Thrombophilia and Recurrent Pregnancy Loss

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Are You at Risk?

Recurrent pregnancy loss is emotionally devastating to the women who suffer from it. Feelings of sadness, grief and guilt may overwhelm you. Having one miscarriage is harrowing enough, but having two or more, as recurrent pregnancy loss is defined, forces you to deal with profound loss again and again.

The most common cause of miscarriages is chromosomal abnormalities in the embryo. This type of genetic problem happens randomly, although it becomes more common as women get older. Other causes of miscarriage include hormonal and immune system problems. However, recent research has found a new area to investigate—thrombophilia.

What is Thrombophilia?

Thrombophilia is a condition where the patient tends to form blood clots. It can be dangerous if the blood clots obstruct blood flow. It can be an inherited problem, or it can be caused by surgery, obesity, pregnancy, use of oral contraceptives (birth control pills), or going for long periods without moving, such as on a very long plane flight, or a condition called antiphospholipid syndrome (APS). APS happens when your immune system attacks some of the normal proteins in your blood, by mistake. APS can cause potentially life-threatening issues such as deep-vein thrombosis, when clots form in your legs and can travel to your heart or lungs.

Recent research suggests a connection between APS and recurrent pregnancy loss, and indicates that patients with one or more markers for APS were more likely to suffer miscarriages. These markers are abnormal antibodies in the blood that attack proteins. Some research suggests that clots can cause abnormal blood flow to the uterus and make miscarriage more likely.

Who Should Get Tested?

Some patients with thrombophilia don’t show any symptoms, or the symptoms may be so subtle that they are hard to detect. If your family has a history of clotting disorders such as stroke, pulmonary embolism or deep-vein thrombosis, or you have had a blocked blood vessel at a young age, your fertility specialist may order blood tests in addition to the usual fertility screening panel to look for markers of thrombophilia. If you have PCOS, polycystic ovary syndrome, your reproductive endocrinologist may recommend these tests, because patients with PCOS often have clotting factor abnormalities associated with high insulin resistance. Markers of thrombophilia include anticardiolipin antibodies, jupus anticoagulant, and anti-beta 2 glycoprotein antibodies. In addition, there are other genetic variations that have been found that may predispose people to thrombosis including the factor V Leiden mutation, prothrombin mutation, activated protein C resistance, and antithrombin III deficiency. The role of thesein miscarriage is uncertain, however.

How Can It be Treated?

Treatment involves preventing blood clots and careful monitoring to make sure you don’t bleed internally. Your doctor may prescribe heparin alone or with low-dose aspirin to prevent clotting.

There is Hope

If you have recurrent pregnancy loss and no cause is found, that doesn’t mean you can’t have a baby. It’s important to remember that 65 percent of women with unexplained recurrent pregnancy loss go on to have a successful pregnancy. So, don’t give up hope!