The underlying cause of recurrent pregnancy losses will guide the treatment approach.
However, it is important to remember that about half of all cases of recurrent pregnancy loss will not have an obvious cause, making a precise treatment more difficult. Ultimately, the majority of women with or without a proven cause of recurrent pregnancy loss will go on to have a successful pregnancy.
In cases in which a known genetic abnormality has been detected there are a variety of diagnostic and treatment options for future pregnancies. A genetic counselor will often be helpful in answering questions regarding the likelihood of future genetic abnormalities and what the specific abnormalities may entail. Some couples undergoing in vitro fertilization may then go on to elect for procedures such as preimplantation genetic testing for aneuploidy (PGT-A), once PGS, or preimplantation genetic testing for monogenic disorders (PGT-M), formerly PGD, to uncover genetic abnormalities about the embryo prior to transferring it back into the uterus.
In other cases, the underlying cause for recurrent miscarriages may be an abnormality of the uterus that hinders an optimal environment for the growing fetus. Uterine abnormalities which fall into this category include fibroids, polyps or a uterine septum, all of which may be addressed with surgical procedures. Among the most common structural causes in this category is a fibroid that encroaches or disrupts the lining of the uterus. Depending on the size and location of the fibroid, it may be removed with a minimally invasive or open surgery.
Sometimes an underlying medical disorder is the only causative factor for miscarriages. This can range from minor perturbations of the thyroid to fulminant diabetes. These conditions must first be well controlled before a healthy pregnancy. In other cases, an underlying medical disease leading to a state in which the blood’s tendency to clot is elevated may need to be addressed with blood thinners.
Ultimately, there is a wide range of reasons which may lead to recurrent pregnancy losses. A thorough diagnostic workup is mandatory to attempt and treat the proper underlying condition. Shared medical decision making will guide the physician and the patient to approach the most suitable treatment options. Early monitoring of the pregnancy will remain a critical component. While there is a wide variety of underlying causes and treatment, most women will go on to a have a healthy pregnancy even after multiple losses.
There is good evidence to suggest that close careful monitoring without extensive medical intervention can improve outcomes for women who has suffered multiple miscarriages. These outcomes highlight the importance of focusing on decreasing stress, improving coping tools, optimizing whole body and mind wellness through a variety of modalities including massage, meditation and therapy.
Miscarriages that occur after the first trimester often have different causes than early miscarriages, however occasionally there is some overlap.
Late miscarriages are often caused by syndromes that can have a genetic cause or by severe birth defects (abnormalities in the physical formation of the baby like a heart defect or neural tube defect).
Antiphospholipid Antibody Syndrome, called sticky blood syndrome, which can cause early losses is also responsible for late miscarriages. There are other blood clotting disorders that could be problematic in late pregnancy that are not causes of early losses.
Medical conditions that are not well controlled, such as high blood pressure, diabetes or thyroid can also cause issues after the first trimester. Certain nfections, both bacterial and viral can be the cause of a late pregnancy loss. The cervix can also be the cause of a late loss, as it can be unable to hold the pregnancy in as a result of previous surgeries or genetics.
The treatment for a late pregnancy loss very much depends on the cause. Therefore an individualized approach is necessary for any future pregnancies.