Failed Pregnancy


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Recurrent fertility loss

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Recurrent pregnancy loss (RPL) is defined as having a history of three miscarriages in the first trimester or a single loss in the second trimester. The basic work up of RPL is typically started after experiencing two consecutive losses in the first trimester, unless there are other identifiable causes for the miscarriages.

Recurrent pregnancy loss is defined as the loss of three or more pregnancies in a row. These miscarriages generally occur during the first or second trimester, before the 20th week of pregnancy. Also known as recurrent miscarriage, recurrent pregnancy loss is an extremely emotional and challenging experience to go through. It can be especially difficult for some couples to deal with miscarriage, as the cause of recurrent pregnancy loss is often never discovered. With the help of diagnostic testing and treatment, however, it is possible for couples suffering from recurrent miscarriage to go on to have a healthy child.

How Common Is Recurrent Pregnancy Loss?

Though many people don't realize it, miscarriage is actually a fairly common occurrence during pregnancy. In fact, 25% of all pregnancies end in miscarriage in the first trimester. Many researchers theorize that the number of single miscarriages is actually much higher - around 50% - because numerous women don't even know that they are pregnant when it happens. Most women who experience single miscarriages go on to have healthy pregnancies.

Recurrent pregnancy losses are more rare, but they do happen. In fact, approximately 5% of couples experience two miscarriages in a row, while about 3% of couples experience three miscarriages in a row. Less than 2% of couples experience more than 3 consecutive miscarriages.

Almost anyone who has suffered a miscarriage or stillbirth worries about the risk of having subsequent losses. Recent information indicates that women should look into RPL testing after two losses when it used to be common to wait until three. This is especially important for women in their 30s and 40s. Newer studies indicate a miscarriage rate of 26-40% after a woman has suffered two losses, so earlier testing makes sense both emotionally, physically, and in many cases financially as well.

The tests and procedures listed below are a mixture of the common elements of a recurrent pregnancy loss (RPL) work-up and some of the more controversial immunological screenings. A doctor might choose to do any or all of them depending on the patient's needs.

Along with basic description, there is an average cost or a price range listed for most tests. A pretty small sample was used to get these numbers, so please just use them as a general idea, nothing definite. You'll have to check with your doctor to get his or her prices, and check with your insurance to see what will be covered.

While the most common cause for pregnancy loss is abnormal number of egg chromosomes, the parents usually have normal chromosomes. Recurrent pregnancy loss due to chromosomal abnormalities is a different story. Chromosomal translocations (relocation of a segment of genes from one chromosome to another) may be found in up to 4% of couples. The parents with this condition are normal because they have all the normal chromosomal complement. The sperm and egg each end up with ½ the original set of chromosomes in a process called meiosis. Depending on whether the one, both or none of these switched chromosomes end up in the egg or sperm, you may end up missing a portion of a chromosome or burdened with extra chromosomal material (miscarriage), normal (carrying the same chromosomal anomaly as the parents, or genetically normal. This rare anomaly is seen twice as often in the woman partner. Testing for this condition is by a blood test on both partners and will likely cost between $1000 and $1,800. Insurance coverage is variable. Some physicians argue against testing as this condition is rather rare and if present 2/3 of the pregnancies will likely end in a live birth, and short of donor sperm or egg effective treatment is not available.

Uterine anomalies such as fibroid tumors or polyps may result in miscarriage if undiagnosed and untreated. Congenital uterine malformations such as a uterine septum may be associated with recurrent pregnancy loss. Surgical correction by operative hysteroscopy may restore fertility and allow the pregnancy to progress to term. Incompetent cervix is a condition where the cervix dilates prematurely without detectable contractions. The use of cervical cerclage (suture placed in the cervix) may reduce the risk of this pregnancy complication that can lead to loss.

Infection has been reported to be associated with pregnancy loss. The role of infection is less clear. Chlamydia and gonorrhea culture are an important part of this evaluation. Less clear is the role of the organism ureaplasma urealyticum. This rather prevalent organism is difficult to culture and its role as a causal agent is less clear. As such, while many physicians recommend culturing for this condition, others suggest a brief course of antibiotics as a more cost effective option.

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