Recurrent Miscarriages: Seeking Answers for a Healthy Pregnancy

Three instances of embryo degeneration?

Hello Doctor,
I had a smooth and normal pregnancy with my first child at the age of 32.
However, during the past three years of trying to conceive my second child, I have experienced three miscarriages due to embryonic development issues (each time the embryo developed slowly: at 5 weeks it looked like 4 weeks, at 8 weeks it looked like 6 weeks, and there was no heartbeat).
Currently, I am in my third pregnancy, but at 8 weeks, I detected a weak heartbeat at 6 weeks and 4 days, but the heartbeat disappeared a week later, and the size shrank to that of 6 weeks and 1 day.
I really want to understand why my body is experiencing this.
Since my second miscarriage, I have consulted with a fertility specialist and underwent hormone and transvaginal ultrasound examinations, all of which showed no issues.
The doctor said I can conceive naturally but cannot maintain the pregnancy.
I was advised to see him as soon as I became pregnant.
After my last menstrual cycle on June 6, I didn't get my period on July 7, so I consulted him.
My blood test showed a level of 41, and the doctor advised me to start progesterone injections.
After that, I received injections and blood tests every three days, with levels increasing from 41 to 91 to 188 to 644.
The doctor said the growth was good, but ultimately it ended in another miscarriage with no heartbeat.
As I am of advanced maternal age, I really want to find out the reasons for my recurrent miscarriages and successfully carry a child to term.
Doctor, I would like to ask you a few questions:
1.
I found online that 15% of habitual miscarriages are due to uterine structural abnormalities.
I have already undergone a transvaginal ultrasound; do I need to have a hysterosalpingogram or hysteroscopy?
2.
Should both my husband and I undergo chromosomal testing? After all, we have successfully conceived a child before.
3.
Is it possible that there is an issue with our immune system? My husband and I currently show no signs of immune issues; should we investigate this further?
4.
Regarding the progesterone injections, I found that they are primarily for hormonal abnormalities (especially in cases of polycystic ovary syndrome).
I received 8 injections of long-acting progesterone oil, but it ultimately did not help.
Should I rule out this cause for my next pregnancy?
I apologize for the lengthy message, and I appreciate your time in responding.
Thank you!

Carol, 30~39 year old female. Ask Date: 2012/08/09

Dr. Lü Lizheng reply Obstetrics and Gynecology

Dear Carol,
1.
There are many causes of habitual miscarriage.
I recommend that you visit a medical center and consult a physician who specializes in infertility for a systematic evaluation.
2.
Based on your description, it seems that the embryo can still implant, which does not suggest any structural abnormalities of the uterus.
3.
Although you have previously given birth to healthy children, it is possible that the problematic genes were not inherited.
Chromosomal testing should still be considered.
4.
Other factors, including hormonal issues, immune system responses, and chronic inflammation, should also be taken into account.
Wishing you safety and health.
Sincerely,
Dr.
Li-Cheng Lu
Director, Department of Obstetrics and Gynecology
Taoyuan Hospital, Health Department

Reply Date: 2012/08/09

More Info

I'm sorry to hear about your struggles with recurrent miscarriages. It's understandable to seek answers and reassurance during such a challenging time. Let's address your concerns one by one.

1. Uterine Structural Abnormalities: You mentioned that you've had a transvaginal ultrasound, which is a good initial assessment. However, if there are still concerns about potential uterine abnormalities, further investigations like a hysterosalpingogram (HSG) or hysteroscopy may be warranted. These tests can help visualize the uterine cavity and check for issues like fibroids, polyps, or congenital anomalies that might not have been detected on the ultrasound.

2. Chromosomal Testing for Both Partners: While you have successfully carried a pregnancy to term, it is still advisable to consider chromosomal analysis for both you and your partner, especially given the history of recurrent miscarriages. Even if you both have normal karyotypes, it’s possible that a balanced translocation or other chromosomal rearrangements could be present that might not have manifested in previous pregnancies. This testing can provide valuable information about the risk of genetic abnormalities in future pregnancies.

3. Immune System Issues: Recurrent miscarriages can sometimes be linked to immune system disorders, such as antiphospholipid syndrome or other autoimmune conditions. If you have not been tested for these, it may be worth discussing with your healthcare provider. Testing for antiphospholipid antibodies, lupus anticoagulant, and other relevant markers can help determine if an immune issue is contributing to your pregnancy losses.

4. Use of Progesterone Injections: The use of progesterone injections, especially in cases of luteal phase defects or conditions like polycystic ovary syndrome (PCOS), is common. However, if you have been tested and found to have normal hormone levels, the effectiveness of progesterone supplementation may be limited. It’s essential to have a thorough discussion with your doctor about the rationale for using progesterone in your specific case, especially since it did not prevent the loss in your recent pregnancy.

In addition to these specific concerns, it’s crucial to maintain open communication with your healthcare provider. They can help guide you through the necessary tests and interpret the results in the context of your overall health and reproductive history.
Moreover, consider seeking support from a reproductive endocrinologist or a fertility specialist who has experience with recurrent pregnancy loss. They can provide a more tailored approach to your situation and help identify any underlying issues that may not have been previously considered.

Lastly, while it’s natural to feel anxious and overwhelmed, remember that many women with a history of recurrent miscarriages go on to have successful pregnancies. It’s essential to take care of your mental health during this time, whether through counseling, support groups, or talking with friends and family.
Wishing you the best in your journey toward a healthy pregnancy.

Similar Q&A

How to Prevent a Third Miscarriage After Two Losses?

I experienced my first pregnancy but did not detect a heartbeat, so I underwent a procedure to remove it. Three months later, I became pregnant again, and although there was a heartbeat initially, it stopped after one week. I would like to inquire whether I should undergo a pre-m...

Dr. Zhang Yongxuan reply Obstetrics and Gynecology
1. Three or more consecutive miscarriages are classified as recurrent pregnancy loss. 2. The average incidence of spontaneous abortion is 15%. When the first pregnancy ends in a spontaneous abortion, regardless of the chromosomal pattern of the aborted fetus, the chance of expe...

Essential Tests for Recurrent Miscarriage: A Guide for Couples

Hello, I would like to ask about my wife. She has had two pregnancies where the fetus did not have a heartbeat. My wife has diabetes and is overweight, and we both have a family history of diabetes. My wife has diabetes, but I do not. We have consulted other clinics, and they sug...

Dr. Li Guanghan reply Obstetrics and Gynecology
Dear Sir/Madam, Recurrent miscarriage is defined as having three consecutive pregnancy losses. Both partners may consider undergoing blood tests for chromosomal analysis. You can consult with the obstetrics and gynecology department at the hospital. It is recommended that women ...

Understanding Recurrent Miscarriage: Causes, Treatments, and Expert Guidance

Hello, I would like to inquire about habitual miscarriage. I already have two children, but my subsequent pregnancies have resulted in bleeding around three months, requiring bed rest. In the first instance, I experienced premature rupture of membranes and miscarried naturally af...

Dr. Chen Changfu reply Obstetrics and Gynecology
Sorry, please correct Dr. Wu's email address.

Seeking Answers: Overcoming Recurrent Miscarriages for a Healthy Pregnancy

I live in Hsinchu and would like to ask: which hospital in Hsinchu can conduct tests for the causes of recurrent miscarriage? I have been pregnant four times, but there has been no fetal heartbeat each time. Could it be due to my husband's sperm? However, I have conceived na...

Dr. Li Guanghan reply Obstetrics and Gynecology
Hello! 1. If you can conceive naturally, you are not considered infertile. 2. Recurrent miscarriage: a. Chromosomal factors in both partners b. Whether the woman has any underlying immune disorders. 3. Children are a blessing from God to parents; the timing and number of children...