En
Tr
Contents 5
Recurrent Pregnancy Loss
Recurrent pregnancy loss is an especially wearing experience for expectant mothers. In this article, we take a close look at recurrent pregnancy loss in order to examine its causes and, most importantly, to share information about treatment options — a condition that needs to be addressed both physically and emotionally. Dear patients, I want to remind you once again that you are not alone in this process, and that there are many ways to overcome this situation. Recurrent pregnancy loss is defined as the ending of pregnancy through two or more consecutive miscarriages or stillbirths. RPL occurs in 1-5% of pregnancies
Causes of Recurrent Pregnancy Loss
Although the exact causes of RPL are not known, many factors are thought to play a role. These factors include:
Hormonal disorders: Irregularities in hormones are one of the potential causes of recurrent pregnancy loss. For example, hormonal disorders such as polycystic ovary syndrome (PCOS), thyroid disease, and lupus can cause RPL.
Chromosomal abnormalities: Chromosomal abnormalities occurring in the early stages of pregnancy can lead to miscarriage or stillbirth. Certain chromosomal disorders, for which either the mother or the father may be a genetic carrier, can affect the normal development of the embryo and lead to recurrent pregnancy loss.
Infections: Infections such as toxoplasma, cytomegalovirus, and rubella, for example, can cause RPL. In particular, infections in the uterus and cervix can lead to recurrent pregnancy loss.
Anatomical problems: Intrauterine adhesions or uterine fibroids, for example, can cause RPL. Congenital abnormalities within the uterus can prevent the embryo from implanting and growing properly
Immune system problems: Abnormalities in the immune system can cause the body to perceive the fetus as a foreign object, which can increase the risk of miscarriage.
Thrombophilia (blood clotting disorders): Certain genetic or acquired problems related to blood clotting can adversely affect blood flow in the uterus and make it difficult to sustain the pregnancy.
Age factor: A woman's age can emerge as a risk factor for recurrent pregnancy loss. As a woman gets older, the likelihood of chromosomal abnormalities and other health problems occurring increases.
Tubal Factor: Hydrosalpinx — that is, fluid accumulation in one of the tubes — can cause the early loss of an implanted embryo.
Other factors: Factors such as diabetes, stress, and poor lifestyle habits (smoking, alcohol consumption, poor nutrition, etc.) can also contribute to recurrent pregnancy loss.
Tests Performed for Recurrent Pregnancy Loss
Complete blood count: Parameters such as hemoglobin levels, white blood cell count, and platelet count are examined to investigate blood disorders or signs of infection.
Thyroid function tests: Thyroid hormone (TSH, T3, T4) levels are measured to detect thyroid disorders. Thyroid hormone imbalances can cause recurrent pregnancy loss.
Hormonal measurements: Estrogen, progesterone, LH, and FSH hormone levels in the body are measured. Hormonal imbalances can increase the risk of pregnancy loss.
Antiphospholipid antibody tests: Antiphospholipid syndrome, an autoimmune disease, can cause recurrent pregnancy loss. This test detects antibodies such as lupus anticoagulant and anticardiolipin.
Genetic tests: Genetic tests may be performed on both the woman and the man to detect genetic mutations, analyze karyotype, and identify structural abnormalities.
Thrombophilia Tests: Disorders in the blood clotting process (thrombophilia) can be one of the causes of recurrent pregnancy loss. Special tests are carried out to identify genetic or acquired thrombophilia factors.
Radiological Imaging: Ultrasonography or a uterine X-ray (hysterosalpingography) are methods used to detect structural abnormalities and blockages within the uterus.
Intrauterine Tissue Sample (Endometrial Biopsy): This is performed to evaluate the inner lining of the uterus (endometrium). Endometrial biopsy can help reveal abnormalities in the endometrium or hormonal imbalances.
Which Treatment Methods Are Used for Couples Experiencing Recurrent Pregnancy Loss?
Treatment for RPL varies depending on its cause. For RPL due to hormonal disorders, hormone therapy may be applied. For RPL due to chromosomal abnormalities, preimplantation genetic testing (PGT) may be performed. For RPL due to infections, the infection is treated. For RPL due to anatomical problems, surgical intervention may be required. For RPL due to immune system problems, immunosuppressive medications may be used.
Genetic counseling: If a genetic abnormality is identified through genetic testing, genetic counseling is provided to the couple. This counseling covers the assessment of possible genetic risks for future pregnancies and the identification of suitable options.
Hormone Therapy: In pregnancy losses caused by hormonal imbalances, hormone therapy may be applied. For example, progesterone support helps the uterine lining thicken sufficiently, supporting the continuation of the pregnancy.
Treatment of Structural Abnormalities: If structural problems in the uterus are leading to recurrent pregnancy loss, surgical intervention may be required. Such interventions may include removal of a uterine septum or removal of polyps or fibroids.
Thrombophilia Treatment: If a blood clotting disorder (thrombophilia) is causing recurrent pregnancy loss, anticoagulant (blood-thinning) medications may be prescribed to prevent clotting, helping to sustain the pregnancy.
Immune System Regulating Treatments: If immune system problems are causing recurrent pregnancy loss, treatment with immune-regulating medications may be applied.
Immune-Regulating Medications: If immune system-related issues are the cause of recurrent pregnancy loss, immune-regulating medications may be used.
In vitro fertilization (IVF): If the cause of recurrent pregnancy loss (RPL) cannot be found, or if other treatment methods have not been successful, some couples may be directed toward IVF treatment. IVF is an assisted reproduction method that involves fertilizing eggs and creating embryos in a laboratory setting. During this process, embryos can be examined through genetic analysis (PGS or PGD), and healthy embryos can be transferred to the uterus.
Recurrent Pregnancy Loss and IVF Treatment
For couples experiencing recurrent pregnancy loss, IVF treatment may be considered in the following situations:
When the cause cannot be identified: If the cause of recurrent pregnancy loss (RPL) cannot be found, or if no treatable cause can be identified, IVF treatment may be an option. With this method, embryos are created in a laboratory setting and undergo genetic analysis. In this way, healthy embryos can be identified and transferred to the uterus.
When there are genetic abnormalities: If genetic testing reveals genetic abnormalities in the couple, IVF treatment may be used. Genetic screening of the embryos (PGS or PGD) can be performed, and in this process, healthy embryos can be selected and transferred to the uterus.
When other treatment methods have not been effective: If hormone therapy, structural correction, or other treatment methods have not been successful in cases of recurrent pregnancy loss (RPL), IVF treatment can offer an alternative. IVF can increase the chance of achieving pregnancy and reduce the risk of miscarriage.
Can RPL Be Prevented?
There is no guaranteed way to prevent RPL. However, a healthy lifestyle and regular check-ups can help reduce the risk of RPL.