Recurrent miscarriages are one of the main reasons that lead patients to seek help from fertility specialists. Although spontaneous abortion can occur in any pregnancy, its recurrence creates the need for further investigation.
Some experts point out that pregnancy losses do not have to be consecutive to be considered a problem, and a history of giving birth to a live baby between miscarriages does not necessarily reduce the risk of recurrence. In addition, there is no universal consensus on the exact number of miscarriages required to initiate a thorough medical evaluation.
Early diagnosis and a personalised approach can contribute to the successful outcome of a future pregnancy. With proper investigation, it is possible to identify possible factors affecting pregnancy and to propose solutions that will help improve fertility.
What are the types of repeated miscarriages?
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Biochemical elimination
This is an early pregnancy that is detected by a urine or blood test, but does not progress to show up on ultrasound. Beta chorionic gonadotropin levels decrease gradually, without the need for medical intervention.
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Recurrent miscarriage
A pregnancy that stops progressing after implantation of the embryo, but without immediate miscarriage. It is often diagnosed by ultrasound when no heart function is detected.
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Delayed miscarriage
It occurs after the 12th week and up to the 20th week of pregnancy.
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Premature birth
When fetal loss occurs beyond the 20th week of pregnancy.
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Causes of recurrent miscarriages
Genetic causes
Causes related to fetal genetics include alterations in the karyotype of the parents and chromosomal mutations associated with advanced maternal age and/or sperm problems.
Immunological or coagulation disorders
Immunological or coagulation disorders in the expectant mother are one of the main causes of miscarriages of known origin.
Infections in the 1st quarter
Infections in the first trimester, such as cytomegalovirus infection, toxoplasmosis or rubella, can be a cause of miscarriage.
Other risk factors
There are other factors that increase the risk of recurrent miscarriages, such as maternal obesity, associated pathologies (high blood pressure, diabetes) and multiple gestation.
Prevention and Treatment of Recurrent Miscarriage
To prevent recurrent miscarriages, it is important to have various tests and evaluate all risk factors.
First, serological tests should be performed to detect infections such as rubella, cytomegalovirus and toxoplasmosis.
In addition, we assess the morphology of the uterus and the permeability of the fallopian tubes by ultrasound study or hysterosalpingography to exclude malformations or fibroids.
It is also important to investigate for thrombophilia or blood clotting disorders, as these can cause clotting and affect blood flow, making pregnancy dangerous.
In cases of recurrent miscarriages, the karyotype of the parents should be tested and preimplantation genetic testing (PGD) should be performed to rule out genetic abnormalities or structural alterations.
Also, preimplantation genetic testing for aneuploidies (PGT-A) may be performed to detect abnormalities associated with advanced maternal age or abnormal sperm to select embryos with the highest probability of successful implantation and viable pregnancy.