Most miscarriages are related to chromosomal abnormalities
Clinically, miscarriage is considered a common phenomenon, with about 15–25% of pregnant women experiencing it. Most miscarriages that occur before 10 weeks are caused by chromosomal abnormalities, especially triploidy, haploidy, and polyploidy. Most miscarriages are sporadic, primarily associated with genetics, and are highly correlated with maternal age.
Studies on recurrent miscarriage have identified several contributing factors
These include genetics, age, antiphospholipid syndrome, uterine abnormalities, thrombophilia, hormonal or metabolic issues, infections, autoimmunity, sperm quality, and lifestyle habits.
Although there are some recommendations for evaluating and managing recurrent miscarriage, most of these are based on studies of general miscarriages rather than recurrent ones, and thus may not fully apply. Knowledge about recurrent miscarriage is continuously evolving.
The causes of recurrent miscarriage are often unclear
Approximately 60% of early miscarriages are due to chromosomal abnormalities, primarily trisomy, which is partly age-related.
For women under 35 who miscarry between 6–12 weeks, the rate is about 9%–12%. For those over 35, the risk increases due to a higher incidence of trisomy. For women over 40, the miscarriage rate reaches 50%.
Apart from genetic causes, the physiological mechanisms of recurrent miscarriage remain unclear, and most causes cannot be identified.
Key conclusions from recurrent miscarriage research
－Evaluation should be conducted after two clinically confirmed pregnancy losses.
－Diagnosis should focus on genetic factors, antiphospholipid syndrome, uterine abnormalities, hormonal and metabolic factors, and lifestyle variables, including:
➡️Parental chromosomal analysis
➡️Autoimmune disease screening
➡️Ultrasound, hysterosalpingography, hysteroscopy
➡️Thyroid and prolactin testing
－Embryonic karyotyping may help guide treatment.
－Women with moderate to severe antiphospholipid syndrome may benefit from prophylactic heparin and low-dose aspirin.
－Psychological counseling and support should be provided to couples experiencing recurrent miscarriage.
Recurrent miscarriage is different from implantation failure in IVF. In recurrent miscarriage, the embryo implants but is later lost, whereas implantation failure means the embryo never implants.
“The most common identifiable cause of miscarriage is chromosomal variation, which is closely tied to age.”
True immune-related issues are rare, but patients with a history of recurrent miscarriage should be checked for immunological problems.
The psychological impact of miscarriage on women is greater than that of infertility.
It may take 2–3 months to recover from one miscarriage. This sense of loss is something men cannot experience directly, so emotional support from the partner is vital. Gentlemen, never let your partner face this alone!
❣️“Reproduction is a shared responsibility between husband and wife.”❣️
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