Recurrent Miscarriages or Recurrent Pregnancy Loss (RPL)

A miscarriage is truly a cruel thing to happen to any hopeful couple. It is almost as if they just saw the light at the end of the tunnel and suddenly it went away. We at Janini IVF understand the emotional turmoil a patient goes through, when she has to face a miscarriage. Having said that, a single miscarriage is very common thing to happen and you should not worry about it so much because the chances of another miscarriage after having just one is not too high. It is only when miscarriage repeats itself two or three times when we call it RPL syndrome

Recurrent Pregnancy Loss is defined as two or more pregnancy failures (abortions). Although earlier it used to be defined as 3 or more, now if someone has even 2 successive pregnancy losses she should undergo a thorough evaluation to ascertain the cause behind this. A point to be noted is that a patient can be called an RPL patient only when the pregnancies were "Clinical" and not merely "biochemical". A Clinical pregnancy means it has crossed at least 6 weeks and is visible on Ultrasound whereas a chemical pregnancy is very short lived and is not detected unless sensitive blood betaHCG tests are done serially.

Why should RPL be investigated?

• Hear from the best IVF center in Delhi, About 1/5th or 20% of all pregnancies end up in a loss or abortion in human population.
• Most common cause of any spontaneous miscarriage is chromosomal abnormality and this is sporadic i.e. non-recurrent. In other words, a single spontaneous miscarriage is nothing to worry about as not only its common but also because the most probable cause was something that won't recur again.
• Things start getting dicey when miscarriages happen again and again. While chance of one miscarriage is 20% chance of two successive miscarriages is only 4% whereas the chance of having three spontaneous miscarriages due to independent, random reasons is only 0.16% !!
• In other words, if one patient has three consecutive abortions, there is a very high chance that there was an underlying condition that was responsible and this was not a random event repeating three times.
• So if left untreated or undiagnosed, the same condition could strike again in the fourth pregnancy. To prevent this from happening, it is imperative you get thoroughly evaluated after two or three miscarriages.

What are the causes of Recurrent Pregnancy Loss?

Numerous causes that can be categorised into following :-

• Anatomical defects - uterine septum, polyps, adhesions, fibroids, incompetent cervix and didelphis uterus
• Endocrinological problems - Diabetes in the mother, Thyroid issues, calcium disorders, liver or kidney diseases, PCOS in the wife, Luteal phase deficiency are some of them
• Genetic causes - karyotypic abnormalities in the wife or husband, high sperm DNA Fragmentation in the husband, chromosomal translocations in either of the partner, etc
• Immune disorders - auto-immune diseases in the mother (wife) like Lupus Anticoagulant, Anti-Phospholipid antibody syndrome (APLA), Systemic Lupus Erythematosus (SLE)
• Hereditary or Acquired Thrombophilias in the wife - Factor V Leiden deficiency, Prothrombin Gene mutation, etc are other rare causes
• Sadly but truly, one common reason is Idiopathic - no cause can be found in spite of doing all tests

For detailed information and help, you can seek guidance with our highly qualified gynaecologists at Janini IVF Clinic at Delhi.

What are the recommended investigations to be done in RPL?

• Hysteroscopy - to thoroughly evaluate the uterine cavity
• Karyotyping of both husband and wife
• Sperm DNA Fragmentation index test
• Blood tests like APLA panel, anti-thyroid antibody test, tests for Thrombophilias
• Hormone tests like thyroid, sugar, progesterone

Treatment of Recurrent Pregnancy Loss

Treatment depends on the reports on the investigations. If no cause is found (i.e. all reports are normal) then all you need is TLC - Tender Loving Care and a warm, relaxed environment at home to take care of future pregnancies. Believe us, in many cases that is the best thing. But if one of the reports is abnormal, we need to treat you accordingly. Some of the treatment protocols include:-

• If APLA screen or Thrombophilia screen positive we need to treat you with one tablet of Aspirin and LMWH (low molecular weight Heparin) daily from the time you are detected pregnant. This will be continued till 36 weeks of pregnancy.
• If hormone problems like Thyroid or Diabetes we need to treat you to correct them
• If uterine defects are found they can mostly be correct by Hysteroscopic surgery. If not a combined Laparo-Hysteroscopy might be required
• If the chromosomal test of one of you is abnormal we might have to consider donor sperm or donor egg treatment
• If sperm DFI is high we will ask your husband to stop smoking or alcohol and prescribe him certain anti-oxidant medications

Why Janini IVF?

Dealing with RPL is indeed frustrating and disheartening. To see your precious pregnancy go waste can be sorrowful. We, at Janini IVF, the best IVF clinic in Delhi, excel in dealing with such difficult cases with compassion and patience that you deserve. Armed with latest technologies like pre-implantation genetic screening (PGS) and Hysteroscopic procedures, we can offer you a scientific, systematic approach with a human touch to your sensitive problem. All you have to do is be mentally strong and stay positive for better things ahead.