Recurrent miscarriage: causes and treatments

Recurrent miscarriage: causes and treatments Recurrent miscarriage is a phenomenon that affects many couples and represents an emotional and physical challenge.

Recurrent miscarriage is when a woman experiences two or more spontaneous gestational losses before the 20th week of pregnancy.

In this article we will explore together with Prof.

Claudio Manna, Gynecologist in Rome, the main causes and treatments available to deal with this condition.

Causes of recurrent miscarriage The causes of recurrent miscarriage can be multiple and must be investigated carefully to find an adequate solution.

The main categories of causes include: Chromosomal and gene anomalies Genetic anomalies are one of the causes of recurrent miscarriage, although not too frequent.

When there are alterations in the embryo's chromosomes, such as trisomy or monosomy, the body is unable to support the pregnancy, leading to miscarriage.

These errors can occur randomly or be linked to a genetic problem in the parents such as unbalanced chromosomal translocations of one of the two.

Alterations in genes that regulate blood clotting or other cellular functions can compromise the outcome of pregnancy even repeatedly.

Hormonal factors Hormonal disorders, such as corpus luteum insufficiency, polycystic ovary syndrome (PCOS) and hypothyroidism, can compromise the ability to carry a pregnancy.

Insufficiency of the corpus luteum, in particular, leads to a deficiency of progesterone, a hormone essential for maintaining pregnancy.

However, in PCOS, especially if there is insulin resistance, a general inflammatory situation is created which predisposes to miscarriage.

Hypothyroidism such as Hashimoto's on an autoimmune basis must be recognized and treated. Anatomical anomalies Uterine malformations, such as the uterine septum, bicornuate uterus or other structural anomalies, can hinder the implantation of the embryo or cause repeated spontaneous abortions.

These conditions can be identified by ultrasound or hysteroscopies.

Conditions such as Endometriosis and Adenomyosis are very predisposing to spontaneous abortions, even repeated ones. Autoimmune diseases Some autoimmune diseases, such as antiphospholipid antibody syndrome, are linked to an increased risk of miscarriage.

In these conditions, the immune system mistakenly attacks the pregnancy's tissues, preventing its normal development.

Infections Infections, both bacterial and viral, can be a risk factor for recurrent miscarriage.

Infections such as toxoplasmosis, listeriosis, or cytomegalovirus infections can compromise the outcome of the pregnancy.

Recently it has been seen that chronic endometritis can also cause repeated miscarriage. Environmental factors and lifestyle Exposure to toxic substances, such as smoking, alcohol or other harmful substances, increases the risk of spontaneous abortion.

Additionally, chronic stress and obesity can negatively impact your ability to maintain a pregnancy.

Obesity in particular is considered one of the conditions of greatest risk for multiple abortions, especially if associated with other conditions such as PCOS. Andrological factor Sometimes the cause or contributory cause of recurrent abortion can depend on the man.

It has in fact been seen that an increase in sperm DNA fragmentation is linked to miscarriages.

It is advisable to do the specific test to recognize this condition even when the simple spermiogram appears normal. Treatments for recurrent miscarriage Once the causes have been identified, it is possible to adopt various therapeutic strategies to reduce the risk of miscarriage and increase the chances of a healthy pregnancy.

Hormone treatments If the problem is related to an insufficiency of the corpus luteum, treatment with progesterone may be useful.

In the case of polycystic ovary syndrome, hormonal management may be necessary to regulate the menstrual cycle and promote pregnancy.

But treating insulin resistance or diabetes with Metformin or Insulin may be essential.

In any case, the metabolic control of these situations must be very accurate. In Hashimoto's hypothyroidism, the administration of thyroid hormones is essential. Surgery for uterine anomalies In the presence of uterine malformations, surgery, such as hysteroscopy, can be useful to correct the structure of the uterus and favor the implantation of the embryo.

Immunological therapies In case of autoimmune diseases, treatment with immunosuppressive or anticoagulant drugs, such as low-dose aspirin and heparin and in some cases cortisone, can reduce the risk of even recurrent spontaneous abortion.

Genetic assistance When a genetic cause is suspected, the use of genetic counseling can help to better understand the risks and treatment options, such as the use of in vitro fertilization (IVF or ICSI) with preimplantation genetic diagnosis (PGTM).

Lifestyle changes Adopting a healthy lifestyle is essential.

Avoiding smoking, alcohol and maintaining a suitable body weight are actions that can improve the chances of a successful pregnancy.

Psychological counseling to reduce some conditions of "reproductive stress" can help prevent miscarriages Andrological therapies In case of excessive fragmentation of sperm DNA there are suitable therapies to reduce it Medical monitoring Continuous medical monitoring during pregnancy, through ultrasound scans and blood tests, can help to promptly identify any problems and intervene before complications such as infections and early rupture of the amniotic sac and premature birth occur.

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Manna for you? Recurrent miscarriage is a complex condition that requires thorough medical evaluation.

Understanding the causes, preventing complications and adopting the most appropriate treatment is essential to improve your chances of starting and completing a pregnancy.

If you have faced a recurrent miscarriage, contact a specialist like Prof.

Claudio Manna for an accurate investigation and a personalized treatment plan for all causes of this pathological condition.