Recurrent Pregnancy Loss Testing

What is Recurrent Pregnancy Loss?

Recurrent Pregnancy Loss (RPL) means having two or more miscarriages in a row (the loss of a pregnancy before 20 weeks). RPL can be emotionally and physically challenging, but many people with RPL go on to have successful pregnancies.

Why Does Pregnancy Loss Happen?

The most common cause of pregnancy loss is genetic abnormalities (chromosomal aneuploidy) in the embryo. This means that the embryo has either too many or too few chromosomes, which prevents it from developing normally.

What Does "Genetic Abnormality" Mean?

• Every embryo gets half its chromosomes from the egg and half from the sperm. In order for this to happen, the sperm and egg cells have to split their chromosomes. Sometimes, this splitting process doesn’t go very well and an embryo ends up with the wrong number of chromosomes. This is not caused by anything you did or did not do—it is a natural error that can happen to anyone and the chances of it happening increase with age.

• Result: When an embryo has the wrong number of chromosomes, it usually cannot develop into a healthy baby, and the pregnancy ends in miscarriage. There are some aneuploidies that can result in a live birth but the child is typically affected by health conditions. One aneuploidy you may have heard of is 3 copies of chromosome 21 – which is Down Syndrome.

  
  

How Common Are Genetic Abnormalities in Miscarriage?

• First Miscarriage: About 60–70% of first-trimester miscarriages are due to genetic abnormalities in the embryo.

• Recurrent Losses: Even in people with recurrent miscarriages, about 50% of losses are still due to these random genetic errors.

• What This Means: Most miscarriages are not preventable and are not caused by anything you did.

  
  

Other Causes of Recurrent Pregnancy Loss

While genetic abnormalities are the most common cause, other possible causes include:

• Anatomical Factors: Problems with the shape or structure of the uterus (e.g., septum, fibroids, adhesions).

• Hormonal Factors: Thyroid disorders, uncontrolled diabetes, or polycystic ovary syndrome (PCOS).

• Blood Clotting Disorders: Conditions like antiphospholipid syndrome or inherited thrombophilias.

• Immune Factors: Abnormal immune responses affecting pregnancy, specifically antiphospholipid antibody syndrome or APLA.

• Lifestyle Factors: smoking, marijuana use, excessive alcohol us

• Infections: chronic endometritis

Evaluation and Testing for RPL

If you have experienced two or more miscarriages, Dr. Shirin Dason may recommend the following tests when you are not pregnant, ideally 6 weeks after any pregnancy or loss :

1. Genetic Testing

• Karyotype Analysis: Chromosome testing for both partners to look for genetic abnormalities. (approximate cost - $800 per patient)

• Products of Conception (POC) Testing: If a pregnancy loss occurs, testing the tissue (products of conception) can help determine if a genetic abnormality was the cause. This information can guide further management and testing. (approximate cost - $800 per loss)

  
  

2. Hormonal & Metabolic Testing

• Thyroid Stimulating Hormone (TSH): To check thyroid function.

• Hemoglobin A1C (HbA1C): To screen for diabetes and insulin resistance.

• Prolactin: To check for elevated levels that can affect ovulation.

  
  

3. Uterine Evaluation

• Sonohysterogram: An ultrasound with saline to look for uterine abnormalities such as polyps, fibroids, or adhesions. (covered by OHIP)

• Endometrial Biopsy (after ovulation): 

  • CD138 Staining: To check for chronic endometritis (inflammation of the uterine lining). (covered by OHIP)

  • EMMA/ALICE Testing: Advanced tests to assess the endometrial microbiome and detect infections or imbalances. (approximate cost - $1200)

    
    

4. Blood Clotting and Immune Testing

• Antiphospholipid Antibody (APLA) Testing: To check for antiphospholipid syndrome, a blood clotting disorder. (approximate cost - $400)

  
  

5. Male Factor Testing

• Sperm DNA Fragmentation Testing: To assess the quality and integrity of sperm DNA, which can contribute to miscarriage risk. (approximate cost - $400)

  
  

Fertility Testing and Treatment Options

In addition to the above, fertility testing may be recommended to assess your overall reproductive health. This may include:

• Ovarian reserve testing (e.g., AMH, FSH, antral follicle count) (approximate cost - $125)

• Semen analysis for your partner (OHIP Covered or $400 with DNA fragmentation)

  
  

IVF with Preimplantation Genetic Testing for Aneuploidy (PGT-A)

For some couples, especially where genetic abnormalities are suspected, in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A) is an option.

• What is PGT-A?

  During IVF, embryos are created in the lab. PGT-A allows us to test these embryos for the correct number of chromosomes before transferring them to the uterus. Only embryos with the right number of chromosomes are selected, which can reduce the risk of miscarriage due to genetic problems.

• Who should consider this?

  IVF with PGT-A may be considered for couples with recurrent pregnancy loss, especially if genetic causes are suspected as it can help prevent another loss.

  
  

Monitoring and Support in Early Pregnancy

If you become pregnant again, TRIO FERTILITY can offer close monitoring in early pregnancy. This may include:

• Early ultrasounds to check for normal development

• Blood tests to monitor pregnancy hormone levels

  
  

Medications That May Help

• Low-dose Aspirin: There is some evidence that taking low-dose aspirin in early pregnancy may help reduce the risk of miscarriage in certain situations.

• Progesterone Support: Progesterone supplementation in early pregnancy has shown possible benefit in some women with a history of recurrent pregnancy loss.

  
  

These treatments are not guaranteed to prevent miscarriage, but they may improve the chances of a successful pregnancy for some people.

Emotional Support

Experiencing multiple miscarriages can be emotionally distressing. Support is available:

• Counseling: Individual or couples therapy can help. https://triofertility.com/fertility-counselling/ OR Better Bria

• Support Groups: Connecting with others who have experienced RPL. https://triofertility.com/fertility-support-groups/

• Pregnancy and Infant Loss Network

  
  

Frequently Asked Questions

Q: Will I ever have a successful pregnancy?A: Most people with RPL eventually have a successful pregnancy, especially with evaluation and appropriate care.

Q: Is there anything I can do to prevent miscarriage?A: Most miscarriages are due to genetic abnormalities that are beyond your control. Maintaining a healthy lifestyle (adequate nutrition, exercise, sleep), managing chronic conditions (i.e. diabetes), and following your provider’s recommendations can help. Dr. Dason encourages you to take 1 mg of folic acid, vitamin D 2000 units and omega-3 supplements.

Q: When should I seek help?A: Whenever you feel ready for intervention, please let Dr. Dason know.

Recurrent pregnancy loss can be lonely and confusing.

If you have questions or concerns, please contact Dr. Shirin Dason’s office by email : dasonoffice@triofertility.com 

**this post does not represent medical advice and is for education purposes only