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Recurrent Pregnancy Loss (RPL)

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  • Recurrent Pregnancy Loss (RPL)

“No matter how much time passes there will always be this hollow place deep inside that throbs for the one who is gone.”

Pregnancy loss occurs in 10 to 15% of all pregnancies, of which 1-2% are recurrent. The World Health Organization (WHO) has defined miscarriage as the loss of a fetus weighing <500g, which would normally be at 20-22 complete weeks of gestation.

Recurrent abortion is traditionally defined as three or more consecutive miscarriages occurring before 20 weeks.

ASRM guidelines suggest two or more clinical miscarriages (Ultrasound Documented) but may not be consecutive.

When to start testing?

(Do we wait for 3 abortions before start testing?)

  1. No at 2 abortions we can start testing the causes of recurrent pregnancy loss
  2. In some cases even at 1 abortion testing is done like:
    1. If women is older >35 years
    2. Pregnancy after infertility treatment.

Causes of Recurrent Pregnancy Loss:

Genetic causes

  • 2-4%
  • Associated with parental chromosomal abnormality in which most common cause is balanced translocation.

Infectious Factor

  • 0.5%
  • Toxoplasma gondii, rubella, HSV, measles
  • Direct infection to the uterus, foetus or placenta

Immunological Factor

  • 3-5%
  • Antiphospolipid syndrome

Anatomic factor

  • 10-15%
  • Endometrial factor
  • Congenital uterine anomalies
  • Intrauterine adhesions
  • Uterine fibroids or Polyp
  • Other mullerian anomalies like: unicornuate, didelphic, bicornuate
  • Asherman syndrome

Endocrine factor

  • 17-20%
  • luteal phase defect
  • PCOS
  • Diabeties
  • Thyroid disease
  • hyper prolactinemia

Environmental Factor

  • Exposures to
    1. Smoking
    2. Alcohol
    3. Caffeine

Diagnosis of Recurrent Pregnancy loss

Diagnosis evaluation mainly includes:

Karyotypes of POC/ parents

Uterine Anatomy (evaluation by 3D USG/ Hysteroscopy)

Evaluation of Thyroid Dysfunction

Testing For Diabetes

Antiphospolipid Syndrome

Selected Thrombophilias

Conditions

Some of the treatments used in recurrent pregnancy losses are

1. Antiphospolipid Syndrome thrombophilia. Ecosprin & Heparin

ANTICOAGULANT DRUGS are used

2. Parental Chromosomal abnormality: Treatment may be either use of donor gametes or IVF with PGD

3. Unexplained recurrent pregnancy loss: No proven treatment yet available for unexplained reasons but lot of clinical trials are going on for immune therapy / G-CSF Therapy etc.

4. Progesterone Support

For such patients three magical words needed are:

Studies have shown in patients of RPL that Tender LovingCare (TLC) is equally effective as other experimental treatments.

Origyn Fertility & IVF, winner of Best IVF clinic award have dealt with many complicated cases of recurrent pregnancy loss in a very comprehensive manner. Our aim is to give couple’s hope turn into reality.

So don’t lose hope have a second opinion/advice from Dr Rashmi Sharma, an international name in Infertility & IVF, contact today or mail us at info@origynivf.com