Recurrent Pregnancy Loss
Definition
The recurrence of consecutive pregnancy losses. It is one of the most challenging conditions in reproductive medicine; it requires diagnostic investigation, treatment, and an assessment of the risk of recurrence.
Purpose
To investigate whether there is an underlying cause. According to a comparative review of five major international guidelines, the core components agreed upon for the investigation are:
- A detailed personal history
- Screening for antiphospholipid syndrome
- Investigation of structural abnormalities of the uterus
Results
Guidelines differ on some tests, meaning which test is ordered depends on the physician's assessment and the guideline being followed:
| Topic | Status |
|---|---|
| Cytogenetic examination of the pregnancy tissue | Guidelines differ |
| Parental karyotype | Guidelines differ |
| Ovarian reserve, thyroid, diabetes, prolactin | Guidelines differ |
| Hyperhomocysteinemia, endometrial biopsy | Guidelines differ |
Points of agreement on treatment: low-dose aspirin plus heparin for antiphospholipid syndrome; levothyroxine for overt hypothyroidism.
If the parental karyotype is abnormal, genetic counseling is required. A parent carrying a balanced translocation may be healthy but carries a risk of recurrent pregnancy loss, a situation described under the glossary term Chromosome Abnormalities.
Risks and Limitations
Some tests are not recommended as part of routine investigation. The guidelines reviewed do not recommend including hereditary thrombophilias, vaginal infections, immunological factors, or male infertility factors as part of the routine work-up for recurrent pregnancy loss. The use of heparin for hereditary thrombophilia and immunotherapy and anticoagulants for unexplained recurrent pregnancy loss is also not recommended.
Because of these differences between guidelines, the choice of tests must always be made together with a physician.