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Dealing With Multiple Miscarriages

Managing Recurrent Pregnancy LossMultiple miscarriages strike a heavy blow to those who are trying to have a child. Recurrent pregnancy loss (RPL) is traditionally defined as three or more spontaneous consecutive pregnancy losses with the same partner.

In 2012, the American Society for Reproductive Medicine Practice Committee issued a statement that defined RPL “as a disease distinct from infertility defined by two or more failed consecutive pregnancies.” In the U.S., the majority of infertility specialists will begin testing after two losses. Most insurance companies will agree to pay for complete evaluation for RPL after two consecutive losses.

In previous blogs, we have discussed the causes, testing and management of RPL, as well as immune tests for RPL.

In a recent paper, Kutteh W.H. at Vanderbilt University Medical Center proposed a novel strategy for managing recurrent pregnancy loss. It involves a new testing evaluation algorithm based on the testing of the products of conception after a second miscarriage (see Figure). Using this algorithm, the chromosomal status (karyotype) on the second miscarriage determines the next step in the evaluation for RPL.

Algorithm for the management of RPL

If the miscarriage tissue is chromosomally abnormal (aneuploid), the explanation for the pregnancy loss is known and in the absence of other factors, no further evaluation is necessary at that point in time. In those cases where the karyotype has not been obtained or a karyotype is normal, a full RPL evaluation should be performed.

If the miscarriage tissue shows specific abnormalities (unbalanced translocation or inversion), both parents should have their chromosomes checked. These patients may benefit from preimplantation genetic diagnosis (PGD) for future pregnancy attempts.

If products of conception from the first miscarriage are normal, the chance that the second miscarriage will have a normal karyotype is 65%. Conversely, if the genetic analysis on the products of conception from the first miscarriage is aneuploid, the second miscarriage will be aneuploid in 65% of cases. In patients with sporadic spontaneous miscarriage, the incidence of chromosomal abnormality is around 50%. In RPL patents, the incidence of aneuploid is actually lower (35%)!

To see a fertility specialist with many decades of experience treating patients who have had multiple miscarriages and / or repeated pregnancy loss, make an appointment at one of InVia’s four Chicago area fertility clinics.

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