Recurrent miscarriage treatment depends on the underlying problem.
Half of all patients who undergo testing for recurrent pregnancy loss are found to have an abnormality. The recurrent miscarriage treatment prescribed for you will depend on the abnormality that is discovered.
Anatomic recurrent miscarriage treatment
Anatomic problems of the uterus are associated with increased risk of miscarriage. These anatomic problems may include:
- Uterine abnormalities present at birth. Examples include: uterine septum, where the uterine cavity is partitioned by a longitudinal septum or wall; bicornuate uterus in which a woman has separate uterine cavities sharing a single cervix; unicornuate uterus, a congenital uterine abnormality that results in a small uterus with only one functioning fallopian tube.
- Uterine scar tissue
- Uterine fibroids or polyps
Whether the anatomical uterine problem is present at birth (e.g. septate uterus) or develops over times (e.g. scar tissue from a D&C perhaps), hysteroscopy is generally indicated to fully diagnose the problem and to provide treatment at the same time. However, certain uterine malformations (e.g. a unicornuate or bicornuate uterus) are left alone as surgical treatment has not been shown to be of benefit.
Genetic recurrent miscarriage treatment
Chromosomal testing of both partners can reveal if a genetic problem exists that is impacting the woman’s ability to carry a pregnancy to term. In this case, recurrent miscarriage treatment would be consulting with a genetic counselor to determine the overall prognosis since chromosomal abnormalities can vary in their impact.
Serious chromosomal problems that affect the chance for normal pregnancy, such as both partners being carriers for an autosomal genetic disease, may necessitate genetic testing on embryos before they would be placed in the uterus. This process is called preimplantation genetic testing for monogenetic disease, or PGT-M, and requires IVF treatment. Another possibility could be using donor sperm or donor eggs in place of the affected patient’s sperm or eggs.
Even if the parental chromosomes are normal, if multiple pregnancy losses have been identified as having a genetic abnormality through the testing of tissue, preimplantation genetic testing can also be considered on embryos created through the process of IVF. Only chromosomally ‘normal’ embryos would be transferred to the uterus.
Autoimmune recurrent miscarriage treatment
Clotting issues can cause pregnancy loss. If a patient with recurrent pregnancy loss tests positive for lupus anticoagulant, anticardiolipin antibody, or anti β2 glycoprotein I, appropriate treatment would include treatment for excess blood clotting. This is commonly done with some combination of low-dose aspirin and heparin (blood thinner). Though prednisone (which is used to treat other autoimmune problems) has been tried as a treatment for this condition, it does not improve pregnancy rates — and may be associated with higher rates of gestational diabetes and high blood pressure.
Hormonal recurrent miscarriage treatment
A number of hormone problems that are related to recurrent pregnancy loss can be effectively treated. These can include thyroid problems, uncontrolled diabetes, and elevated prolactin levels. Thyroid issues are generally treated with administration of additional thyroid hormone (for underactive thyroid) or treatment of the thyroid gland directly (for overactive thyroid). Diet and exercise as well as insulin-controlling medications will help with patients diagnosed with diabetes. Elevated prolactin levels can be managed with a prolactin hormone lowering medication.
Though there is some controversy, some patients with recurrent miscarriages may benefit from empiric use of progesterone. Progesterone supplements have been evaluated in clinical trials and have not been shown to be of any benefit to most people. Some patients will truly benefit, but it’s hard to determine which patients will improve. Therefore, sometimes progesterone is prescribed with the hope of success (realizing it may not be any better than placebo).
Women hoping to have a healthy pregnancy should cease smoking and minimize exposure to secondhand smoke. Weight, either too much or too little, can also be a problem. Patients with a body mass index (BMI) considered underweight (BMI <18.5) or overweight /obese (BMI 25-30/BMI>30) should seek advice on weight gain or weight loss. Alcohol should be eliminated and caffeine should be significantly minimized.
The 50% of patients who are not found to have an abnormality on testing may still benefit from different types of fertility treatment.The only intervention to have demonstrated benefit is serial ultrasound scans in the early months of pregnancy. It is certainly not unreasonable to expect this psychological support to improve outcome given the close interaction between the higher areas of the mind and the delicately balanced hormonal system.
Most patients who have no known causes may be encouraged to take a baby aspirin (80 mg) to improve uterine artery blood flow and also help treat a possible undiagnosed immune problem. Some patients are given heparin (blood thinner) to treat immune problems (such as antiphospholipid antibody syndrome).