The treatment for recurrent pregnancy loss should depend on the underlying causes contributing to loss. Unfortunately, the precise cause for loss remains unknown in many cases and thus effective treatment modalities remain elusive. Many empiric therapies involving immunologic phenomena such as intravenous immunoglobulin, leukocyte immunization and even low dose aspirin therapy have been proposed, but studies to date have disproven their effectiveness and health related issues potentially caused by these now disproven empiric therapies further limit their use.
When Should Fibroids or Polyps be Removed to Prevent Recurrent Pregnancy Loss?
With emphasis on maintaining fertility, a conservative approach is most often taken. The current standard of care is to remove and partially-remove those fibroids impinging upon the uterine cavity. Data demonstrates that fibroids influencing the cavity reduce chances of pregnancy. Outpatient surgery involving hysteroscopy with removal of any intrauterine filling defect (polyps, fibroids, or adhesions) or resection of a uterine septum should be done in cases where an anatomic abnormality has been found. Consideration for surgery should also be given in cases where there are large fibroids (>5cm) within the muscle of the uterus even if the uterine cavity appears normal.
Hormonal Causes of Recurrent Pregnancy Loss
If certain hormones are imbalanced recurrent miscarriage can occur. Hormonal problems are treated with medical therapies such as thyroid hormone replacement in cases of hypothyroidism where there is an elevated TSH level, dopaminergic drugs in cases where there is an elevated Prolactin, and insulin-sensitizing agents if there is evidence of high insulin levels as often occurs in cases of PCOS associated severe ovulation dysfunction.
Ovulation Disorders and Recurrent Pregnancy Loss
An ovulation disorder can be a common cause of infertility and recurrent pregnancy loss. In a typical menstrual cycle, which is around 28 days, a woman will ovulate once. During this time the endocrine system prepares the body for pregnancy by releasing hormones such as follicle stimulating hormone (FSH), luteinizing hormone (LH) and gonadatropin-releasing hormone (GnRH). These hormones play a crucial role in helping an egg mature when in the ovary. Some women may have a hormone imbalance or deficiency that can cause inconsistent ovulation.
Ovulation induction with gonadotropins is used in cases of disordered ovulation. However, clomiphene citrate has no place in the management of recurrent pregnancy loss associated with ovulation dysfunction due to its anti-estrogen effects. Luteal support with progesterone may be warranted in some cases but the efficacy of this therapy has not been found.
No matter what your situation, we will work with you toward a solution. At Fertility Centers of New England, our team keeps on top of the latest advances in assisted reproductive technology and tailors treatment for each person.
Contact us to schedule your free initial consultation to discuss treatment for recurrent pregnancy loss. We are here for you.