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What Causes Recurrent Pregnancy Loss (Rpl)?

What is Recurrent Pregnancy Loss?

Recurrent Pregnancy Loss (RPL) is when a woman has two or more clinical pregnancy losses (miscarriages) before the pregnancies reach 20 weeks.

The best IVF center in India recommends some evaluation after each loss with a more extensive workup after three or more miscarriages. A prompt and thorough assessment of RPL is critical in the setting of advancing reproductive age. Where time is particularly of the essence. It is essential to find potentially remediable factors and assist a couple in conceiving again. As soon as possible to maximize the chances of a successful outcome. 

While miscarriage affects about 15% of pregnancies in general, only 2% of couples are affected by two consecutive losses, and even less, about 0.5%, have three back-to-back losses.

What causes a recurrent miscarriage?

There are multiple causes of Recurrent Pregnancy Loss, out of which a few are listed below: 

  1. Chromosomes Abnormalities: Mismatched chromosomes account for at least 60 per cent of miscarriages. Chromosomes are the minute structures in each cell that carry our genes. Every person has 23 pairs of them, one set from our mother and one from our father. When a sperm and egg meet, one or the other is faulty, and the chromosomes cannot line up correctly. In such cases, the resulting embryo has a chromosomal anomaly, and the pregnancy usually ends up in a miscarriage. Most couples who experience two or more miscarriages in a row discover, this through medical testing. They have chromosomal abnormalities that do not affect them but prevent a pregnancy from taking hold.
  2. Uterine Abnormalities and Incompetent Cervixes: If a person has an abnormally shaped or divided uterus called the uterine septum, miscarriage occurs because the embryo either cannot implant or cannot get the nourishment it needs to survive. Uterine anomalies account for about 10 per cent of miscarriages. A weakened or incompetent cervix occurs toward the end of the first trimester. In this case, the fetus grows large enough that causes the cervix to bulge. The weakened cervix does not have the strength to hold the fetus.
  3. Immunological Disorders: This happens when a woman’s body considers sperm as a foreign object and does not let fertilization occur. Antiphospholipid antibodies attack one’s tissues, including embryos, accounting for miscarriage.
  4. Polycystic Ovary Syndrome (PCOS): is now an emerging cause of recurrent miscarriages. Women with polycystic ovaries have extremely high levels of the male hormone testosterone, which, among other things, causes irregular menstruation and ovulation. Women with PCOS are more prone to acquire gestational diabetes, and even if they do not have diabetes. PCOS related insulin resistance can still affect the lining of the uterus.
  5. Bacterial Infections: Two bacteria called Mycoplasma hominins and Ureaplasma urealyticum live in the genital tract of healthy men and women but can elevate the chance of miscarriage. In women, infection with these bacteria can inflame the endometrium (the internal lining of the uterus), impeding an embryo to develop.
  6. Lifestyle: Smokers have twice the rate of miscarriage than nonsmokers. Nicotine travels through the placenta and interferes with the blood supply and fetal growth, causing miscarriage.

Are there treatments available for RPL?

In certain conditions, medical or surgical treatment can reduce a woman’s risk for future miscarriage. 

The treatment of RPL is based on clinical imaging and laboratory results. Couples in which one of the spouses carries a chromosomal abnormality should be directed for genetic counselling in order to discuss the probability of achievable pregnancy based on the chromosomes involved.

Will a person be able to have a baby even with a history of RPL?

Even after having three miscarriages, a woman has a 60%-80% chance of conceiving and carrying a full-term pregnancy.  

Fertility centers provide two alternatives: IVF and Pre-implantation genetic diagnosis (PGD). In IVF, fertilization is done outside the body in a laboratory, and PGD is a laboratory procedure used in confluence with IVF to reduce the risk of passing on inherited conditions.

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