(Fort Worth Fertility)
(Fertility)
(Fort Worth)
(817-348-8145)
An evaluation for known causes of recurrent pregnancy loss is usually initiated after 2 or 3 consecutive pregnancy losses. The tremendous emotional impact of each loss may encourage an evaluation sooner than later. A full evaluation includes:
If a full evaluation is completed on couples with either 2 or 3 consecutive losses there will still be about 50% (1 of 2) of couples with "unexplained" recurrent pregnancy loss. That is, roughly half of couples seem to have a reason for recurrent loss that is beyond modern medicine's ability to diagnose this cause. This can be frustrating for both the couple and the physician. In this situation, the couple will at least know that potentially repairable pathology has been ruled out.
An estimated 15% of couples (1 in 6) with recurrent pregnancy loss have an anatomic abnormality of the uterus as the primary reason. The two categories of anatomic defects that cause recurrent pregnancy loss are abnormalites in 1) the normal process of uterine fusion during embryonic development (Mullerian duct abnormalities such a septate uterus) or 2) the size of or circulation to the uterus due to fibroids, endometrial polyps or scar tissue (Ashermann's syndrome).
Hormonal causes for recurrent pregnancy loss are generally considered "luteal phase defects." Luteal phase defects are most often thought to result from inadequate progesterone effect on the uterine endometrial lining. Thyroid deficencies are reasons for miscarriages as well.
Certain chromosomal abnormalities are universally accepted by infertility specialists as a cause for recurrent pregnancy loss. Fortunately, these major chromosomal abnormalities are uncommon. They may occur within either the maternal or paternal chromosomes. The overall incidence of chromosomal abnormality as the cause of recurrent pregnancy loss is low (less than 5% of couples with recurrent losses).
Immunologic causes of recurrent pregnancy loss are poorly understood. The theories proposed by authorities in this field appear to be constantly evolving. We do know that these are known reasons for miscarriages. We evaluate these factors by measuring in the blood acquired and hereditary thrombophilias. The acquired thromobphilias consist of antiphospholipid antibodies which include antiphospholipid antibodies, anticardiolipin antibodies and lupus anticoagulant. Heretitary thromophilias can be evaluated by immunicological testing for the MTHFR gene, prothrombin gene, antithrombin III protein C and S activities and Leiden Factor V gene. Not all patients need all this testing. Patients are evaluated and treated on an individual basis depending on their prior history and evaluation.
Overall you chances of a successful outcome is excellent. We will try to evaluate all the pertanant factors which may contribute to your losses. Often there are multiple factors that are responsible for your miscarriages. Therefore, going into the next pregnancy you will know that every reason for your miscarriages has been looked into. You will have the confidence that you and your doctor are doing all they can to help you. We will follow your pregnancy very closely until we see a healthy fetus and you are comfortable being referred back to your obstetrician.