Causes of recurrent pregnancy loss
Uterine or cervical abnormalities (eg, polyps, myomas, adhesions, cervical insufficiency)
Maternal (or paternal) chromosomal abnormalities (eg, balanced translocations)
Luteal phase defects (particularly at < 6 wk)
Overt and poorly controlled endocrine disorders (eg, hypothyroidism, hyperthyroidism, diabetes mellitus)
Chronic renal disorders
Placental causes include preexisting chronic disorders that are poorly controlled
Fetal causes are usually
Chromosomal or genetic abnormalities
Anatomic malformations
Diagnosis
Evaluation should include the following to help determine the cause:
Genetic evaluation (karyotyping) of both parents and any products of conception as clinically indicated to exclude possible genetic causes (see Genetic Evaluation)
Screening for acquired thrombotic disorders:
Thyroid-stimulating hormone
Diabetes testing
Evaluation of ovarian reserve including measuring follicle-stimulating hormone level on day 3 of the menstrual cycle
Hysterosalpingography or sonohysterography to check for structural uterine abnormalities
Cause cannot be determined in up to 50% of women. Screening for hereditary thrombotic disorders is no longer routinely recommended unless supervised by a maternal-fetal medicine specialist.
Treatment
Some causes can be treated. If the cause cannot be identified, the chance of a live birth in the next pregnancy is 35 to 85%.