Even if you have had repeated miscarriages, you still have a good chance to have a baby

Causes

There are many reasons for repeated miscarriage. In at least one half of all repeated miscarriages the cause cannot be found. Sometimes your doctor can identify a certain cause. In other cases, the cause is suspected but the link is not clear. If you have had more than one miscarriage, each may have a different cause.

Known Causes

Sometimes a miscarriage can be linked to chromosomal problems in the fetus, medical conditions in the woman, or problems with the woman's uterus. There are tests to help your doctor determine what caused the miscarriage and in some cases treatment is available to avoid problems in future pregnancies.

Chromosomal Problems. More than one half of miscarriages in the first 13 weeks of pregnancy are caused by problems with the chromosomes of the fetus. Chromosomes are tiny structures in the cells of the body. Each carries many genes. Genes determine all of a person's physical traits, such as sex, hair and eye color, and blood type.

There can be problems with the number or structure of chromosomes, or with the genes they carry. Extra or missing chromosomes or genes mean the fetus will not grow as it should. Often miscarriage is nature's way of ending a pregnancy in which the fetus would not have been able to live.

Many such problems occur by chance and have nothing to do with the health of the mother or father. However, in a small number of cases, problems with the parents' chromosomes can cause repeated miscarriage. There are tests to find out if such problems are a factor in repeated miscarriage.

Problems of the Uterus. Several problems of the uterus are linked to repeated miscarriage. Most are not common. They include:

• Defects present from birth, such as a uterus that is divided into two sections by a wall of tissue (septate uterus).
• Benign growths in the uterus, such as fibroids, made up of muscle tissue.
• The cervix that begins to widen and open too soon, in the middle of pregnancy, with no sign of pain or labor.

Medical Conditions. Certain conditions in the mother have been linked to a greater risk of repeated miscarriage. These include:

• Lupus and other autoimmune disorders
• Heart disease
• Severe kidney disease, mainly when linked with high blood pressure
• Diabetes
• Thyroid disease
• Infection in the uterus
• Polycystic ovary syndrome

Antiphospholipid Syndrome. Antiphospholipid syndrome is a disorder of the immune system. Women with antiphospholipid syndrome are at increased risk for blood clots and pregnancy loss. Tests can be done to diagnose this condition.

Possible Factors

There are other factors that are known to cause pregnancy loss. The link between these factors and miscarriage is not clear. The most common ones include hormone imbalance and some blood disorders. If your doctor suspects any of these conditions, he or she may want to do a test and, if necessary, prescribe medication to treat the problem so it does not affect your pregnancy.

Hormone Imbalance. Progesterone is a hormone that prepares the lining of the uterus to nourish a fertilized egg. This happens during the second half of the menstrual cycle. Early in pregnancy, if progesterone levels are too low to maintain the pregnancy, miscarriage can occur. Tests can show if a woman's body is not making enough progesterone. Her doctor may prescribe medication to treat the problem.

Certain Blood Disorders. Thrombophilia is a type of disorder that can make blood clot more than it should. There are several types of genetic disorders that can lead to thrombophilia. One type of disorder, Factor V Leiden mutation, may allow clots to form in the blood vessels to the placenta and lead to miscarriage. Pregnant women with this disorder may be prescribed blood thinners.

Diagnosis

To help find the cause of repeated miscarriage, you will be asked about your medical history and past pregnancies. A complete physical exam, including a pelvic exam, may be done. You may be offered genetic counseling. You also may need certain tests:

• Blood tests to detect any problems with hormones or the immune system
• Chromosomal testing of both you and your partner or of the miscarriage tissue, if it is available
• Tests to detect infection of the uterus

• Hysterosalpingograophy. An X-ray of the uterus and fallopian tubes is taken after the organs are injected with a small amount of dye.
• Hysteroscopy. A thin, light-transmitting device is inserted through the vagina and cervix to view the inside of the uterus.
• Ultrasound. Sound waves are used to create an image of the internal organs.
• Sonohysterogram. A vaginal ultrasound is used to view the uterus. A saline solution is injected into the uterus to help expand the uterus for better viewing.

Coping

The loss of a pregnancy—no matter how early or how late—can cause feelings of grief. You may be troubled and even overwhelmed by these feelings. You may feel discouraged. For many women, it takes longer for their emotions to heal than for their bodies to heal.

Your feelings of grief may differ from those of your partner. You may express your feelings in different ways. Reach out to those closest to you and ask for their comfort and support. Talk to your doctor. There may be support groups in your area that are eager to help. Counseling can help both you and your partner to cope with your feelings.

What You Can Do

If you have had repeated miscarriages, you need to think ahead. Future pregnancies should be planned, diagnosed early, and checked closely. You may be able to improve your chances of having a successful pregnancy in the future by doing certain things:

• Have a complete medical workup before you try to get pregnant again.
• If you think that you might be pregnant, see your doctor right away.
• Follow your doctor's instructions.
• Maintain a healthy lifestyle by eating healthy foods, exercising, and avoiding alcohol, tobacco, and illegal drugs.

Finally. . .

Even if you have had repeated miscarriages, you still have a good chance to have a baby. This is true even if the causes of the past losses cannot be found. Future pregnancies will need early care. Talk to your doctor about any special care you may need as your baby grows.

Glossary

Autoimmune Disorder: A condition in which the body attacks its own tissues.

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Chromosomes: Structures that are located inside each cell in the body and contain the genes that determine a person's physical makeup.

Genes: DNA "blueprints" that code for specific traits, such as hair and eye color.

Lupus: An autoimmune disorder that causes changes in the joints, skin, kidneys, lungs, heart, or brain.

Pelvic Exam: A manual examination of a woman's reproductive organs.

Placenta: Tissue that provides nourishment to and takes away waste from the fetus.

Polycystic Ovary Syndrome (PCOS): A condition in which increased androgen levels occur and eggs are not released from the ovaries.

Repeated Miscarriage: Consecutive loss of two or more pregnancies before 20 weeks of pregnancy. Also called habitual abortion.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © September 2005 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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