Recurrent Pregnancy Loss (RPL) is defined as two consecutive pregnancy losses in a row prior to the 20th week. Statistically, less than 5% will experience two pregnancy losses back to back, and only 1% will experience three or more. Each loss merits careful review to determine if further evaluation is appropriate. After three or more losses, a thorough medical evaluation is warranted to help determine the cause.
Miscarriage is a somewhat loaded term – insinuating that something was amiss in the carrying of the pregnancy. This is rarely true. Research has shown that the large majority of spontaneous miscarriages in the 1st trimester are due to abnormal chromosomes in the developing fetus. Most often, chromosomes may be missing or extra or even sometimes may be attached to the wrong chromosome.
Age too can be a related factor. After age 40, more than one-third of all pregnancies end in miscarriage as most of these embryos have an abnormal number of chromosomes. Hormonal, metabolic and uterine abnormalities also increase the risk of pregnancy loss. Low progesterone levels, poorly controlled diabetes (due to obesity or elevated blood sugars prior to conception), or distortion of the uterus may cause repeated miscarriages. The male factor too may also play a card in the disruption of a pregnancy. Though data is still preliminary, increasing evidence suggests that the integrity of sperm DNA may affect embryo development and possibly increase miscarriage risk.
Though there are some known abnormalities that can help determine the loss of a pregnancy, most miscarriages are difficult to determine the cause. In fact, 50% to 75% of couples with recurrent pregnancy losses often receive no explanation. But on the contrary, couples may take comfort in knowing that approximately 70% of next case pregnancies are successful for those with unexplained recurrent pregnancy losses.
Like early pregnancy, miscarriages are a very private affair. Unlike a birth or a death, they rarely have rituals to mark it. Even close friends can feel isolated and alone, not wanting to share such intimate details. Often grief or debilitating depression affects many women in one form or another. Give yourself time to heal and seek the encouragement and help from loved ones. Understand that typically miscarriages are errors that occur by chance – not problems inherited by the parents. You’ll likely never forget the hopes and dreams surrounding a pregnancy, but in time your pain may subside. Talk to Santa Monica OB-GYN, Tristan Bickman, if you’re feeling profound sadness or depression.
Feel free to seek for guidance about when you might try to conceive. If you think you’re ready to try and experience pregnancy soon, make sure you are physically and emotionally ready. Contraception can be used immediately after a miscarriage, but having sexual intercourse or using internal feminine hygiene products should be avoided for at least two weeks. It is possible for pregnancy to occur within the first menstrual cycle after a miscarriage but just remember that everyone is different and it may take a little time. Most importantly, don’t lose hope – many, many couples go on to experience successful and healthy pregnancies without any intervention at all.
Struggling with multiple miscarriages? For more information and many other women’s health questions contact our office. Dr. Bickman is a well-respected, board-certified obstetrician and gynecologist practicing in Santa Monica, Marina Del Rey, and the Los Angeles surrounding area – a skilled healthcare partner bringing hope and quality care to patients for over 14 years.
In some cases, several miscarriages can cause scarring to occur which can make it more difficult to carry a pregnancy.
No; in fact in more than half of all cases of recurrent miscarriage, the cause cannot be definitively determined. In many of these cases, though, there are clues that can guide successful treatment.
Dr. Bickman will perform a physical exam and a pelvic exam as well as ordering tests that can look for genetic causes and some medical causes like an autoimmune disorder. You may also have an imaging test to check for problems with your uterus or fallopian tubes. And of course, you'll need to provide a complete medical history including information about your past pregnancies.
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