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What Causes Recurrent Miscarriage?

Posted on Mon, 13 Apr 2015

Question: Dear Doctor,

My Wife ( 28 years old, healthy ) had 2 back to back miscarriages in May 2014 and Feb 2015.
After the second loss the doctor asked us to do following tests.

1. TORCH test.
2. ANA profile
3. Lupus Anticoagulant
4. Pelvic scan

Test reports are attached.

In TORCH test CMV and Rubella were positive and the GYN informed us that these MAY be the possible reason for the miscarriages and we can try to conceive after our next cycle. ( 2 periods after Miscarriage ) . We are not under any medication now.

All other reports are normal as per the gynaecologist.

Pls reply on my following queries.
1. Do you concur with our Gynaec's conclusion?
2. Are there any other test we should undergo?
3. Will it be safe for us to try and conceive in March ( After first cycle after miscarriage )
4. We also like to increase the possibility of conceiving as my husband is working abroad and need to report back to duty soon. What are the options we should consider for this ?

Many thanks in advance.

Answered by Dr. Richa Agarwal (31 minutes later)

Brief Answer:
Your doctor opinion is right.

Detailed Answer:
Hi,

Thanks for writing to us about it.

I can understand your concern here.

I am so very sorry about your loss.

I have gone through your history and reports and it seems your doctor's opinion is right.

You suffer a past infection of rubella and CMV and it may be the cause of miscarriage.

In my opinion you should go for repeat titre after 4-6 weeks to ascertain the level of antibodies.

You should try for pregnancy after 6 months-1 yrs. After last miscarriage for healthy pregnancy.

You should get to your thyroid profile, blood sugar level and Rh factor ( you are positive or negative blood group).

Your husband should go for semen analysis.

Advice to conceive fast-

-Find out your ovulation time by using ovulation kit and use your fertile period maximum for sex.
- Start taking folic acid tablet
- Do not take any stress, perform some yoga and meditation.
-Consume healthy and balanced diet rich in protein.

Hope it is useful, feel free to ask more.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Richa Agarwal (45 hours later)

Dear Doctor,
Many thanks for your reply.

My husband had done semen analysis and everything was found normal.
My blood group is O -ve and husband's is A+ve.

I have following queries.
1. As on this occasion we had miscarriage during the first ~ second week itself trust its okay to go in for next pregnancy by 2~3 months.
2. Will the Rubella antibodies detected in the TORCH test be due to Vaccine taken during childhood?
3. Any chances of these infections active agaun?
4. Any chances of these past infection affecting the next pregnancy?
5. Will our blood groups have any affect on pregnancy loss?
We had taken anti-D injection on both occasions.

Kindly provide your valuable comments.
Many thanks in advance.

Answered by Dr. Richa Agarwal (3 hours later)

Brief Answer:
Your blood group may also be responsible for misc.

Detailed Answer:
Hello,

You are most welcome.

Here are the answers to your questions.

- Yes, your blood group may also be responsible for miscarriage.
- Rubella antibodies may develop due to immunization in chilhood, past infection and vaccination in adult.
- The chances of repeat infection are rare because you have already built up antibodies against rubella, so you should not be worried about it.
- In my opinion you should try for next pregnancy after 6months to 1 years. as we discuss earlier also.
- As you had already taken anti - d then chances of abortion are less.

Hope it is useful, feel free to discuss more.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Richa Agarwal (32 hours later)

Dear doctor,
Thanks again for valuable reply.
I have the following queries now,
1. Once we undergo repeat TORCH test after abt a month, how should we interpret the results by comparing level of antibodies with that detected now?
2. What are chances of genetic defects and chromosomal abnormalities in our miscarriages?

Thanks in advance.

Answered by Dr. Richa Agarwal (7 hours later)

Brief Answer:
Repeat test to see the level of antibodies.

Detailed Answer:
Hi,

Sorry for the delay in my response.

You are always welcome in healthcaremagic for your health care.

You have to repeat antibody titre after 3-4 weeks to see whether your titre is increasing or decreasing in comparison to your recent antibodies titre.

Four fold increase in antibodies titre from recent report may indicate repeat infection.

The chances of miscarriage by chromosomal abnormalities in the first trimester is almost 70% because chromosomal abnormalities play important role in first trimester miscarriage.

Hope it is useful, feel free to discuss more.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Richa Agarwal (2 days later)

Dear doctor,
Thanks again for yr reply.
What we are worried is , does the level of CMV antibodies as per the TORCH test report denote an infection that we had in early feb?
As we have understood, CMV infection occur only happens once in a life time. Pls comment.

Answered by Dr. Richa Agarwal (1 hour later)

Brief Answer:
It indicates infection in the past.

Detailed Answer:
Hi,

Nice to hear from you once again.

She is positive for IgG antibodies for CMV, it indicate past( previous ) infection.

So possibly you had infection in early February and produce antibodies against infection and produce immunity against it.

Hope it is useful.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar