Recurrent Pregnancy Loss

17 Jan
Recurrent Pregnancy Loss

Recurrent Pregnancy Loss (RPL) is defined as more than 3 consecutive first trimester losses or miscarriages. The incidence is approximately 2% of reproductive aged women. There are various causes of RPL including anatomic, endocrine, genetic, immunologic and infectious disorders. The causes can generally be categorized as a) problems with the embryos and b) problems with the environment that support the embryo.

Anatomic causes can include things such uterine polyps, fibroids or congenitally abnormal uteri. This can be diagnosed by several methods including hysterosalpingogram (HSG), sonohysterogram or fluid ultrasound (FUS), or hysteroscopy. Anatomic problems other than congenital disorders can typically be treated by minor surgery.

Endocrine disorders can involve problems such as an underactive or overactive thyroid gland, elevated prolactin levels, diabetes or insulin resistance. The disorders can be diagnosed with simple blood tests and can be treated rather easily through diet and medication.

Genetic problems can come from the parents or the fetus itself. Parental disorders can be diagnosed with a blood chromosome test called a karyotype. Fetal genetic problems can be diagnosed by biopsying an early stage embryo and testing a single cell with a test called comparative genomic hybridization (CGH). This is done during in vitro fertilization, and only genetically competent embryos are transferred to the uterus, thus reducing the risk of miscarriage greatly.

Immunologic causes result when the maternal immune system rejects the implantation process. There are several reasons for this, including rejection of the maternal aspect of the pregnancy, as well as rejection of the paternal aspect of the pregnancy. Good screening tests for immune disorders include natural killer cell (NK Cell) assay and antiphospholipid antibodies (APA).

In rare cases, certain bacteria have been implicated in RPL. These include bacteria such as mycoplasma and ureaplasma. These can easily be diagnosed with cervical cultures and treated with antbiotics.

18 Comments

  • Cindy says:

    Hi Dr. Sher. I was told to contact you with my story. I am 36 years old. I have 4 healthy children. 3 of them are from a previous marriage and 1 with my current husband. With all of my living children, I had normal, healthy pregnancies. We decided in December of 2011 that we wanted to have another baby. I got pregnant right away and did well until I reached 15 weeks. I lost that baby….. A few months later, we decided to try again. Everything was great until 16 weeks and the same thing happened. Only the cord was wrapped around the baby’s neck very tightly, 4 times.Many months later, we try again. I get pregnant right away and made it to 17 weeks. Now we’ve had all genetic testing done and all the clotting disorder tests done. They have even checked my thyroid. Everything is perfect. I have researched everything I can for RPL and have found out about testing for MR and NK cell testing. I have contacted my Ob, RE and MFM and all 3 refuse that testing. They say it’s unnecessary and doesn’t have anything to do with losses. I would love to know how I can go about getting the tests done with you. I’m sorry this is so long. Thank you for taking the time to read this.

    • Cindy says:

      It should say I have researched testing for MTHFR, not MR. I apologize.

    • Geoffrey Sher says:

      Hi Cindy,

      I cannot disagree with your RE’s about this being unlikely to be an immunologic implantation issue…with one exception. First let me say that that all your losses seem to have occurred after you had one child with your 2nd husband. Thereupon you started losing pregnancies in the 2nd trimester (by the way, I do not believe that a cord entwined around the neck, that early in pregnancy would have caused the one loss). The exception I am alluding to is an uncommon form of immunologic implantation dysfunction-IID (i.e., Alloimmune Dysfunction) where genetic similarities between the man and the woman can cause natural killer cell activation after one or even more successful pregnancies to term. With this variety of IID there is a DQ alpha or HLA genetic match that can result in gradual activation of uterine natural killer cells (NKa) after the successful conclusion of one or even two pregnancies. Usually such activation will result in earlier (1st trimester losses) but it is not “inconceivable” that it could cause later losses. Call our office at 702-699-7437 and have Tina set up a Skype consultation at least 2 weeks later, with me to discuss. Ask Tina also to have you speak with Linda Vignapiano RN (Clinical manager) and tell hero arrange for your and your husband’s blood to be sent to Reprosource Reproductive immunology Reference Laboratory in Boston, MA for the following tests: DQa, HLA, NKa, ATA, APA. Explain to Linda that I need these results available before we have our Skype consultation.

      Please go to the home page of this blog, http://www.IVFauthority.com. When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

      1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

      2. “Ovarian Stimulation for IVF: The Most important Determinant of Outcome! (November 18th 2013)”

      3. “Agonist/Antagonist Conversion Protocol”

      4. “Immunologic Implantation Dysfunction” (2 articles, posted on May, 10th and on May 16th respectively).

      5. “Thyroid Autoimmunity and IVF”

      6. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

      In conclusion……perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization, the ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

      • Cindy says:

        Thank you very much for your response. I will definitely be calling your office and get things started. I’m just wondering. If this were to be our problem, what exactly is the treatment, or is there one? Am I through having babies? It saddens me to think this could be the end for me.

  • Sarah says:

    My first pregnancy was very normal resulting in my now almost 2 year old child. I have now had 2 consecutive miscarriages in the past 6 months – the first was a blighted ovum ending in d&c, the second was a missed miscarriage at 11 weeks (baby stopped developing at 9 weeks) after hearing a healthy heartbeat. This also ended with a d&c for RPOC. I have just learned that I have the homozygous MTHFR gene mutation and am wondering if this could have contributed to my losses. I also wanted to see what is normally done for patients with this gene mutation. Thanks!

    • Geoffrey Sher says:

      SARAH!

      I doubt the MTHFR thrombophilia played the predominant role here.

      Perhaps you would consider calling 800-780=7437 on Monday to set up a Skype consultation with me so we can discuss in depth.

      Heoff Sher

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