Recurrent Pregnancy Loss: Exploring Causes and Treatment Options

Frequent pregnancy loss is a surprisingly common phenomenon. Research on the matter has revealed that nearly 15% of all medically recorded pregnancies end in failure. Recurrent Pregnancy Loss or RPL is a term that is used to define a condition wherein a repeated miscarriage occurs or someone experiences three or more pregnancy losses before reaching 20 weeks from their last period. It’s a challenging situation for those hoping to have a baby.

Impact of Recurrent Pregnancy Loss or RPL

1. Emotional Strain: Recurrent pregnancy loss often tends to deeply challenge couples. It  subsequently affects them emotionally thereby also testing their resilience.
2. Physical Impact: Beyond the obvious emotional toll that occurs as a consequence of RPL, there’s also significant physical strain on a woman’s body during and after the loss.
3. Grief and Sorrow: Anticipation and hope are replaced by grief and sorrow, creating a complex emotional landscape.
4. Isolation Challenges: Couples often grapple with a mix of emotions, including grief, sadness, and, at times, a sense of isolation.

Recognizing and addressing various repercussions of Recurrent Pregnancy Loss  or RPL – both the emotional and physical – is crucial for providing comprehensive support during the healing process.

What are the causes of Recurrent Pregnancy Loss or RPL? 

1. Genetic Causes: Aneuploidy stands out as quite a prevalent factor in recurrent pregnancy loss (RPL). Foetal translocations that include both balanced and unbalanced translocations, as well as Robertsonian translocations, often contribute to spontaneous miscarriages.
2. Anatomic Factors: Congenital anomalies in the Mullerian tract, such as septate, unicornuate, bicornuate, didelphic, and arcuate uteri, can lead to RPL. Acquired uterine issues like fibroids, polyps, and Asherman syndrome also elevate the risk.
3. Endocrine Influences: Maternal endocrine disorders, notably diabetes and thyroid dysfunction, are potential causes of RPL. Evaluation and appropriate treatment are crucial. While hyperprolactinemia is associated, its direct link to RPL is not conclusively proven.
4. Antiphospholipid Antibody Syndrome (APLS): Accounting for a notable percentage of RPL cases (8 to 42%), APLS increases the risk of thrombosis and placental insufficiency, contributing to recurrent pregnancy loss.
5. Environmental Contributors: Lifestyle factors play a role, with cigarette smoking affecting trophoblastic function and raising RPL risk. Obesity, alcohol consumption, cocaine use, and excessive caffeine intake are also associated with an increased likelihood of spontaneous miscarriages.
6. Immunological Aspects: Routine testing for inherited thrombophilias in women with RPL is not currently recommended. However, screening may be considered in cases of a personal history of venous thromboembolism or a family history of high-risk thrombophilia, though prospective studies have not consistently confirmed this association.

Clinical Considerations to consider during Recurrent Pregnancy Loss  

Understanding recurrent pregnancy loss (RPL) as a clinical entity demanding diagnostic testing and therapeutic intervention is of paramount importance. This recognition is grounded in the awareness of the heightened risk associated with subsequent foetal loss and the possibility of uncovering a treatable cause. 

By acknowledging RPL as a distinct clinical concern, healthcare professionals can proactively engage in diagnostic measures to pinpoint potential contributing factors, enabling a more targeted and effective approach to intervention. 

This proactive stance not only addresses the immediate concerns surrounding foetal loss but also opens avenues for personalised and potentially preventive measures, fostering a more comprehensive and nuanced approach to managing and mitigating the impact of recurrent pregnancy loss on prospective parents.

Evaluation Criteria for RPL

While the probability of finding an etiology for RPL after 2 versus 3 or more miscarriages isn’t exactly quantified, available data suggests a 30% risk of miscarriage in subsequent pregnancies after 2 losses, compared to 33% after 3 losses in patients without a history of a live birth.

The data strongly supports the need for evaluation after just 2 losses, particularly in patients without a live birth. Early assessment may be especially warranted if foetal cardiac activity was detected before a loss, the woman is over 35 years old, or the couple has experienced difficulty in conceiving.

What are the treatments available for Recurrent Pregnancy Loss?

• Hormonal Correction: Addressing hormonal issues is a key aspect of treating recurrent pregnancy loss.
  
• Surgical Intervention: Surgical procedures may be employed to correct uterine abnormalities or remove fibroids contributing to recurrent pregnancy loss.
  
• Preimplantation Genetic Testing (PGT): Utilizing PGT allows for the screening of embryos before implantation, reducing the risk of genetic abnormalities and recurrent pregnancy loss.
  
• Immunological Treatments: Immunotherapy may be recommended to modulate the immune system and mitigate factors contributing to recurrent pregnancy loss.
  
• Blood Thinning Medications: The use of anticoagulant medications is considered to manage blood clotting issues, potentially reducing the risk of recurrent pregnancy loss.
  
• Innovative Therapies: Various innovative therapies aim to improve implantation and reduce pregnancy loss. These include Intralipids, which modulate immune responses, and Low Dose Naltrexone (LDN), an immune system modulator that aids oocyte implantation.
• Antibiotics and Immunomodulators: Antibiotics are utilised to eradicate bacteria causing inflammation in the reproductive system, decreasing the risk of infection during IVF. Immunomodulators like Prograf and Prednisone address immune system issues associated with recurrent pregnancy loss.
• Blood-Thinning Medications: Medications such as Lovenox and low-dose aspirin play a role in preventing blood clotting, especially for patients with a history of blood-clotting disorders or autoimmune issues.
• Specialised Infusions: Treatments like HCG wash and Intravenous Immune Globulin (IVIG) are designed to enhance the chances of successful implantation by creating a receptive uterine environment and modulating immune responses.
  
• Innovative Medications: Medications like Filgrastim (Neupogen), Sildenafil (Viagra), and Metformin are explored for their potential in immune system modulation, improved blood flow, and regulation of metabolic systems.
  
• Nutritional Supplements: Essential nutrients like Folate, Omega-3s, and Vitamin D play vital roles in reducing the risk of recurrent pregnancy loss. These supplements contribute to maternal health, reduce inflammation, and support foetal development.
  
• Comprehensive Testing: Pregmune testing assesses folate levels, contributing to risk reduction for recurrent pregnancy loss. The use of comprehensive prenatal supplements, such as Molecular Fertility’s Peak Prenatal and VivoMega Fish Oil, is recommended for preconception and prenatal health.

Why choose Banker IVF?

Considering the complexities of recurrent pregnancy loss (RPL), we at Banker IVF understand the emotional and physical challenges you face. Our compassionate team specialises in personalised treatments, including hormonal correction, surgical interventions, preimplantation genetic diagnosis (PGD), immunological therapies, and blood-thinning medications. 

With over 65 years of expertise, we recognize RPL as a clinical concern, offering proactive diagnostic measures for targeted interventions. Early evaluation is crucial, especially if you’ve faced two losses or exhibit specific risk factors. Discover hope and comprehensive support at Banker IVF – your partner in navigating the journey toward parenthood.