Recurrent Pregnancy Loss: an emotional roller-coaster that can be overcome

Those who have experienced recurrent pregnancy loss need empathy and understanding.  They are often looking for answers to what exactly it is and what can be done about it.  At Sher Fertility Institute New York, we are here to help you during this time and answer any questions you may have.

Recurrent pregnancy loss (RPL) is defined as two or more consecutive clinical pregnancy losses. Although spontaneous pregnancy loss occurs in approximately 15% to 20% of clinically recognized pregnancies in reproductive-aged women, RPL occurs in 5% of the same population. RPL is diagnosed in couples who have never had a previous viable infant, or others who have previously delivered a pregnancy. Notably, this condition can be overwhelming and frustrating for affected couples and is associated with significant emotional distress as up to 50% of cases of RPL will not have a clearly defined etiology.

But patients should remain optimistic in that:

 With a directed approach to diagnosis and careful treatment by REI specialists, a successful outcome will occur in more than two-thirds of all couples!!

  • The couple’s evaluation typically begins after 2 or 3 consecutive miscarriages of less than 10 weeks of gestation.
  • But the assessment may be warranted earlier if a prior miscarriage was found to be euploid (chromosomally normal), or if there is concomitant infertility and/or advancing maternal age.
  • The evaluation should begin with a thorough history and physical, followed by a systematic diagnostic screening protocol.
  • Importantly, management must be evidence-based; unproven treatments should be avoided.
  • But keep in mind: even If no factor is identified, many couples will still eventually have a successful pregnancy outcome with supportive therapy alone.

RPL is a heterogeneous disorder, and a definite cause of pregnancy loss can be established on about 50% of all couples after an extended evaluation. New diagnostic strategies, which include 23-chromosome microarray genetic testing of the products of conception in failed pregnancies, offer the promise of understanding the cause of most pregnancy losses.

A complete evaluation should include investigations into genetic factors (parental -genetic screening and karyotypes, and of miscarried tissue if possible -microarray), uterine anatomic problems (congenital anomalies, fibroids examined by sonohysterogram, hysterosalpingogram, and/or hysteroscopy), immunologic factors (detection of antiphospholipid antibodies and lupus anticoagulant), thrombophilia, endocrinologic (TSH and prolactin hormones and metabolic parameters), and iatrogenic factors.

Treatments should be directed to the correction of specific causes. IVF and PGS can be successful in selecting normal embryos to transfer. Psychological counseling and support should be offered to couples with RPL.

Contact Sher Fertility Institute New York at 646-792-7476 or click here to schedule an appointment with one of our fertility doctors. Our Patient Care Specialists will contact you within the next 24 hours.