Potential causes of recurrent miscarriage include:
- Luteal insufficiency (either insufficient progesterone production and or hCG production)
- Immunology (there is a great deal of debate about the involvement of Natural Killer cells in recurrent miscarriage. Endometrial biopsies have shown that women with recurrent miscarriage have differing numbers of decidual NK cells with fewer CD56Bright cells and more CD56Dim cells than in control women. NK cells in the blood vary hugely and there is no clear association with recurrent miscarriage)
- Thyroid Peroxidase Antibodies (have been associated with an increased prevalence of recurrent miscarriage)
- Maternal and Paternal HLA antigen conformity
It is important to assess each couple on an individual basis and the need for tests tailored accordingly.
It should be remembered that even after thorough investigation, a cause may not be identified as the cause of recurrent miscarriage is still not fully understood.
Whilst treatment of recurrent miscarriage should be evidence based, many treatments are given empirically with no clear evidence of efficacy. Empirical treatments should be safe and patients should be aware of the lack of evidence to support their effective use.
Support can be obtained from The Miscarriage Association