Treatment for Recurrent Pregnancy Loss
Patients who undergo testing for recurrent pregnancy loss are found to have an abnormality of some type about 50% of the time. A number of treatments exist and depend on the abnormality that is discovered. The 50% of patients who are not found to have an abnormality on testing may still benefit from different types of fertility treatment.
If a genetic problem is found upon chromosomal testing of the mother or father, speaking with a genetic counselor is critical to determine the overall prognosis. This is because chromosomal abnormalities can vary in their impact.
If a significant chromosomal problem is present – that would seriously affect the chance for normal pregnancy – some patients may consider doing genetic testing on embryos before they would be placed in the uterus. This is called preimplantation genetic testing. This kind of testing would necessitate 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, 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. Though this type of genetic testing has limitations (it may miss small genetic mistakes or embryo problems that are not genetic), the overall success rate is very good.
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 standardly done with some combination of low-dose aspirin and heparin. 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.
Whether a uterine problems is present at birth (e.g. septate uterus) or develops over times (e.g. scar tissue from a D&C), 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.
A number of hormone problems that are related to recurrent pregnancy loss can be effectively treated.
- Thyroid problems can generally be dealt with administration of additional thyroid hormone (for underactive thyroid) or treatment of the thyroid gland directly (for overactive thyroid).
- Uncontrolled diabetes would be controlled with diet/exercise modification, insulin, and medications to make insulin more effective.
- 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.
To optimize pregnancy health, patients should have ceased smoking (and minimized exposure to secondhand smoke as well). In addition, modification of body mass index (BMI) should be considered if the patient is underweight (BMI <18.5) or overweight /obese (BMI 25-30/BMI>30). Alcohol should be eliminated and caffeine should be significantly minimized.