Recurrent Pregnancy Loss (RPL)
Recurrent pregnancy loss (RPL) affects 2-4% of reproductive-aged women and is defined as two or more pregnancy losses back to back. A thorough evaluation is required to diagnose the cause of RPL. Causes include:
**- Immune factors
- Anatomic factors (e.g. abnormalities in the anatomy of the uterus)
- Genetic factors (in a woman, her male partner, or the fetus)
- Endocrine factors (e.g. thyroid disease, diabetes)
- Thrombophilia factors (i.e. blood clotting disorders)
- Immune Factors (e.g. Antiphospholipid Antibody Syndrome)
- Environmental factors (which may be found at work, at home or following certain medical procedures)
- Lifestyle issues (e.g. tobacco use or heavy alcohol use)
A thorough examination by a reproductive endocrinologist will identify which of the above issues is causing your RPL, but in many cases, the diagnosis can be genetic factors in the embryo related to a mother’s age, or a condition called Diminished Ovarian Reserve (DOR).
What both these conditions have in common is that they lead to a higher than normal number of abnormal embryos. Since research has shown that the number one cause of miscarriage is an abnormal, or chromosomally-imbalanced, embryo, recurrent miscarriage is often a product of abnormal embryos implanting inside the mother’s uterus before failing to progress because of their poor reproductive potential.
As mentioned above, there are two main causes of a higher than normal number of abnormal embryos (women of all ages can make abnormal embryos), and thus RPL.
The first is advanced maternal age. Because eggs age as a woman ages, and age contributes to cellular breakdown and disrepair in all parts of our body, including our eggs, the older the woman, the higher the chances her eggs will be abnormal and lead to abnormal embryos once fertilized with sperm. These abnormal embryos will, in turn, most likely lead to miscarriage.
The second cause is DOR, which is when a woman has fewer eggs, and fewer good quality eggs, than she should at her age. In other words, it’s when a woman’s eggs age faster than they should. Women with this condition can be as young as in their 20s.
Both of these conditions can be treated with In Vitro Fertilization (IVF) and Preimplantation Genetic Testing for Aneuploidy (PGT-A), which tests embryos for their chromosomal makeup before implantation so doctors can transfer only one normal embryo that has a high chance of resulting in an ongoing pregnancy and birth.