Recurrent Pregnancy Loss
Finding a way forward after loss.
About Recurrent Pregnancy Loss
Recurrent Pregnancy Loss (RPL) refers to the experience of having 2 to 3 consecutive miscarriages. It is a devastating condition that affects 1-2% of women. There are multiple risk factors that have been associated with RPL, including genetic, uterine, hormonal, immune and infectious factors. A comprehensive approach to this problem is necessary to ensure that all factors are optimized to prevent future losses.
Our recurrent loss program focuses on the work-up and treatment of patients with RPL. Therapies that can improve the maintenance of pregnancy are provided, and when patients conceive, close monitoring is offered in a careful and compassionate setting.
We offer a comprehensive approach to diagnosing and treating the root causes of miscarriage and provide therapies that help to prevent future losses.
Your Journey After Recurrent Pregnancy Loss
Each person's pathway when they experience recurrent pregnancy loss will differ depending on the information we are presented with as we investigate the causes. Nevertheless, it may be helpful to understand what steps we generally take along the way. The timeline to complete all of the testing and receive results for all tests outlined below is about 4-6 weeks. Many patients come to Markham Fertility Centre for our unique Immune Program, which is not covered by OHIP. However, all other tests are covered by the provincial health plan.
The first step is understanding the problem. Our physicians will take a full reproductive history to understand how many pregnancy losses you have suffered and determine if any risk factors for miscarriage exist. Based on your history, the following tests may be proposed.
TESTING - Genetics
We will run a test called karyotype analysis for you and your partner. The most common reason for miscarriage is genetic aneuploidy of the embryo, which is an abnormal number of chromosomes in the embryo’s cells. This could happen due to random chance, but there are also genetic conditions that might predispose people to making aneuploid embryos.
TESTING - pelvic imaging and uterine cavity assessment
Through our collaboration with Care Imaging, we provide state of the art, high resolution pelvic ultrasonography services. This enables us to get a detailed survey of pelvic anatomy, and assess for anatomic issues and uterine anomalies that may contribute to miscarriage. We also can perform 3 dimensional sonohysterogram and hysteroscopy to assess the uterine cavity.
TESTING - Identifying your hormone profile
Extensive hormonal testing (for thyroid disorders, diabetes, etc.) is performed to ensure that the hormonal environment is conducive to pregnancy.
TESTING - Uterine microbiome and infection screening
In some cases, your expert physician might recommend an endometrial biopsy to rule out abnormal bacterial colonization of the uterus.
TESTING - Immune system profiling
Autoimmune conditions such as antiphospholipid antibody syndrome have been associated with RPL. Other immune system factors like Natural Killer cells and pro-inflammatory cytokines have also been associated with miscarriage. At MFC we offer specialized testing to address the immune system and its possible impact on pregnancy loss. Immune testing is not part of the routine work up for recurrent pregnancy loss. Your expert physician will discuss your case and advise you on the pros and cons and costs of doing this testing.
Patients with RPL may consider either trying to conceive on their own or pursuing IVF treatment with Preimplantation Genetic Testing for Aneuploidy (PGT-A). The value of PGT-A is to test embryos for aneuploidy before transferring them to the uterus, to try to minimize the risk of miscarriage.
Combining IVF with PGT-A as well as addressing structural anomalies, hormonal and immune issues, is a powerful approach to achieve a live birth rate after recurrent pregnancy loss.