All Things Infertility
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.
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I have two children. One at age 31 and one at age 35. Both conceived naturally and easily and carried to term. I am now 38 and trying for #3. I have been pregnant naturally 4 times in 7 cycles. HCG never got above 100 and they all ended at 4-5 weeks. I haven’t had FSH, AMH, etc tested because I keep getting pregnant and they won’t test it on a pregnant cycle. I had an elevated TSH of 3.75 and one factor on thrombo. panel elevated at 26 and should be less than 10. I don’t remember what it was. They were to be repeated at 3 day blood work, but I got pregnant again, so it hasn’t been repeated. Also, my LH surge detected with opks is very low and fast. It peaks, sometimes not becoming all the way positive and lasting about 12-24 hours from increase to decline. I was first told that this was just bad luck and old eggs and I would need to catch a good one, but after 4 in 7 cycles, it seems like more than bad luck. I have long cycles at 31-35 days with ovulation at 18-24 and an 11-12 day luteal phase. Progesterone was 14 at 12 dpo in last pregnancy. Could the elevated TSH be causing this. I was told at one US that there didn’t appear to be any fibroids or cysts. What other tests do I need and what could be causing this.
It sounds as if the biological clock could be at work here. I would be happy to review your case with you. Call 800-780-7437 and set up a Skype consultation with me if you wish.
Geoff Sher