Introduction 

Recurrent Pregnancy Loss (RPL), defined as the loss of two or more pregnancies before 20 weeks of gestation, affects many couples worldwide. It’s a condition that not only impacts physical health but also emotional wellbeing. Understanding the causes and available treatments is crucial for those affected. In this detailed discussion, we’ll delve into the underlying reasons for RPL and explore diagnostic methods as part of comprehensive women’s health screening, emphasising how these insights can guide effective treatments. 

What Causes Recurrent Pregnancy Loss (RPL)? 

Hormonal Imbalances 

Hormones regulate every aspect of pregnancy from conception to delivery (Pascual & Langaker, 2023). An imbalance, particularly in progesterone and estrogen, which are crucial for maintaining early pregnancy, can lead to recurrent pregnancy loss. The luteal phase defect, an inadequacy in progesterone production in the second half of the menstrual cycle, is a common hormonal problem associated with recurrent pregnancy loss.  

Genetic Issues and Chromosomal Abnormalities 

Chromosomal abnormalities in the developing embryo are among the most common causes of pregnancy loss. These abnormalities can be random, or they can be inherited from parents who may carry balanced chromosomal traits without experiencing any adverse effects themselves. Most miscarriages (60-70% in the first trimester) happen due to genetic abnormalities in the developing embryo. These often involve trisomies, where an extra chromosome is present, leading to miscarriage. Trisomy 21 (Down syndrome) is an exception, allowing for live births. 

Couples with repeated miscarriages (2-3) may benefit from genetic testing (karyotype analysis) to check for normal chromosomes in themselves. Certain chromosomal rearrangements (like balanced translocations) in parents can increase the risk of miscarriage or birth defects in their children. Balanced translocations involve an exchange of genetic material between chromosomes. While some couples with balanced translocations conceive healthy babies naturally, others consider assisted reproductive technologies (ART) with preimplantation genetic diagnosis (PGD) to improve pregnancy success rates. PGD helps select embryos free of chromosomal abnormalities before implantation. Having a previous successful pregnancy doesn’t rule out balanced translocations. 

Uterine Abnormalities 

The shape and health of the uterus play a crucial role in supporting a healthy pregnancy. Certain structural abnormalities can unfortunately increase the risk of miscarriage. For instance, a septate uterus has a wall dividing the cavity, potentially hindering proper implantation or limiting space for the growing baby. Fibroids, which are benign tumors, can distort the uterine cavity and disrupt blood flow, affecting both implantation and placental development. Similarly, polyps, which are benign growths on the uterine lining, can create an uneven surface that makes implantation difficult. If you’re concerned about uterine abnormalities impacting your fertility, a doctor can perform imaging tests to assess the uterine cavity and discuss treatment options to optimize your chances of a successful pregnancy. 

Hereditary Thrombophilias 

Some inherited blood clotting disorders, like antiphospholipid syndrome (aps), can pose a challenge to a healthy pregnancy. These conditions can cause abnormal blood clots to form, even in small vessels. In the context of pregnancy, such clots can develop within the placenta, the vital organ that nourishes the growing baby. This disrupts the delicate blood flow between mother and embryo, potentially leading to miscarriage or other pregnancy complications. If you have a family history of blood clotting disorders or have experienced pregnancy loss, consulting with a doctor for specialized testing and potential preventative measures during pregnancy can be crucial. 

Infections 

 Sexually transmitted infections (STIs) like chlamydia and syphilis can pose a significant threat to a healthy pregnancy. These infections don’t just cause discomfort – they trigger an inflammatory response within the reproductive organs. This inflammation can make it difficult for a fertilized egg to implant properly in the uterus, potentially leading to miscarriage. Even if implantation occurs, STIs can travel through the bloodstream and infect the developing baby, causing serious health problems or birth defects. Early detection and treatment of STIs are crucial for a healthy pregnancy. Getting tested before conception and practicing safe sex are essential steps to minimize these risks. If you’re concerned about a past STI or current symptoms, speak to a doctor to ensure a safe and healthy pregnancy journey. 

General Body Health 

 A healthy pregnancy thrives on a strong foundation – your overall well-being. Uncontrolled chronic conditions like diabetes or thyroid disorders can disrupt the delicate hormonal balance and metabolic processes needed for a developing embryo. By managing pre-existing conditions before conception and throughout pregnancy, you can optimize your health and give your baby the best chance for a successful development. 

Lifestyle and Environmental Factors 

 Our lifestyle choices and environment can significantly impact both fertility and pregnancy success. Exposure to environmental toxins, smoking, excessive alcohol consumption, and poor nutrition can all disrupt delicate hormonal balances and hinder the health of sperm and eggs. These factors can make it more challenging for conception to occur or for a fertilized egg to implant successfully. Additionally, chronic stress, whether physical or emotional, can take a toll on the body’s resources and potentially contribute to pregnancy complications. While the exact influence of stress on miscarriage is still being studied, managing stress levels through healthy coping mechanisms can certainly benefit your overall well-being and potentially improve your chances of a healthy pregnancy. 

In general, the causes of recurrent pregnancy loss can be divided into genetic, hormonal, anatomic, infectious, autoimmune, and thrombophilic categories. Approximately 40% to 50% of patients with two or three consecutive pregnancy losses will be determined to have an apparent cause. In these cases, treatment would depend on the specific problem identified. 

In those patients without any obvious causes of their recurrent pregnancy loss, treatment options include empiric progesterone, empiric baby aspirin, treatment with fertility medications and IUI, IVF, and IVF with preimplantation genetic diagnosis (PGD). 

Treatment for Recurrent Pregnancy Loss 

Correcting Hormonal Imbalances 

Treatment often involves supplementing hormones or medications to correct hormonal imbalances. Progesterone supplements can be prescribed to support the luteal phase and help maintain a pregnancy. 

Managing Genetic Issues 

For genetic abnormalities, couples may be advised to undergo genetic counselling. In some cases, assisted reproductive technologies like IVF with preimplantation genetic diagnosis (PGD) may be recommended to select embryos without genetic abnormalities. 

Surgical Treatment of Uterine Abnormalities 

Surgical interventions can correct structural anomalies of the uterus. Procedures like hysteroscopic resection of septa or fibroids may improve the chances of a successful pregnancy. 

Addressing Hereditary Thrombophilias 

Treatment for conditions like APS includes the administration of blood thinners such as low-dose aspirin or heparin to reduce the risk of clotting. 

Treating Infections 

Detecting and treating infections early in pregnancy or before conception can prevent complications that lead to RPL. 

Optimizing General Health 

Managing pre-existing conditions like diabetes or thyroid issues is crucial. Lifestyle modifications to address obesity, stress, and exposure to toxins are also important preventive strategies. 

Lifestyle Modifications 

Encouraging a healthy diet, regular exercise, quitting smoking, and limiting alcohol intake are general recommendations to improve outcomes in pregnancy. 

Golden Gate Fertility Centre’s Approaches 

At Golden Gate Fertility Centre, we recognize the complexities of recurrent miscarriage and offer a sophisticated approach by integrating Modern Chinese Medicine with contemporary reproductive technologies. Golden Gate Fertility Centre provides comprehensive support and specialized treatments for patients experiencing recurrent pregnancy loss (RPL), which is typically defined as having two or more consecutive miscarriages.  

Understanding that recurrent pregnancy loss can be emotionally draining and physically challenging, the Golden Gate Fertility Centre adopts a multidisciplinary approach to diagnose underlying causes and tailor effective treatment plans. This integrative approach not only focuses on treating the physical symptoms but also emphasizes restoring balance and enhancing overall well-being, which is crucial for a healthy pregnancy. 

Our treatment options include customized herbal medicine prescriptions specifically tailored to each patient’s unique health profile and fertility needs. These prescriptions are designed to improve reproductive health by enhancing hormonal balance and supporting overall well-being. Additionally, we provide acupuncture services targeted at enhancing fertility. This ancient practice is known to improve blood flow to the reproductive organs, reduce stress, and optimize the chances of conception.  

Beyond these treatments, our approach focuses on the holistic rebalancing of Qi (energy), Xue (blood), Yin, and Yang, which are fundamental concepts in Chinese Medicine believed to be essential for achieving and maintaining health. By addressing these elements, we aim to restore the body’s harmony and improve fertility outcomes, providing a comprehensive and deeply nurturing experience for those seeking help with conception.