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Recurrent Miscarriage, Spontaneous
Abortion
Nothing is more disappointing
for a couple than to achieve pregnancy only to have
it end prematurely
in miscarriage. This is particularly true for couples
who have undergone infertility treatments such as advanced reproductive techniques
including IVF
or Donor
Egg.
Unfortunately miscarriage will occur
in approximately 15% of all pregnancies in younger women.
Recurrent pregnancy loss is defined as the loss of three
or more consecutive pregnancies. Data also indicate
that the miscarriage
rate increases as females' age and some studies
indicate that 75% of women
over 45 will experience miscarriage.
Miscarriage's three main causes
include anatomic, where there are
uterine abnormalities, genetic causes, or hormonal
disorders. Uterine abnormalities include an improperly
segmented uterus as in the septate uterus, fibroids
and other conditions. Many of these diseases are diagnosed
by conducting a hysterosalpingogram or hysteroscopy.
In some cases, uterine abnormalities can be surgically
treated. Where successful treatment is not possible,
the only option is to use
a surrogate mother.
Miscarriage is associated
with genetic abnormalities of the fetus and couples
experiencing recurrent pregnancy loss should have a
genetic evaluation, however, this is a rare cause of
miscarriage. Most chromosomal abnormalities are seen
in the fetus and are "random" occurrences.
Preimplantation
genetic diagnosis (PGD) can now be used to rule
out many chromosomal abnormalities in the fetus. In
PGD, embryos are created using IVF and a small sample
of DNA is taken from a cell in the embryo and tested.
If the genetic disorder is present, the embryo will
not be transferred to the mother's uterus. PGD does
not damage the embryo. Even though PGD can rule out
many disorders, women should still undergo routine prenatal
screening.
Endocrine abnormalities can be a cause of miscarriage.
Thyroid abnormalities, Type I diabetes, and elevated
prolactin levels have been associated with recurrent
miscarriage. The miscarriage workup should include testing
for these conditions.
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