From Robin Elise Weiss, LCCE,
Your Guide to Pregnancy & Childbirth.
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Miscarriage is hard to deal with. It occurs in 15-20% of all pregnancies, usually in the first three months. However, some families will experience multiple miscarriages. After three or more miscarriages, it's referred to as repeated miscarriage or habitual abortion.

Once you've suffered from multiple miscarriages, though the exact number will be determined with the help of your care provider, you might be offered special tests to try and help determine the cause of your losses.

Causes of Repeated Miscarriage

Chromosomal

This is one of the most common causes of miscarriage, comprising over half. It may be a case of problems with the number of chromosomes, the structure of the chromosome, or even the genetic material that they carry. Random, chance problems are the usual cause of genetic problems, however there are times when some genes are repeatedly passed on which can contribute to multiple pregnancy losses. You and your partner should be tested by a genetics specialist if you are repeatedly passing on chromosomal problem.

Uterine Anomalies

Abnormalities of the uterus can be something that you're born with, like a double uterus, a uterus that is divided by a wall (septate), etc. There are also problems with fibroids for some women. These are growths that can occur any place in the uterus, which may have no effect on conception or pregnancy or can cause problems. The good news is that the majority of these problems can be dealt with prior to conception through surgery, thus increasing your chances of a health pregnancy.

Hormone Imbalance

Hormonal imbalance can be a problem for some women, usually known as a luteal phase defect, where there is not enough progesterone to sustain a pregnancy. Treatment is usually given in the form of hormones prior to the luteal phase to increase the progesterone or in the form of progesterone supplementation.

Progesterone therapy has been wildly popular and many women and practitioners swear by this form of treatment. However, there are also those who have no found it to be beneficial. The studies available are really inclusive. A look at the potential risks and benefits is advisable for those considering it.

Immunization Problems

Sometimes your body will see the baby as a foreign body and attack it rather than accept it. When this happens the mother's body rejects the baby and a miscarriage ensues. There are certain blood tests, which can help determine if this is your problem and there may be medications to help you maintain a pregnancy. It can also be caused by an immune difference between the mother and father.

Maternal Illness

Generally a healthy mother, even with a history of chronic illness can have a successful pregnancy. Usually the key to this pregnancy will be diagnosis and control of the underlying factors. Some will have no effect on the pregnancy, while others require monitoring. Here is a list of some of the potential problems:

• Diabetes
• Heart Disease
• Kidney Disease
• High Blood Pressure
• Thyroid Disease
• Infections
• Environmental Factors

Exposure to certain chemicals, drugs, x-rays, etc. have the potential to cause repeated miscarriage. Some of these factors are work related, while others may be related to your life style. Factors like drinking, smoking (first and second hand) do have an impact on pregnancy, for both partners.

Diagnosis & Future Pregnancy

This can be the difficult part of the process. Sometimes no answer is ever found. However, the process is quite involved. In addition to complete medical history for both you and your partner, you will have a complete physical exam as well. Which may include:

• Blood work (hormones, antibodies, disease)
• Genetic Counseling and potential testing (You and your partner)
• Testing for infection in the reproductive organs
• Ultrasound to look for structural problems of the uterus
• Biopsy of the uterine lining
• X-rays of the reproductive tract (hysterosalpingogram)
• Hysteroscopy (Minor surgery to visualize the reproductive organs through the vagina)
• Laparoscopy (Minor surgery to visualize the reproductive organs through the abdomen)
• Testing of any genetic material from previous miscarriages, if available

When to get tested will depend on your feelings and those of the practitioner you are using. Generally having one miscarriage is not a reason to run for testing unless something out of the ordinary is expected. However, it is hard to realize that sometimes there is nothing we can do to prevent the loss of a pregnancy.

Future Pregnancy

The good news is that even after more than one miscarriage your chance of having a healthy pregnancy is still good. With testing and possibly treatment you and your practitioner can hopefully bring down the risks of a future loss. What type of treatment will be necessary will depend on the cause or causes determined. Make sure you talk to your practitioner about what a future pregnancy will be like, what type of special tests or monitoring you might require.