Causes of Recurrent Pregnancy Loss

Recurrent pregnancy loss refers to the condition in which a woman loses two or more pregnancies consecutively.

Genetik faktörler: Genetic abnormalities can be an important cause of recurrent pregnancy loss. Certain genetic disorders, where both the mother and father can be carriers, may affect the normal development of the embryo and lead to recurrent pregnancy losses.

Hormonal dengesizlikler: Hormonal imbalances are another potential cause of recurrent pregnancy loss. Hormonal disorders, especially levels of thyroid hormones, progesterone, and estrogen, can affect the formation of a healthy uterine lining (endometrium) during pregnancy.

Bağışıklık sistemi sorunları: Bağışıklık sistemi anormal yanıt verdiğinde, vücut gebeliği bir yabancı cisim olarak algılayabilir ve düşük riskini artırabilir. Bağışıklık sistemi sorunları, embriyonun tutunmasını ve gelişimini engelleyebilir.
Yapısal anormallikler: Rahimdeki yapısal anormallikler, tekrarlayan gebelik kayıplarına neden olabilir. Rahim içerisindeki doğumsal anormallikler, embriyonun uygun şekilde yerleşmesini ve büyümesini engelleyebilir.

Trombofili (kan pıhtılaşması bozuklukları): Some genetic or acquired disorders related to blood clotting can affect blood flow in the uterus, making it difficult to maintain pregnancy.

Infections: Certain infections, especially those affecting the uterus and cervix, can lead to recurrent pregnancy losses.

Age factor: A woman's age can also be a risk factor for recurrent pregnancy losses. As a woman gets older, the likelihood of genetic abnormalities and other health issues increases.

Tubal factor: Fluid accumulation in one of the fallopian tubes (e.g., hydrosalpinx) can cause early loss of an implanted embryo.

Other factors: Certain conditions such as polycystic ovary syndrome (PCOS), diabetes, thyroid disorders, uterine fibroids, stress, and unhealthy lifestyle habits (smoking, alcohol consumption, poor nutrition, etc.) can also contribute to recurrent pregnancy losses.

Tests Performed in Recurrent Pregnancy Loss

Complete blood count (CBC): Parameters such as hemoglobin levels, white blood cell count, and platelet count are examined to investigate blood disorders or signs of infection.

Thyroid function tests: Thyroid hormone levels (TSH, T3, T4) are measured to detect thyroid disorders. Hormonal imbalances in the thyroid can cause recurrent pregnancy losses.

Hormone level measurement: Hormone levels such as progesterone, estrogen, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) are examined. Hormonal imbalances may increase the risk of pregnancy loss.

Antifosfolipid antikor testleri: Antifosfolipid sendromu, tekrarlayan gebelik kayıplarına neden olan otoimmün bir hastalıktır. Bu test, antifosfolipid antikorları (örneğin, lupus antikoagülan, antikardiyolipin antikorları) tespit etmek için yapılır.

Genetic tests: Genetic testing can be performed on both the female and male partners. Karyotype analysis is used to assess the presence of genetic mutations and structural abnormalities.

Thrombophilia tests: Blood clotting disorders (thrombophilia) can be a cause of recurrent pregnancy losses. Tests are performed to detect genetic or acquired factors that lead to thrombophilia.

Radiological imaging: Ultrasonography or hysterosalpingography (HSG) is used to detect structural abnormalities or blockages within the uterus.

Endometrial biopsy: Performed to evaluate the inner lining of the uterus (endometrium). An endometrial biopsy can help detect abnormalities or hormonal imbalances in the endometrial tissue.

What Treatment Methods Are Used for Couples Experiencing Recurrent Pregnancy Loss?

• Genetic counseling: If a genetic abnormality is detected through testing, couples are offered genetic counseling. This counseling includes evaluating potential genetic risks and options for future pregnancies.
• Hormone therapy: In cases where pregnancy loss is caused by hormonal imbalances, hormone therapy may be applied. For example, progesterone supplementation can support proper thickening of the endometrial lining and help maintain pregnancy.
• Correction of structural abnormalities: If structural abnormalities in the uterus are causing recurrent pregnancy losses, surgical intervention may be necessary. For example, procedures such as removal of a uterine septum or excision of polyps or fibroids may be performed.
• Thrombophilia treatment: If blood clotting disorders (thrombophilia) lead to recurrent pregnancy losses, anticoagulant medications (blood thinners) may be prescribed. These medications can help maintain pregnancy by preventing clot formation.
• Immunomodulators: If immune system issues are the cause of recurrent pregnancy losses, immunomodulators may be used. Treatments such as low-dose corticosteroids or intravenous immunoglobulin (IVIG) infusions can help balance the immune response.
• In vitro fertilization (IVF): If the underlying cause of recurrent pregnancy loss (RPL) cannot be determined or other treatments have failed, some couples may be referred to IVF. IVF is a reproductive technology that involves fertilizing eggs and creating embryos in a laboratory setting. In this method, genetic analysis of embryos (PGS or PGD) can be performed to ensure the transfer of healthy embryos.

Recurrent Pregnancy Loss and In Vitro Fertilization (IVF) Treatment

In vitro fertilization (IVF) treatment may be considered for couples experiencing recurrent pregnancy loss (RPL) in the following situations:

If the underlying cause cannot be determined: If the cause of RPL cannot be identified or no treatable cause is found, IVF may offer a solution for couples. IVF allows embryos to be created in a laboratory setting and genetically screened. This enables the selection and transfer of healthy embryos into the uterus.

If genetic abnormalities are present: If genetic testing reveals abnormalities in one or both partners, IVF treatment may be used. Genetic analysis of embryos (PGS or PGD) can be performed to ensure the transfer of healthy embryos.

If other treatments have failed: If hormone therapy, structural correction, or other treatments have not been effective for couples experiencing RPL, IVF may be considered as an alternative option. IVF can increase the chances of achieving pregnancy and reduce the risk of miscarriage.

What is the likelihood of a successful pregnancy in the future?

Couples who experience recurrent pregnancy loss may want to understand the likelihood of a successful future pregnancy. This question can be answered by considering factors such as the effectiveness of treatment options, the treatability of underlying causes, and other individual circumstances.

What could be the underlying cause of recurrent pregnancy loss?

• Genetic factors
• Hormonal imbalances
• Immune system disorders
• Structural abnormalities
• Tubal factors

What kind of treatment plan should we follow after experiencing recurrent pregnancy loss?

Depending on the identified cause, treatment options such as hormonal therapy, surgical intervention, genetic counseling, or in vitro fertilization (IVF) should be discussed.