How To Deal With Recurrent Pregnancy Loss

Recurrent pregnancy loss exacts a devastating emotional toll on patients' lives. Each miscarriage brings with it a profound sense of loss and frustration. While hormonal, uterine, immune system, and chromosomal abnormalities are widely accepted as possible causes of repeat miscarriages, the latest studies point to a new area of investigation - inherited blood clotting factors.

When a patient has a tendency to form blood clots, the condition is called thrombophilia. Thrombophilia can be a life-threatening event if the clots restrict blood flow. Thrombophilia can be an inherited disorder, but can also be caused by external events such as surgery, obesity, pregnancy, use of oral contraceptives, antiphospholipid syndrome, or long periods of immobility. Physicians may suspect thrombophilia when patients have a blocked blood vessel at a young age or have a strong family history of clotting disorders (such as stroke, pulmonary embolism, or deep vein thrombosis). However, some patients with thrombophilia do not experience any symptoms. Or if they do have symptoms, the condition often goes undiagnosed because the tendency to make clots is subtle. Recent research suggests a possible correlation between inherited thrombophilia and recurrent fetal loss. Genetic markers for these clotting factors include factor V Leiden mutation and prothrombin G20210A mutation. These two mutations are the most common causes of inherited thrombophilia. These markers, as well as several others that have also been associated with recurrent miscarriage, can be detected through simple blood tests (see recommended testing).

Recent research indicates that patients who experience recurrent miscarriage may have one or more of these markers for thrombophilia. One study found that 19% of miscarriage patients (15 of 80) carried the factor V Leiden mutation compared to 4% of controls. Other indicators of thrombophilia (prothrombin mutation, activated protein C resistance, and antithrombin III deficiency) are also more prevalent among women experiencing frequent miscarriages [1,2]. Several other recent studies have reached similar conclusions. While more research is needed, this is a promising new area of investigation.

Treatment regimens used at Georgia Reproductive Specialists to manage thrombophilia may include heparin or Lovenox (low molecular weight heparin) injections, and baby aspirin or metformin (for insulin resistant patients with elevated PAI-1). These treatments are designed to improve blood flow in the follicle, optimize egg quality, and improve pregnancy outcomes. All patients receiving treatment must be carefully monitored. Patients on heparin require monthly PTT, blood counts, and platelet levels. These patients should also consider dietary calcium supplementation.