Recurrent Pregnancy Loss – possible causes, and the tests you can run

A pregnancy loss is a gut-wrenching experience.  You know that statistics – 1 in 4 pregnancies end in loss. But when you’re on the other side of that statistic more than once, it can be even more terrifying. Especially when our doctors tell us that it’s common (and even some of them tell us it’s just bad luck). 

But just because it’s common, doesn’t mean it’s normal. And you don’t have to just roll the dice and try again without taking preventative measures. Information is power, so if you’d like to know the reasons for loss, and some tests you can do to find out why this is happening to you, with a view to preventing it, keep reading.

Please note that all information contained herein is based on an interview with Dr Aumatma Simmons  – a naturopathic doctor, and nutritionist, who specialises in women’s health. You can watch the full interview over on Instagram HERE, or read the highlights below. 

While this is not personal medical advice, and everyone’s situation is different, it is designed to give you a little direction, when you don’t know what to do next.

Typically, recurrent pregnancy loss is considered to consist of two or more pregnancy losses. Once you get to three losses, most reproductive doctors will do further investigations. However, contrary to popular belief, you do not have to wait until you have 3 losses before you advocate for yourself. Even after one loss, you could go to a functional medicine practitioner and do some of the underlying groundwork evaluation. Sadly, however, most people are advised to just go ahead and try again. 

The common causes of pregnancy loss relate to genetics, are immune system related, or due to uterine malformation – these comprise of 10-15% of losses.  The other 85-90% of losses that aren’t being looked at, fall into the unknown category.   

While the focus is normally on the female, and her age, research has shown that there are a lot of factors on the male side, that have nothing to do with the sperm count, that also cause recurrent loss. This is something that falls through the cracks and is largely an unspoken conversation.  So, let’s talk about it, and start with the male.

Tests for the male.

It’s a common misconception, but just because sperm looks good on the surface (i.e. motility/morphology/count), doesn’t automatically mean everything is ok with it. DNA fragmentation has been linked to recurrent pregnancy loss. Signs that this may be an issue for you are if you’re doing IVF and are getting a large number of eggs, but are finding the percentage of fertilised embryos drops off significantly i.e. less than 50% turn into decent-quality embryos.

A sperm DNA fragmentation study could be a good idea even if the reason for the loss is due to a genetically abnormal embryo, because something is happening with the meeting of the egg and the sperm, which shows there is a mismatch.

You don’t have to wait for your doctor to order these tests, as it’s usually out of pocket and not covered by insurance anyway.  You can order it online yourself, and do the test at home yourself.

There are also 3 factors or markers that are test worthy, for the male – Haemoglobin A1c, Insulin, and Homocysteine.  All of these factors have been linked to recurrent pregnancy loss.  This is done via a blood test, and you can order this yourself at a cost of approximately $50 each, depending on where you are in the world.

Tests for the female.

While it’s very simple for the male, things are a little more complicated for us females.

A common misconception around fertility is that pregnancy loss is automatically linked to progesterone deficiencies. So the most common treatment is to give you progesterone the next time you get pregnant. While progesterone could save the pregnancy, if there are other underlying factors at play, unrelated to progesterone, other complications could arise at a later date, and pregnancy still won’t proceed.

So how do you know if you’re deficient in progesterone?  Common signs are (a) a short luteal phase or a luteal phase defect, where your post-ovulation to your next period is less than 10 days; (b) a long period of PMS (i.e. more than a day); (c) spotting before your period.

But that doesn’t always mean you need to supplement with progesterone – that is the last resort. First, we need to figure out why you may have the deficiency. And the reasons why could be (a) that your body doesn’t have enough vital nutrients to make progesterone i.e. B6 and Magnesium (b) the progesterone comes from the shell of the egg, which means that the shell from the egg of that cycle stays behind in the ovaries to make progesterone. So, if that shell is not doing its job, then that could indicate the quality of the egg is not sufficient. Of course, we want to do everything we can to improve egg quality, so please refer to THIS BLOG for more insights on that.

So what are the other reasons for recurrent pregnancy loss associated with the female?

While it could be immune issues or malformation issues, there are 3 things at the top of the list when it comes to recurrent pregnancy loss –

1. Vaginal microbiome – the bacteria in our reproductive system are going to be pro-fertility or anti-fertility. If you have anti-fertility bacteria, it’s going to be hard for implantation. This is where you see an uptick of chemical pregnancies and multiple rounds of embryo transfer in IVF where implantation doesn’t happen. There are two possible tests for this (both aren’t always necessary – you could do one or the other) –

a. Emma/Alice – This test is done through your reproductive endocrinologist and tests the endometrial microbiome. Unfortunately, a limitation of this test is that it’s only testing for the organisms you request the test for, and there are hundreds of possible organisms.

b. Vaginal microbiome swab – this is something you can do at home, and it tests the 50,000 species of microbe, so it’s not limited at all.

2. Uterine lining – when we think of the lining of the uterus, the focus is normally just on the thickness of it, however, this is only one piece of the puzzle. When it comes to the lining, we want to make sure there is blood flow into the uterus and the lining that supports the flow of blood to the baby. Tests can be done to look at whether your nitric oxide levels are adequate to get the right amount of blood flow to the uterus.  Nitric oxide helps to open the specific microarteries and veins that go to the uterus.

3. Mitochondrial function – this affects the quality of the egg. We want to test to ensure that there aren’t any deficiencies in absorption, or in what you’re eating or supplementing. It’s a balance between how much inflammation is there vs. how much anti-oxidant value is there. Inflammation causes oxidation. The more oxidated stress, the less your mitochondria can function. And the way we balance that out is the anti-oxidants.

While we’re talking about testing, it would be remiss of us not to mention PGTA testing for the genetic normality of the embryo if you’re doing IVF. There are mixed opinions on this. Normally, if you’re over 35 it’s recommended, however, it’s a catch 22.  If you’re over 35, your embryos may not be of great quality, so you don’t want to risk damaging the embryo by testing it.  Of course, it’s a personal preference, however, it makes sense not to damage the embryo, but implant a greater number (if possible), to offset the chance that some may not be genetically normal.

So those are a few of the reasons and tests you can do to try to get in front of recurrent pregnancy loss. It’s absolutely terrifying when you don’t have a reason. So, if you’re sick of just rolling the dice, and want to find some answers and a potential solution, I hope this helps.

You can also seek guidance from a Naturopathic Doctor who specialises in fertility and recurrent pregnancy loss, like Dr Aumatma Simmons.  You can find her details HERE.