What causes repeated miscarriages in early pregnancy?

Hello,

Welcome to icliniq.com.

I can understand your concern.

I am truly sorry you are going through this. Repeated early miscarriages can be emotionally and physically distressing. Here is a clear, professional breakdown of potential reasons and the next best steps you can take to understand and prevent it from happening again.

Possible causes of recurrent early miscarriage, especially around six weeks, include the following -

1. Polycystic ovary syndrome (PCOS) is a known risk factor due to hormonal imbalances, particularly elevated insulin and androgens. PCOS can affect the quality of the egg and the endometrial environment for implantation.

2. Genetic abnormalities are another common cause, as most early miscarriages at this stage result from chromosomal abnormalities in the embryo, which are often random. Repeated loss may suggest a need for parental karyotyping to check both your and your partner’s chromosomes.

3. Thyroid issues, even mild hypothyroidism or the presence of thyroid antibodies such as TPO antibodies, can increase the risk of miscarriage. Thyroid-stimulating hormone (TSH) levels should ideally be below 2.5 during early pregnancy.

4. Progesterone deficiency, also called luteal phase defect, is important since progesterone supports early pregnancy, and its deficiency can lead to early pregnancy loss.

5. Autoimmune conditions, such as antiphospholipid syndrome, a blood-clotting disorder, can cause miscarriages and can be tested through specific blood tests like lupus anticoagulant and anticardiolipin antibodies.

6. Blood sugar or insulin resistance, especially in PCOS, can impact implantation and fetal development.

The next steps you should take include seeing a reproductive endocrinologist or fertility specialist and requesting a recurrent pregnancy loss workup. Recommended tests may include hormonal tests such as TSH, prolactin, anti-Mullerian hormone (AMH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). PCOS management evaluation with blood sugar and insulin levels, ultrasound to assess uterine anatomy, progesterone levels measured in the mid-luteal phase, genetic testing with parental karyotyping, and an autoimmune panel for antiphospholipid antibodies are also important.

Supportive measures include continuing Folic acid at 400 to 800 micrograms daily, considering vitamin D supplementation after testing, and possibly using Metformin if you have PCOS with insulin resistance. Progesterone supplements may be prescribed after ovulation or early in pregnancy. Lifestyle steps to follow are maintaining a healthy body mass index, engaging in moderate exercise, and following a balanced diet low in refined carbohydrates, especially if you have PCOS.

You can discuss with your doctor questions such as whether to evaluate your progesterone and thyroid levels, testing for antiphospholipid syndrome or other autoimmune issues, genetic testing for you and your partner, and whether Metformin or progesterone support is recommended given your PCOS. You are not alone in this, and with the right investigation and treatment plan, many women with your history go on to have healthy pregnancies.

I hope this helps.

Thank you.