are due to aneuploid embryos. About 3% of miscarriages are due to one of the partners being the carrier of a genetic anomaly known as a balanced translocation. This results in missing or extra chromosomes in the embryo.
Abnormal uterus. Some recurrent miscarriages are due to problems with the anatomy of the uterus. A malformed uterus can make implantation difficult or hinder the growth of the embryo or fetus. Examples include:
- Septate uterus, where a membrane divides the inner portion of the uterus.
- Bicornate uterus, where the uterus has a partial split, forming a heart shape.
- Adhesions or scarring of the uterus.
- Recurrent D&Cs can cause adhesions that bind the walls of the uterus together.
- Endometriosis can cause scarring and inflammation in the uterus. Prior surgeries can leave behind scar tissue.
- Fibroids are benign tumors that grow inside the uterus.
- Polyps are small, usually benign growths of endometrial tissue inside the uterus.
Cervical insufficiency. The cervix is the very bottom portion of the uterus. During pregnancy it remains tightly shut until close to the time of labor. However, with cervical insufficiency, also called incompetent cervix, the cervix begins to open too early, which can result in miscarriage.
Possible causes of cervical insufficiency include trauma to the cervix caused by medical procedures; exposure to diethylstilbestrol (DES), a synthetic form of the hormone estrogen, before birth; or a genetic disorder affecting the production of collagen. Ethnicity also plays a role as black women are more at risk of developing cervical insufficiency than other groups.
Certain medical conditions. A woman’s risk of recurrent miscarriage goes up if she has certain medical conditions such as Antiphospholipid syndrome (a blood clotting disorder), diabetes, thyroid conditions, or polycystic ovarian syndrome (PCOS).
Despite the pain of recurrent miscarriage, there is hope. With today’s advanced fertility treatment options, women who have had recurrent miscarriages can often, with the help of their doctors, carry a healthy baby to term. Talk to us today about the “other” type of infertility.
