Recurrent Miscarriage (RPL)
Recurrent Miscarriage, a devastating condition is also known as ‘Recurrent Pregnancy Loss’ (RPL). It is associated with reproductive problems with the parents, resulting in the loss of viable pregnancies. According to scientists from the Monash Institute of Medical Research and Sydney’s St Vincent’s Hospital, 5% of women will suffer two miscarriages or more.
http://www.bbc.com/news/health-24047842 (12 Sept 2013)
Defining recurrent miscarriage
The recurrent miscarriage figures in NZ start from 3 miscarriages and are defined as being
- after ‘3 or more consecutive early miscarriages (before 13 weeks),
- or 2 late miscarriages (13 – 20 weeks)’
and all pregnancies must be by the same partner, which affects between 2%-3% of women. Only 1%-2% of these women do not go on to have a family according to statistics from various sources. The internet information can be confusing because in American they use two definitions of multiple miscarriage: Recurrent Miscarriage is; 3 consecutive losses (causes – immunological, haematological, physiological etc.). Recurrent Pregnancy Loss is; two miscarriages and is positively correlated to maternal/paternal age (i.e. egg/sperm quality). The first may be treated for, the second may eventually require IVF screening tests and development of a viable egg outside the womb – especially when time is running out e.g. either partner is over 35 years of age.
Even with a second miscarriage, it is not generally a precursor to future problems and there is around a 72% chance that a third pregnancy will be fine. However, if you wish to take positive action, have some basic diagnostic tests done and treated when appropriate. It could be helpful and prevent further trauma, especially if the miscarriage is with the same partner and you suspect that you or he suffer from one or more of the listed ‘Why Miscarriages Happen’. You may need to be persistent and ask around for a medical professional who agrees.
After 3 consecutive miscarriages
After three consecutive miscarriages, testing is essential for chances of a normal pregnancy. In his report ‘Recurrent Miscarriage’, published in the medical journal The Lancet, UK Obstetrician Professor Gordon Stirrat wrote: ‘The risk of mis-carriage increases with each successive pregnancy loss, however some studies report a pregnancy ending in live birth reduces the risk of miscarriage in the subsequent pregnancy.’ His report gives the risks as: 14-21% after one miscarriage; 24-29% after two miscarriages; 31-33% after three miscarriages. (Next Magazine June 2012.)
In many cases of recurrent miscarriage, the reason is found; however in around 50%, nothing is ever discovered as the definitive cause. In one research study on this 50%, no specific treatment was offered except asking participants to remove as many stress factors as possible in their lives. How this was achieved is not described and the resulting 80% success rate is controversial. Scientists have also identified the gene NOS3 which appears to trigger repeated unexplained miscarriages in some women. The latest news (09.13) is that Otago University researchers have discovered there is a switch in the brain that actually turns fertility off and on. They hope to be able to control it with-in 5 years. http://www.scoop.co.nz/stories/SC1309/S00056/otago-researchers-make-brain-fertility-break-through.htm (You may wish to follow this on-going research yourselves.)
15 minute procedure could end misery of miscarriage
The agony of repeated miscarriages may be prevented by a 15-minute procedure already being routinely offered in IVF clinics. In the technique, a tool called a pipelle is inserted through the cervix and used to scratch the surface of the womb – the endometrium.
“Miscarriage causes considerable anxiety, stress and depression,” says Professor Siobhan Quenby, director of the Biomedical Research Unit in Reproductive Health and Professor of Obstetrics at the University of Warwick. Read more
Meantime, individuals have their own body rhythm, family history, stresses and circumstances. You may wish to address those that can be altered and make life style adjustments to help yourself. Experiment with relaxing techniques and eat organic foods. Avoid as much stress as possible and perhaps stop work or shorten your hours. Generally coddle yourself to whatever level you feel comfortable. It would only need to be for a short period and could be life changing.
Miscarriage is also self correcting to some degree with a spontaneous cure rate of 30%-50% so there is hope. Women who have suffered as many as six or seven miscarriages, can and do still go on to have a successful pregnancy which has happened in our group. We also know of women with as many as 17 miscarriages who have had babies but that is not a situation that many would have the tenacity, courage or will to endure.
How to be tested for Recurrent Pregnancy Loss.
Fertility NZ video on Recurrent Miscarriage
‘After my first miscarriage I was very upset, but picked up the pieces reasonably quickly and began moving forward. After my third I was less philosophical. I felt inadequate and a little panicky – after all 3 is not “normal”. After my seventh I felt angry and cheated out of my basic rights as a woman. I was in despair, and was coping with the very real horror of never having the baby I felt I needed. I mean ‘needed’ in the sense of oxygen or food – a baby was something I couldn’t imagine living without. It was after this that my husband and I completed the adoption education and assessment, and became approved.
Each time I got pregnant, it was with a sense of impending doom, and the inevitable joy which I tried very hard to control in the face of almost certain disappointment. I would lie on the bed, hands on my belly and say “this time, please, this time”. It got to the point of obsession, and it was all I could think about. Pregnant women were everywhere, flaunting their swollen stomachs. I was jealous and angry it wasn’t me. I was ashamed of those feelings, and didn’t like who I was becoming. The adoption education forced a real confrontation of those feelings, and after months of being a toxic savage b*tch I came to terms with my fertility. (P.S. Leah later went on to successfully have twins.)
‘You’ve got to have hope. We are just waiting I guess until my desire to have a child outgrows my fear of having another miscarriage. We will run out of the strength to continue before we run out of fertile years. The day the hope disappears I’m not going to try anymore. I’m not going to let this rule my life. There is only so long you can do it because it consumes you. There are other things that we’ll end up planning in our lives.’ (Next Magazine June 2012.)