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6 Potential Causes of Miscarriage and Recurrent Pregnancy Loss (RPL)

By Satu Kuokkanen, MD, PhD

May 2nd, 2016 at 11:31 am

image courtesy of David Castillo Dominici/

Experiencing a pregnancy loss is always devastating for individuals hoping to establish or expand their family. Patients describe a range of grieving emotions related to the loss of a person they never had a chance to meet, love and share the future.  This grieving process may last anywhere from few weeks up to several years.  Not surprisingly, I have heard from many patients that one of the most difficult coping times was around the expected due date of the pregnancy that they miscarried.


It may be somewhat comforting for patients to know that they are not alone. In fact, miscarriage is the most common pregnancy complication and it affects 1 in every 6-8 confirmed pregnancies, that’s 12-15%. The risk of miscarriage increases with maternal age. While women younger than 30 years old have a 10-12% risk of pregnancy loss, the risk is four fold higher for women in their 40’s. Identifying a potential cause may help with the emotional impact of the pregnancy loss whether it is isolated or recurrent loss.


Recurrent pregnancy loss (RPL) is diagnosed after a woman has had two or more consecutive miscarriages and RPL affects 1 in 20 couples who are attempting to conceive. While isolated miscarriages are commonly due to chromosomal and genetic abnormalities, other factors are responsible for RPL. These factors vary depending on the gestational age of the pregnancy loss. Evaluation of potential RPL causes is important in determining whether therapy is available to the patient.


6 Potential causes of RPL:


  1. Congenital and acquired structural uterine factors. A uterine septum, a partial or complete division of the uterine cavity, is the most common congenital structural uterine abnormality.  Uterine septum and bicornuate uterus (“heart shaped womb”) have been linked to RPL. Acquired structural uterine pathologies that distort the normal uterine cavity include endometrial polyps that are skin tag-like growths of the uterine lining, fibroids that are affecting the uterine cavity, and intrauterine scarring that can develop after surgical procedures, such as dilatation and curettage (also known as D&C).  Radiology studies of the uterus with saline ultrasound (‘water sonogram”) or magnetic resonance imaging (MRI) are standard methods to evaluate the womb.


  1. Chronic endometritis is inflammation of the uterine lining. This condition is diagnosed by sampling of the uterine lining with an endometrial biopsy or D&C.


  1. Structural chromosome abnormalities of the parents is a rare but known cause of RPL. A simple blood test of both parents to assess numeric and structural chromosomal component (karyotype) is done.


  1. Abnormalities of blood clotting.  The well-known condition in this category is anti-phospholipid antibody syndrome (APAS) which women can acquire during their reproductive years. Anti-phospholipid antibody levels can be measured in blood for diagnostic purposes.


  1. Endocrine-related abnormalities include elevation in alterations in thyroid hormone secretion and diabetes with uncontrolled blood sugar levels.  Also, women with polycystic ovary syndrome (PCOS) appear to have heightened risk of pregnancy losses.


  1. Environmental and lifestyle factors have also been linked to an increased risk of miscarriages. Such factors may include maternal obesity, cigarette smoking, and exposure to environmental toxins. How these factors may impact pregnancy or pregnancy loss differs and is still being studied at the current time.


It is important to remember that, although painful, an isolated miscarriage may often be followed by a healthy and successful pregnancy. And that, RPL, while devastating, can be caused by a factor that may be treated with proper, specialized medical care. In either case, your dream of parenthood may still be within reach.

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Have you suffered one or miscarriages, been treated for an underlying cause, and gone on to have a successful pregnancy?

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Long Island IVF-WINNER: Best in Vitro Fertility Practice 2015 AND 2016

It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 and 2016 contest…two years in a row!

The doctors, nurses, embryologists, and the rest of the Long Island IVF staff are so proud of this honor and so thankful to every one of you who took the time to vote. From the moms juggling LIIVF babies… to the dads coaching LIIVF teens…to the parents sending LIIVF adults off to college or down the aisles… to the LIIVF patients still on their journeys to parenthood who are confident in the care they’re receiving…we thank you all.

We love what we’ve gotten to do every day more than 28 years…build families. If you are having trouble conceiving, please call us. Many of our nurses and staff were also our patients, so we really do understand what you’re going through. And we’d like to help. 631-752-0606.


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ASRM 2011 and IVF’s “Magic Bullet”

By David Kreiner, MD

November 10th, 2011 at 1:52 am

This past October, reproductive endocrinologists from around the globe gathered for the annual scientific meeting of the American Society for Reproductive Medicine (“ASRM”).  It is an opportunity for us to share experiences and learn from each other.  

I had lunch with a colleague practicing IVF in Mumbai, India and was fascinated with how similar our practices felt despite the huge geographic and cultural differences.  The human interactions and emotional and social issues of infertility afflict our apparently disparate populations of patients in very similar ways.

There were a few presentations during the five day conference worth noting.  

Regarding ovulation induction for patients unable to ovulate on their own: Metformin, in combination with clomid appears to be slightly more effective than clomid alone or letrizole which may have a lower risk of multiples.  Ovarian drilling (a surgical procedure involving cauterizing small craters in the ovaries) is equally effective and was suggested for clomid/letrizole failures.

The best presentation according to many attendees was on surgery to enhance IVF success.  Data was presented documenting the huge benefit of eliminating hydrosalpinges (fluid filled fallopian tubes) prior to embryo transfer.  It is thought that the inflammatory fluid in these tubes bathes the uterine cavity… creating a hostile environment for the embryos.  It appears that salpingectomy (removal of the tubes), or tubal ligation laparoscopically or by one of the less invasive hysteroscopic procedures (such as Essure) appear to be equally effective.

Cysts of endometriosis do not affect the number or quality of a patient’s embryos. Because of the risk of removing normal ovarian tissue (and thereby reducing the ovarian reserve), it is not generally recommended that patients undergo endometriosis surgery to improve IVF outcome.

Routine hysteroscopy (visualization of interior of uterus through a scope) on asymptomatic patients found abnormalities in 11-12% of cases.  Removing polyps significantly improved pregnancy rates.  It was recommended that patients undergo a hysteroscopy after one failed IVF, if not done sooner.

Fibroids that were partially in the uterine cavity affected pregnancy rates and should be removed.  Likewise, fibroids that are intramural (in the muscle of the uterus) and distort or increase the size of the uterine cavity should be removed to increase the IVF pregnancy rate.  

It was also suggested that resection of the uterine septum increases the IVF pregnancy rate.

There were several interesting presentations about IVF over the course of the five day conference. But the one that stimulated the most conversation on the trip home was a study from Egypt.  

This program injected (through a catheter placed vaginally through the cervix) 500 units of HCG into the uterine cavity just before performing the embryo transfer.  They found higher pregnancy rates in women who were injected with this "magic bullet".  It inspired enough interest that I expect a year from now, we will learn if the intrauterine HCG is in fact the IVF magic bullet.

Certainly, we will endeavor to utilize the worthwhile studies presented at this year’s ASRM to continue to improve the outcomes for our patients.

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Did you learn anything new from this post? What is the most interesting thing? If the “magic bullet” was available to you, do you think you’d be interested in it? How important is it to you that your RE attends the annual ASRM conference?

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