Multiple Miscarriages

[adgal]

Hi Dr.

I am a 39 year old women in good health who just suffered my 3rd m/c since Jan.  The first was diagnosed at 10 weeks after spotting since day 1.  I never got a heartbeat and they said it looks like things stopped developing at about 6-7weeks.  I ultimately had a d&c, and the tissue tests came back normal.  The second was a chemical pregnancy, I started to bleed 2 days after a positive early home pregnancy test.  The third was just 2 weeks ago, diagnosed at 8 weeks pregnant with an ultrasound.  There had been no spotting, or any other real symptoms, baby just stopped developing around 6 weeks again.  They called it a missed abortion. I also had a d&c that time.  Again,the tissue was normal. My question is, when I have my follow up in 2 more weeks, are there any specific tests I should be requesting?  The only real common factor in both d&c's was severe hemoragging after being given cypotec (spelling?) as I had not dialated in either case.  I have never had any severe bleeding problems in the past, although my mother did in labour with me.  She also experienced several m/c and I am her only living child.  Could there be something genetic? Thank you for your advice.

[Keith Downing, MD]

Hello,

Well demonstrated causes of recurrent miscarriage are genetic factors (parental chromosomal rearrangements or aging eggs), anatomic (e.g., uterine septum or submucosal fibroids), and immunologic (anti-phospholipids).  Others possible factors include endocrine abnormalities (e.g., abnormal thyroid hormone, diabetes), environmental factors (alcohol or caffeine intake), and thrombophilias (having an increased propensity to form blood clots).

The initial work up for recurrent miscarriage involves the following: Chromosomal analyses of you and your partner (called a Karyotype--although if the chromes on the pregnancy tissue was normal this could be bypassed; but I'd recommend it), a Day 3 FSH and estradiol to assess ovarian reserve, assement of the uterine cavity(there are multiple ways this can be accomplished), and blood tests checking for anti-phospholipid antibodies.  Based on your medical and social history your doctor will decide whether other tests are warranted.

Best regards,

Dr. Downing

[dakjilsim]

Hi, I'm 38 and had 2 mc's in 4 months.  Both times the baby stopped growing at 6 wks.  They did tissue testing the second time and it was chromosomal.  I chose to have a D&C both times.  I just found out that I'm pregnant again and I'm terrified that I'll mc again.  It seems so unfair that at 38 my body won't work the way it used to.  

We are truly blessed in that we have 3 wonderful children.  I thank God every day for them but we really do want to have a 4th child.  I wish you all the best for you and your husband with your journey and hope for a successful pregnancy to come.

I did't have any severe bleeding with either D&C so I'm not sure about that.  I have heard with some women, the bleeding was an issue and that taking a baby aspirin during the pregnancy actually helped.  There was another womam on this forum who also had 2 mc's...tissue came back normal and her MD instructed her to take the aspirin when she got pregnant a 3rd time.  It helped and she did go on to have a successful pregnancy.  Also, has your husband had his sperm tested?