OHSU

Recurrent Pregnancy Loss

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Pregnancy loss is an emotionally charged experience. It is often associated with feelings of isolation and uncertainty.  The distress of miscarriage can occur when the loss occurs early during pregnancy (first trimester) or later in pregnancy. We offer  you testing and treatment options in a supportive and compassionate setting.

Miscarriage is the loss of a pregnancy before viability. Miscarriages occur in 15 to 20 percent of all pregnancies.  It is the most common complication of pregnancy. When miscarriages are repetitive, then the condition is referred to as recurrent pregnancy loss (RPL). Approximately 25% of all women experience at least one miscarriage in their lives.

CAUSES OF PREGNANCY LOSS

Alterations in genetic, autoimmune, uterine, hormonal, and immunologic factors have all been identified in women with miscarriage.  The occurrence of pregnancy loss can be related to maternal age. Estimates show that approximately 15 percent of women who are pregnant in their twenties will miscarry.  And 40 to 50 percent of women in their late forties will experience a miscarriage.

For more than 50 percent of women, a complete evaluation can identify a potentially treatable cause of miscarriage. Our team includes specialists in maternal fetal medicine, genetics  and reproductive imaging. We use scientific and proven techniques to diagnose and treat miscarriage.

FREQUENTLY ASKED QUESTIONS

Why do I need genetic testing?
Two separate types of genetic issues are relevant in women with pregnancy loss. Recent studies show that the fetus has some kind of chromosomal abnormality in up to 75 percent of miscarriages. These chromosomal errors begin during the stages of cell division in the embryo. They are not related to the genetic makeup of the male or female partner. In most cases, these types of losses are not repetitive. However they are linked to maternal age. On the other hand, four to six percent of couples with recurrent pregnancy loss have an altered set of chromosomes. This abnormality  predisposes them to pregnancy loss. Genetic testing can identify these alterations, providing an answer and basis for treatment.

Can the uterus be a cause of pregnancy loss?

A normal uterus is critical in the beginning and throughout a healthy pregnancy. Some women’s uteruses are shaped differently. These abnormalities occurred during their own initial development.  They are called congenital malformations. The range of congenital malformations varies widely. Each specific problem requires a unique approach to diagnosis and treatment.

There are other uterine issues linked to pregnancy loss. They include uterine scarring or the presence of leiomyomata (fibroid tumors). There are many techniques used to assess your uterus. They include hysteroscopy, hysterosalpingography, MRI, and saline infused sonography. . Each test has important benefits and limitations. There is no single diagnostic test for the investigation of RPL. Our doctors will help you determine the appropriate screening procedure based on a clinical exam and your history of pregnancy loss.

Are there other reasons for repeated miscarriages?

Some blood disorders (whether known or undiagnosed) have been linked to recurrent pregnancy loss. Women with abnormal blood clotting may be more prone to early or late miscarriage. Women with high-risk personal or family histories should be tested. With proper treatment, these problems can be solved successfully.

Do you recommend counseling services?

Miscarriage can be a personally traumatic experience. And you may have long-lasting effects. Anxiety, depression and stress in your relationship are common following a miscarriage. Several studies show the benefits of supportive and positive settings.  We recommend that you consider counseling or other supportive programs after a miscarriage. We can refer you (individually or as a couple) to counselors who are experts in the field of pregnancy loss.

What is the best treatment for recurrent miscarriage?

Some of the most common treatments for pregnancy loss are surgery, blood thinners or supplements. Your ideal treatment will be based on your individual history, physical exam and the results of tests. In some cases, preimplantation genetic diagnosis (embryo screening), egg or sperm donation or a gestational carrier (surrogate) may be recommended.

Treatment of miscarriage should be based on proven therapies. You should know why a specific therapy is used for you, whether it is safe and what the typical outcomes may be.  All patients with recurrent pregnancy loss are monitored closely during early pregnancy.  Our goal is provide you sound professional advice and support.