recurrent miscarriages

Recurrent miscarriages (Habitual abortion)

A woman’s repeated miscarriage is an extremely traumatic event emotionally. It can even be said that the sadness experienced in an early pregnancy loss is almost as heavy as a stillbirth or a baby lost after birth. Apart from this, one of the important concerns of a woman (and her environment) who has had several miscarriages is whether she will be able to have children in the future.
The risk of miscarriage for a woman in her first pregnancy is about 10%. If the previous pregnancy resulted in a miscarriage, the risk of miscarriage in the current pregnancy increases to 15%. If there is a history of more than 2 miscarriages before, the risk of the next pregnancy resulting in miscarriage is around 30%.

On the other hand, since the possibility of a miscarriage is not at all low, every miscarriage should not be worried, it should be kept in mind that the possibility of not having a miscarriage in the next pregnancy is high, and the physician should not resort to unnecessary and expensive tests after a single miscarriage event.

After how many miscarriages is defined as “recurrent miscarriage”?

It is classically defined as 3 consecutive miscarriages. However, these definitions differ between different researchers (especially considering the age of the patient, there are also those who consider 2 or more miscarriages).

What are the causes of recurrent miscarriages?

Although this issue is very important in terms of women’s health, it is still a subject with many unknowns. Unfortunately, only 50% of women investigated for this reason can find a cause. The underlying causes can be classified as:

1. Anatomical factors (such as uterine deformities, fibroids, polyps, intrauterine adhesions)
2. Immunological factors (conditions related to the immune system)
3. Endocrinological factors (Hormone disorders – deficiency of progesterone hormone, diabetes, prolactin, that is, high milk hormone, polycystic ovary syndrome, goiter)
4. Genetic factors
5. Blood clotting disorders
6. Environmental factors

What are the studies on recurrent miscarriages?

The following are the tests that can be done in line with the reasons mentioned above.

1. Karyotype examination (detection of chromosome number and establishment with blood taken from parents)
2. Evaluation of the uterus (with uterine film or hysteroscopy)
3. Anticardiolipin antibody and lupus anticoagulant research
4. Thyroid function tests

Although less useful, in addition to these examinations;
5. Evaluation of ovarian reserves
6. Evaluation of blood coagulation status
7. Progesterone levels
8. Diabetes research
9. Endometrial biopsy

What are the treatment methods in recurrent miscarriages?

As we have just mentioned, despite all the tests performed, no cause can be found in approximately 50% of the patients. It is clear that if a cause is found, treatment will be applied for it (for example, surgical treatment when the presence of a veil or myoma is detected in the uterus, blood thinning treatment if a coagulation disorder is detected). The main issue here is how to approach patients for whom the cause cannot be clarified. Although there are many treatments that are routinely applied to patients with this condition, most of them lack sufficient scientific basis. Although these treatments seem like harmless treatments, it should be kept in mind that no treatment should be used unnecessarily. According to the characteristics of the patient, it is recommended to make a treatment plan with lower risk and starting from simple to more complex.

Treatment options:

1. Progesterone
2. Aspirin
3. Heparin (blood thinner injection)
4. HCG (cracking needle)
5. HMG (ovulation therapy)
6. IVF and PGD (in vitro fertilization and genetic diagnosis)

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