Treatment for recurrent miscarriage at Texas Fertility Center New Braunfels

Losing a pregnancy is one of the hardest life events for any woman. Losing two or more in a row is a condition known as recurrent miscarriage that needs specialized fertility care.

On average, 15% of pregnancies are lost. Much of this depends on the age of a woman, though there can be other factors. In her 20s, the risk is about 10% chance of loss. The chance increases to 50% in the early 40s and up to 80% in the mid-40s. Much of this is a result of egg quality. As a woman ages, the likelihood of her eggs being chromosomally abnormal increases greatly. Since miscarriage is one of the ways that the body prevents the development of abnormal babies, the odds of both increase with age.

The good news is that most women who have a single miscarriage will go on to have normal pregnancies in the future. However, if a woman has 2 or more consecutive losses, it is recommended that she seek evaluation and possibly treatment.

In the November 2012 issue of Fertility and Sterility, an ASRM committee opinion was published about miscarriages. Here is a summary of what they had to say…

• 15-25% of pregnancies result in miscarriage
• Most miscarriages are due to chromosomal/genetic abnormalities
• Less than 5% of women have 2 consecutive miscarriages (the point where evaluation by your doctor is recommended)
• 1% of women experience 3+ consecutive miscarriages

Evaluating recurrent miscarriage

The tests that are recommended include:

• A karyotype on both partners (a blood test to look at your chromosomes…how many do you have and are they structurally normal)
• Blood tests to evaluate for antiphospholipid antibody syndrome (an acquired condition where your body can fight off a developing pregnancy)
• Evaluation of the uterus and tubes (HSG and saline ultrasound)
• Hormonal imbalances (prolactin, thyroid function tests)
• Blood sugar evaluation (Hemoglobin A1C)

Treatment options for recurrent miscarriage

Although 50% of couples will have a normal evaluation, there are very good treatment options available to address the conditions that are found with the tests mentioned above.
If a chromosomal abnormality is noted, often the use of preimplantation genetic screening (PGS) will allow the couple to increase their chances of having a healthy baby. This is used in combination with IVF. If IVF or PGS is not an option for a variety of reasons, donor eggs or donor sperm may be used to improve the chances of successful pregnancy.

If antiphospholipid antibody syndrome (APLS) is found, treatment during pregnancy with blood thinners such as Lovenox or heparin and low-dose aspirin significantly increase the chances of a healthy baby, and also help keep Mom from developing complications such as blood clots. These medications should only be used under a physician’s supervision.

The HSG and saline ultrasound are used to determine if there are structural abnormalities of the fallopian tubes or uterus. Uterine polyps, which are overgrowths of the lining of the uterus, are very common. They are usually removed through a brief outpatient procedure called a hysteroscopy. Ideally, a hysteroscopy is performed with no incisions and the woman can return to her regular activities the next day. If an abnormality of the tubes called hydrosalpinx is seen on HSG, it will likely be recommended that the tube or tubes be evaluated and potentially removed through an outpatient procedure called laparoscopy. This is a very important finding, as studies have shown that the presence of hydrosalpinx may decrease the chances of successful pregnancy up to 50%.

Prolactin and recurrent miscarriage

Prolactin is a hormone produced from a part of the brain called the pituitary. There are actually many triggers for sporadically elevated prolactin. Because of this, if your levels are high, they will be repeated. If they remain elevated, your physician will likely recommend an MRI of the pituitary to make sure there isn’t a growth that is causing the elevation. Even if there is a growth, often it is not of major concern and is just monitored with MRIs. You may be asked to start to take a medication called cabergoline to help lower the prolactin levels. Thyroid dysfunction is very common. In fact, it is estimated that 20% of women will have some degree of thyroid dysfunction during their lifetime. If you have hypothyroidism (low levels of thyroid hormone, high levels of TSH), you will be placed on a medication to replace the missing thyroid hormone. If you have hyperthyroidism (too much thyroid hormone, low TSH), you will likely be referred to a thyroid specialist for further evaluation.

Obesity and repeat miscarriage

With obesity becoming an epidemic in the US, we are seeing rates of diabetes rise. In addition to having a negative impact on your general health, uncontrolled diabetes can contribute to pregnancy loss. Ideally, hemoglobin A1C levels should stay below 6 for the best pregnancy outcomes.

The important thing to remember is that if you have had 2 or more pregnancy losses, seek evaluation because there are things that can be done to increase the chances of a successful pregnancy.

Dr. Susan Hudson at Texas Fertility Center of New Braunfels specializes in fertility treatments for women who are struggling with recurrent miscarriage. Dr. Hudson sees and treats infertility patients from San Antonio and New Braunfels. Take the first step – call Texas Fertility Center of New Braunfels today to schedule your personal consultation.