Recurrent miscarriage.. Any hope?

Childlessness is an emotive subject I'm our social - culture environment. This is understandable, considering it's implications in issues like inheritance and extended family affiliations.  While infertility (in male or female)  can lead to childlessness, other factors like recurrent miscarriage can render a fertile couple childless.


What is Recurrent miscarriage?
Recurrent miscarriage is classically defined as the occurrence of three or more CONSECUTIVE miscarriages. (though the American society of Reproductive medicine has modified it to indicate two or more miscarriage). It can be quite distressing to miscarry one baby after another. Each loss becomes harder to bear especially if one feels that time is running out. But it is important to remember that 30-60% of all conceptions will end within the first twelve weeks of pregnancy. In 50% of these losses, the woman is even unwarranted that she was pregnant.

Causes of Recurrent miscarriage :


Maternal age:
Advancing maternal age is associated with an increased risk of miscarriage. This is thought to be due to poo egg quality leading to chromosomal (genetic) abnormalities. Sometimes, the mother or father may have a slight irregularity in the genes, but the offspring may be severely affected leading to miscarriage.


Uterine Abnormality :
The uterus (womb) may be abnormal from birth. It could be divided down the center (or septate), or only one half of the womb may have developed. Some women develop abnormalities of the uterus over time. Some women have weakness of the cervix (next of the womb). Again this could be from birth or developed over time. The result is that the almost fully formed fetus is delivered before maturity. It is a cause of a late (or second trimester) miscarriage.


Woman's immune system :
A woman's immune system should (in normal circumstances), be for fighting external forces. But the system is sometimes faulty and forms antibodies (defence chemicals) against some fat cells (phospholipids) of the woman. APS or Anti phospholipid Syndrome makes the blood more sticky and likely to clot. This in turn may stop the pregnancy from embedding. It may also interfere with the blood flow to the placenta. Some other clotting problems may also cause miscarriage.


Infections:
Some serious infections may cause or increase the risk of SINGLE miscarriages. These include Toxoplasmosis, Rubella, Syphilis, and Listeria. It is not clear whether infection plays a role in recurrent miscarriages.


Hormones :
Uncontrolled Diabetes mellitus and uncontrolled thyroid problems can cause miscarriage.


Test done for couples with recurrent miscarriages
After a detailed history (which includes medical, surgical, family and genetic), a physical examination will be conducted. Test include ultrasound, hysterosalpingogram, (XRAY), antiphospholipid antibody check, Hormones tests for thyroid and pancreatic function.


Treatment
The treatment is based on the underlying cause of the recurrent miscarriage. But it must be remembered that irrespective of the findings from the investigations, the chance for successful pregnancy is high.


Unexplained recurrent miscarriage
Over 50% of the patients with recurrent miscarriage will have no cause attributed to it. Thai figure rises in a resource depleted environment like ours where many of the mentioned investigations cannot be done. The good news, Howie, is that of all those with unexplained pregnancy loss, more than 50% will succeed without any intervention