Stanford Fertility and Reproductive Medicine Center  

Recurrent Pregnancy Loss

Recurrent Pregnancy Loss Director

 

The majority of patients prevail over RPL...
realizing their dream of a successful pregnancy.
 

~ Ruth Lathi, MD  


      Ruth Lathi, MD
      RPL Director

Miscarriage is the loss of a pregnancy before viability. Occurring in 15-20% of all pregnancies, it is the most common complication of pregnancy. Studies show that approximately 25% of all women experience at least one miscarriage in their lives. The individual risk may vary depending on age and other factors. Despite its prevalence, many women feel isolated and responsible for the loss of a pregnancy. The unfortunate fact of miscarriages is that the vast majority of them are not preventable because they are due to developmental or genetic problems in the embryo or fetus that cannot be treated.

Recurrent pregnancy loss (RPL) or recurrent miscarriage (RM) affects from 1-5 % of the reproductive age couples. This diagnosis is both emotionally challenging and confusing for most couples, as the definitive diagnosis using conventional evaluations is found in fewer than half of the couples experiencing repeated loss. The distress associated with the experience of recurrent miscarriage often leads patients to unproven testing and treatments. Studies show that women with no identifiable cause have a very good chance of having a successful pregnancy when standard treatments are used. It is our goal to offer scientifically proven testing and treatment for patients with recurrent pregnancy loss in a supportive and productive environment.

Our center offers a multidisciplinary approach to recurrent miscarriage by performing testing and treatment for genetic, anatomic, hormonal and immunologic abnormalities is performed.

Meet Members Of Our Team

Testing the Uterine Cavity

A healthy uterus, or womb, is essential for the success of a pregnancy. Uterine abnormalities can be congenital (meaning present from birth) or acquired as a woman ages. Transvaginal ultrasound can only diagnose a few of the important uterine anomalies, and frequently further testing is required. Testing the uterine cavity can be done with a hysteroscope, a small camera place into the uterine cavity through the cervix. Other testing such as hysterosalpingogram (HSG), saline infused sonogram or MRI can also be used. Our physicians will recommend the tests most appropriate for the condition.

Genetic testing

Studies have concluded that about half of all first trimester miscarriages are the result of chromosomal abnormalities. These generally occur on a sporadic basis, meaning that they are random occurences. They are, however, related to the age of the woman and are more likely to occur with advancing maternal age.

Research suggests that after a couple has had 2 or more unexplained miscarriages, there is a 2-5% risk that one member of the couple is a carrier of a balanced chromosome rearrangement. Chromosomal analysis of the products of conception (the miscarried fetal tissue) and of the woman and her partner may provide additional important information that will affect future reproductive decisions and additional testing recommendations.

Hormonal testing

There are several hormonal imbalances that can contribute to miscarriage rates. These can be evaluated with simple blood tests and treated if present. The recommended hormonal testing will depend up on the symptoms experienced, but may include thyroid, prolactin, follicle stimulating hormone, fasting glucose and insulin levels.

Hematologic and Immunologic Testing

Several blood disorders have been implicated in recurrent miscarriages. Women with abnormal blood clotting may be predisposed to early or late miscarriage and women with high risk personal or family histories should be tested. Women with these disorders have a high success rate when properly treated. Testing and treatment of low risk patients continues to be debated among physicians, however even in these cases, the most common abnormalities should be ruled out.

Emotional Support

Miscarriage can have a profound impact on a woman’s sense of wellbeing. Depression and anxiety are common in the months following miscarriage and can last for a year or more. We recommend that all patients seek emotional counseling and support after a miscarriage. We offer a support group and individual counseling and encourage all patients with concerns or symptoms of depression and anxiety to contact our counselor, Penny Donnelly at 650-498-7911, Option 6.

Please read: RPL Program psychiatrist Katherine Williams, MD, and colleagues' paper on mood disorders and miscarriage.

Frequently Asked Questions

What is a recurrent miscarriage program?

As there are many causes of recurrent miscarriage, there are many places where patients and physicians get information. The recurrent pregnancy loss program at Stanford University is a multidisciplinary approach to this problem. With input from professionals from genetic, hematology, endocrinolgy, immunology, reproductive endocrinology and maternal fetal medicine, we have developed a standardized and scientifically based evaluation and treatment for patients with recurrent pregnancy loss. The Recurrent Pregnancy Loss Program at Stanford gives patients with recurrent pregnancy loss of known or unknown cause a place to receive the needed medical care in a supportive and caring environment.

What about the male causes for miscarriage?

Although we believe that there are male contributions to miscarriage, the majority of the research to date has been on female causes. Some studies suggest an effect of male age on miscarriage and other suggest the increased DNA damage in the sperm may contribute as well. Further research is needed in this area.

What about the effect of female obesity on miscarriage?

Obesity is associated with an increased risk of both sporadic and recurrent miscarriage. Reaching a healthy weight before pregnancy may improve the odds of success.

Does it matter how far along into the pregnancy I was when I had the miscarriage?

Yes, getting accurate records about gestational age at the time of loss is important in evaluating causes of pregnancy loss. If your losses occurred after 14 weeks, you may need an evaluation by a maternal fetal medicine specialist for a cerclage. A cerclage is a stitch placed around the cervix to prevent premature cervical dilation.

What treatment options are there for patients with recurrent miscarriage?

There are many successful treatments available and the optimal treatment recommended will depend on the results of a thorough evaluation. All patients with recurrent pregnancy loss should be monitored closely during early pregnancy. Blood thinners, hormonal supplements or vitamins may be prescribed. In some cases preimplantation genetic diagnosis, egg or sperm donation or gestational carrier may be recommended. It is important for all patients to know that there are multiple options available for everyone and that we are here to provide you the much needed professional advice and support.

Contact information

For New Patient appointments and/or Referrals
Please call: 650-721-6353 or
Email: Fertility Center [fertilitycenter stanfordmed.org]

Returning and/or Current Patients
Please call: 650-498-7911 option 3, 2 or
Email: Fertility Center [fertilitycenter stanfordmed.org]
Fax: 650-725-1345

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