The Fertility Center

A blog about fertility issues, treatments and trends from the specialists at Greenwich Fertility.

April 23, 2020

Treatment for Recurrent Miscarriage

By Nora Miller, M.D.

If you’ve experienced the heartbreak of multiple miscarriages, you may be asking yourself, “What went wrong?” or, “How do I keep this from happening again?”  It’s important to know that in over half of couples with recurrent miscarriage, there isn’t an identifiable cause.  While that may be frustrating to hear, even after three miscarriages, a woman still has a very high chance (approximately 60%-80%), of successfully conceiving and delivering.

When doctors do find a cause for recurrent pregnancy loss, there are several treatment options that can increase your chances of having a successful pregnancy.  Talk with your doctor to find out if one of these treatment options is right for you.

Genetic testing and screening

Up to 70% of early miscarriages are caused by genetic abnormalities in the fetus.  Sometimes it’s a random, non-recurring problem known as aneuploidy in which there are extra or missing chromosomes.   Other times the problem is caused by a genetic abnormality inherited from one of the parents.  In about 2-5% of couples with recurrent pregnancy loss, one of the partners have a chromosomal abnormality that increases the couple’s risk of having another miscarriage.  Your doctor might recommend  in vitro fertilization (IVF). In this this treatment, women take hormones in order to stimulate multiple eggs to grow to maturity simultaneously. Then, the eggs are removed from her body and placed in the laboratory.  There, the eggs are fertilized with sperm to create embryos.  The embryos can then be biopsied and frozen.  The genetic makeup of the embryos can then be tested from the biopsied cells to determine which of them are normal.   If a specific abnormality was identified in one of the parents (e.g., chromosomal translocation), then that abnormality can be identified.  Alternatively, testing for aneuploidy can be done. Lastly, a chromosomally normal embryo, based on the genetic test results, is transferred into the woman’s uterus.  She now has a much lower chance of miscarriage during that pregnancy since the embryo has already been tested.

Surgical treatment

Sometimes miscarriages are caused by uterine abnormalities —congenital or acquired growth inside the uterine lining.  Examples include intrauterine scar tissue, submucosal fibroids, intrauterine polyps, or a uterine septum (an extra piece of tissue inside the uterus).  Minimally invasive surgery with hysteroscopic resection can treat these abnormal growths and make the uterine cavity normal again.  With a normal uterine cavity, the woman has a higher chance that a subsequent pregnancy will not miscarry and progress to a livebirth.

Medical Treatments

Your doctor will also want to treat any underlying conditions you might have such as undiagnosed or poorly controlled diabetes, thyroid dysfunction or hyperprolactinemia (an abnormally elevated prolactin level).  Any of these hormone imbalances could cause miscarriage and by treating them reduce your chance of another loss.

Testing for antiphospholipid syndrome is also recommended.  If a woman has this autoimmune disorder, treatment with low dose aspirin and heparin will help decrease the possibility of another miscarriage.

Testing for a thrombophilia (predisposition to clotting more easily than normal), is not recommended by the American Society for Reproductive Medicine.

Lifestyle Changes

You can improve your chances of a successful pregnancy by leading a healthy lifestyle.  Quit smoking tobacco or marijuana.  Stop using recreational drugs.  Cut back on alcohol.  Limiting caffeine may also be beneficial. Achieving a normal weight with diet and exercise has also been shown to improve pregnancy outcomes.

Take care of yourself—especially if you’re dealing with the emotional strain of losing a pregnancy.  It might be helpful to join a local or online support group to talk about your experience and hear from others like you. It is important to remember, you are not alone and you should be able to have a baby.

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