Unlocking the Mystery of Recurrent Miscarriage

A pregnancy that ends before 20 weeks is called a miscarriage. Most miscarriages happen before the end of the first trimester (before 12 weeks). Many occur before a woman even knows she is pregnant. In the past, a woman who miscarried several times might never know why it happened. Today, more and more women are finding out the causes of their recurrent miscarriages.

Recurrent miscarriage is defined as as three or more consecutive pregnancy losses in the first trimester or early second trimester.

Miscarriages are not uncommon. It is estimated that every woman has a 15 to 20 percent chance of having a pregnancy end in miscarriage.

For women who have had one miscarriage, their chances of carrying the next pregnancy to full term remain about the same as if they had never had one. The chance of miscarrying again after two miscarriages increases with each loss. The risk for recurrent miscarriage increases with age. Women 40 years or older with previous recurring miscarriages have a much higher risk compared to younger women.

Causes

There are many different reasons for miscarriage, including fetal chromosomal defects, hormonal problems or abnormalities of the uterus. Doctors typically do not begin testing and treatment until after three successive miscarriages, or after a second miscarriage if the woman is older than 35, because much of the testing and treatment is controversial, and the reasons that treatments work are not well understood.

It is likely that a woman who suffers recurrent miscarriages will go on to have a healthy baby. A healthy lifestyle, folic acid supplementation, smoking cessation, weight control, and reducing alcohol and caffeine can increase a woman's chance of having a healthy and successful pregnancy. Informative and sympathetic counseling appears to play an important role in these patients' success.

Ask your doctor about the following possible causes of miscarriage.

Genetic factors

Problems with the genes or chromosomes of the fetus are the most common causes of miscarriage with first pregnancy losses. These are usually not problems inherited from parents, but occur spontaneously, by chance, in the embryo. They are less commonly the cause for women with recurrent miscarriage.

Anatomical factors

Uterine abnormalities are associated with both first and second trimester pregnancy losses. Congenital abnormalities include double uterus or uterine septum. Other abnormalities include uterine polyps, fibroids and scar tissue inside the uterine cavity.

Cervical incompetence

Incompetent cervix complicates about 1 percent of pregnancies. Women with an incompetent cervix often have rapid miscarriages, commonly occurring up to 20 weeks.  This condition can be successfully treated with a stitch to help hold the cervix closed.

Industrial solvents

Exposure to certain solvents, either by the pregnant woman or her partner, sometimes may cause miscarriage. Couples should discuss any chemicals in the workplace with their doctor.

Endocrine factors

By doing a biopsy of the lining of the uterus, doctors can test for a luteal phase defect, which means that the body secretes too little progesterone during the luteal phase of the menstrual cycle. This is thought to be a factor in some cases of recurrent miscarriage. The relationship between luteal phase defect and recurrent pregnancy loss remains a subject of controversy, however, according to the American College of Obstetricians and Gynecologists. There is no conclusive data that treating a woman with progesterone or fertility medication is effective against recurrent pregnancy loss.

Maternal endocrine disorders such as uncontrolled diabetes or severe thyroid abnormalities have also been linked to miscarriage.

Environmental factors

Smoking, excessive alcohol consumption and illegal drug use are causes of recurrent miscarriage. Women should not smoke and also should avoid alcohol and drugs during pregnancy.

Immunology

Immunology is the study of how the body recognizes something foreign or different and makes antibodies to protect itself. An immune problem called antiphospholipid syndrome is the cause for recurrent miscarriages in 3 to 15 percent of women. it is recommended that women with recurrent miscarriages be tested for lupus anticoagulant and anticardiolipin antibodies (cardiolipins are a type of phospholipids).

A woman with antiphospholipid antibodies and lupus-like anticoagulant can be treated with low-dose aspirin and heparin. This therapy can increase blood flow to the placenta by inhibiting the tendency for clotting.

Miscarriage

What is a miscarriage?

Miscarriage is usually defined as an early pregnancy loss. Miscarriage is also called spontaneous abortion. Types of miscarriage include the following:

  • Threatened--spotting or bleeding in the first trimester may or may not mean a miscarriage will occur; About 10 to 20 percent of women will miscarry in the first trimester. The woman is monitored for further bleeding. Ultrasound exams (a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs) are usually performed to monitor growth of the fetus and to monitor fetal heartbeat.

  • Complete--the fetus, placenta, and other tissues are passed with bleeding

  • Incomplete--only a part of the tissues are passed; some remain in the uterus. There may be heavy vaginal bleeding.

  • Missed abortion--the embryo or fetus dies, but is not passed out of the uterus. Sometimes, dark brown spotting occurs, but there is no fetal heartbeat or growth.

  • Septic--miscarriage that becomes infected, the mother develops fever and may have bleeding and discharge with a foul odor; Abdominal pain is common. This is a serious condition and can result in shock and organ failure if not treated. Antibiotics and dilation and curettage (D & C) may be necessary. This procedure uses special instruments to remove the abnormal pregnancy.

  • Recurrent--more than three miscarriages

What is an incompetent cervix?

Fetal loss in the second trimester may occur when the cervix is weak and opens too early, called incompetent cervix. In some cases of incompetent cervix, a physician can help prevent pregnancy loss by suturing the cervix closed until delivery, called a cerclage.

How is miscarriage diagnosed?

The most common signs of miscarriage are vaginal spotting or bleeding, passing of tissue, and cramping. Ultrasound is usually used to diagnose miscarriage. If the fetus is no longer in the uterus, or there is no longer a fetal heartbeat, miscarriage is diagnosed. Other tests that may be used include pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG). No increase in this hormone level or a decrease can indicate that the pregnancy is not growing.

Treatment for miscarriage

Treatment for miscarriage in early pregnancy includes a procedure to remove the fetus and other tissues if they have not all been naturally passed. The procedure is called a surgical evacuation of the uterus, or a dilation and curettage (D&C). Anesthesia is used as the procedure can be painful to the mother. The cervical opening is dilated (opened) and either suction or an instrument called a curette is used to remove all the pregnancy tissues inside the uterus (called products of conception). These tissues may be sent to the laboratory for culture or testing for genetic or chromosomal abnormalities. However, not all miscarriages require a D&C. An early miscarriage may also be treated with expectant management or the drug misoprostol.

Later pregnancy loss may need a different procedure using hormones such as prostaglandin or Pitocin to cause the uterus to contract and push out the fetus and tissues.

Pregnancy loss does not usually cause other serious medical problems, unless an infection is present, or unless a missed abortion occurred in which the fetus and other tissues are not passed. A serious complication with a late miscarriage is disseminated intravascular coagulation (DIC), a severe blood clotting problem. This is more likely if there is a long time (usually a month or more) until the fetus and other tissues are passed.

Douglas T. Carrell, Ph.D., H.C.L.D.

Doug Carrell received his Ph.D. degree in reproductive physiology from the University of Utah in 1995, after receiving a M.S. degree in cellular and developmental biology from Brigham Young University. Dr. Carrell has worked in the area of research and treatment of human infertility for 30 years. Dr. Carrell is ... Read More

Specialties:

Andrology, In Vitro Fertilization, Reproductive Endocrinology & Infertility

Locations:

Andrology & IVF Laboratories (801) 581-3740

Jessie A. Dorais, M.D.

Jessie Dorais, M.D. as a Clinical Assistant Professor, in the Division of Reproductive Endocrinology and Infertility. Dr. Dorais received a Bachelor of Science degree in Biology from Brigham Young University in 2003, and her M.D. from the University of Illinois, College of Medicine in 2007. She completed her O... Read More

Specialties:

Endometriosis, In Vitro Fertilization, Polycystic Ovary Syndrome, Reproductive Endocrinology & Infertility, Tubal Ligation Reversal

Locations:

South Jordan Health Center (801) 581-3834
University Hospital (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

James M. Hotaling, M.D., FECSM

Dr. Hotaling has significant training in both the clinical aspects of male fertility and genetic epidemiology and he is currently the only fellowship trained male infertility/andrology expert in Utah. He completed a 6 year residency in urology at the University of Washington, elected to pursue a year of sub-sp... Read More

Specialties:

Andrology, General Urology, Men's Health, Reproductive Endocrinology & Infertility, Urology

Locations:

Utah Center for Reproductive Medicine (801) 587-1454

Erica B. Johnstone, M.D.

Erica B. Johnstone, M.D., M.H.S., is a gynecologist and reproductive endocrinologist in the Division of Reproductive Endocrinology and Infertility. Dr. Johnstone clinical interests include reproductive endocrine disorders and all types of infertility, and she also works with hormonal disorders in children and ad... Read More

Specialties:

In Vitro Fertilization, Menopause, Reproductive Endocrinology & Infertility

Locations:

Centerville Health Center
Madsen Health Center
South Jordan Health Center (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

William R. Keye, M.D.

William R. Keye, M.D., is a board-certified physician specializing in obstetrics and gynecology, as well as reproductive endocrinology and infertility. He received his medical degree from the University of Minnesota, and was an original member of the University of Utah’s I.V.F.(in vitro fertilization) team. He s... Read More

Specialties:

Reproductive Endocrinology & Infertility

Locations:

Redstone Health Center (801) 581-3834
South Jordan Health Center (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

Specialties:

Reproductive Endocrinology & Infertility

Locations:

A location has not yet been added by this physician.

Andrew K. Moore, M.D.

As a sixth-generation resident of Utah Valley, Dr. Moore is pleased to bring the University of Utah’s world-class reproductive medicine closer to home for Utah Valley and southern Salt Lake county residents. He has office hourse daily in Orem, and also each week in South Jordan. During his first year of practi... Read More

Specialties:

Endometriosis, In Vitro Fertilization, Minimally Invasive Pelvic Surgery, Pelvic Pain, Polycystic Ovary Syndrome, Recurrent Miscarriage, Reproductive Endocrinology & Infertility, Robotic Surgery, Tubal Ligation Reversal

Locations:

Parkway Health Center (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834
Utah Valley Regional Medical Center (801) 581-3834

C. Matthew Peterson, M.D.

Matthew Peterson, M.D., is a Reproductive Endocrinologist in the University of Utah Department of Obstetrics and Gynecology. Dr. Peterson received his undergraduate degree, magna cum laude from Brigham Young University in 1977 and his M.D. from the University of Utah in 1981. His residency training in obstetrics... Read More

Specialties:

Adolescent Gynecology, Endometriosis, Gynecological Surgery, Gynecology, In Vitro Fertilization, Minimally Invasive Pelvic Surgery, Pediatric Gynecology, Polycystic Ovary Syndrome, Reproductive Endocrinology & Infertility, Tubal Ligation Reversal, Women's Genetic Counseling

Locations:

Centerville Health Center (801) 581-3834
Parkway Health Center (801) 581-3834
South Jordan Health Center (801) 581-3834
University Hospital (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

Reproductive Medicine services are available at the Utah Center for Reproductive Medicine as well as multiple locations through out the state of Utah, including Centerville, Orem, South Jordan and Park City. Our reproductive endocrinologists offer a wide range of services including:

  • Infertility counseling
  • Infertility monitoring and treatment
  • IUD insertion and removal
  • Annual gynecological exams
  • Endocrinology
  • Diagnosis and treatment of polycystic ovary syndrome
  • In vitro fertilization
  • Treatment of endometriosis
  • Pediatric and adolescent gynecology services

Our highly trained reproductive endocrinology specialists are experts in both the treatment and research of infertility and our clinic consistently boasts one of the highest success rates in the nation.

Neighborhood Health Center Locations:

Utah Center for Reproductive Medicine 675 Arapeen Way, Suite 205
Salt Lake City, Utah 84108-1237
Map
University of Utah Health Care
Centerville Health Center
26 South Main
Centerville, Utah 84014
Map
Dixie Regional Medical Center 544 South 300 East
St. George, UT 84770
Map
McKay Dee Hospital 4401 Harrison Blvd.
Ogden, UT 84403
Map
University of Utah Health Care
Redstone Health Center
1743 W. Redstone Center Drive, #115
Park City, Utah 84098
Map
University of Utah Health Care
South Jordan Health Center
1091 W. South Jordan Parkway, Suite 500
South Jordan, 84095
Map
Utah Valley Regional Medical Center
Woman’s and Children’s Clinic
1034 N 500 W
Provo, Utah 84604
  • FAZST
    Keywords: Fertility, reproductive medicine, pregnancy outcomes, folic acid and zinc supplementation trial, semen quality, infertility
    Status: Recruiting
  • MORENDO
    Keywords: Endometriosis
    Status: Active, not recruiting
  • Healthy Conceptions for Couples Intervention Pilot Study
    Keywords: Infertility, Obesity, polycystic ovarian syndrome, emotionally focused therapy, weight loss
    Status: Recruiting