Category: Recurrent Pregnancy Loss

The What, How, and Why of Recurrent Pregnancy Loss (RPL)

The What, How, and Why of Recurrent Pregnancy Loss (RPL)

Many of us, who have been in the journey of TTC for a while, might have unfortunately experienced one or several pregnancy losses. From biochemical pregnancy, early 1st trimester miscarriages, to a stillborn, each loss is emotionally tolling and frustrating. Many doctors would tell you that one loss is just an unfortunate fluke, very unlikely to happen again. But did you know that as many as 15% of all women under 35 years of age will experience an early loss (Bashiri, Harlev & Agarwal, 2016)? No woman likes hearing these statements or being a data entry in these statistics. So, like a good medical detective and curious “yenta” that I am, (and once my mourning and healing process allowed me to do so), I decided to investigate more about pregnancy loss. I hope that this information might help someone out there achieve closure, accept that you did nothing wrong to cause this, and believe that it is not your fault this happened.

But did you know that as many as 15% of all women under 35 years of age will experience an early loss (Bashiri, Harlev & Agarwal, 2016)? No woman likes hearing these statements or being a data entry in these statistics. So, like a good medical detective and curious “yenta” that I am, (and once my mourning and healing process allowed me to do so), I decided to investigate more about pregnancy loss. I hope that this information might help someone out there achieve closure, accept that you did nothing wrong to cause this and understand more about some of the causes and treatments.

What is RPL?

Recurrent pregnancy loss (RPL) is defined by ASRM as “two or more clinical pregnancies losses documented by either ultrasonography or proved in a histopathologic examination” before 20 weeks gestation. However, the “Royal College of Obstetricians and Gynaecologists (RCOG) and the European Society of Human Reproduction and Embryology (ESHRE) [defines it] as three or more consecutive losses before 24 weeks gestation”. This is a significant discrepancy, which might cause certain physicians to delay diagnosis and treatment in women with only two losses. (This is why is extremely important to understand and accept that you are your best advocate and to seek advice/treatment from an RE who is open minded and would proactively look for the patients’ input). As well, many physicians and medical societies do not count chemical pregnancies as part of the diagnosis of RPL, but after much controversy, it has been included in many studies as part of the RPL diagnosis (as implantation rate could be diminished due to poor uterine lining receptivity, uterine anomalies or blood clots).

Common causes of RPL:

RPL_Causes

  • Autoimmune disorders and other immunological anomalies
  • Parental chromosomal aberrations (genetic problems
  • Uterine anomalies
  • Endocrine/hormonal abnormalities
  • Thrombophilias/Blood clotting disorders.
  • Infections
  • Obesity/Undernutrition
  • RPL: The effects of Age and Aneuploidy

Over the next few articles, I will attempt to further examine each one of these causes and discuss potential treatments (if available).

References:

  • Bashiri, A., Harlev, A., & Agarwal, A. (2016). Recurrent Pregnancy Loss. Cham: Springer International Publishing.
  • Chromosomal Abnormalities: Aneuploidies | Learn Science at Scitable. (2017). Nature.com. Retrieved 11 August 2017, from https://www.nature.com/scitable/topicpage/chromosomal-abnormalities-aneuploidies-290
  • Schattman, G., Esteves, S., & Agarwal, A. (2015). Unexplained infertility. Pathophysiology, Evaluation and Treatment.. New York, NY: Springer.