I am 33 years old, and my husband is 35. I have no problems becoming pregnant -- my problem is remaining that way. We have had three miscarriages in four years; my second pregnancy resulted in a healthy baby boy. My doctors diagnosed my first and last miscarriages as blighted ovum. With my second miscarriage, the doctor said that it was just not a viable pregnancy and was doomed to fail from the moment of conception. My current OB/GYN said that because I have one healthy child, there is no need to do any testing -- I was just unlucky! I am terrified to become pregnant again, yet I want to have another child. What are the chances of this happening again? Do you feel I require any testing? If so, what steps could I recommend to my OB/GYN?

Sharon

I would certainly recommend that you seek consultation with a reproductive endocrinologist experienced in evaluating and managing recurrent pregnancy loss. The presence of one normal pregnancy along with the three losses does not mean there is not an underlying problem causing the miscarriages.

In general, I consider the following potential causes for miscarriage:

Hormonal causes: Some common hormonal problems include high levels of the hormone LH associated with polycystic ovarian syndrome (PCOS); high levels of the hormone FSH on day 3 of the cycle due to advanced maternal age; and elevated prolactin levels.

Chromosomal causes: Chromosomal abnormalities (frequently called translocations) in either the male or female may be a factor. It is interesting that people with this type of abnormality may have both miscarriages and normal offspring, so it should be considered in your case.

Immune causes: Antiphospholipid antibodies attack the site where the placenta attaches to the uterus and interfere with blood flow to the developing placenta. They are most often a factor in midtrimester pregnancy loss. Problems with pregnancy recognition-- in which your own white cells attack the pregnancy as though it were a foreign invader -- are the focus of much debate among doctors and researchers, although many offer tests for this condition. Still, the significance of abnormal test results and treatment options are very controversial. You should discuss the appropriateness of this testing with your own physician.

Structural causes: Uterine abnormalities -- such as scar tissue inside the uterus after D&C or congenital abnormalities of the uterus -- may be involved.

Infectious causes: The role of infection is unclear at this point. In practice, we generally just treat with antibiotics. That is far cheaper than culturing to identify specific infectious agents, as we really don't know which ones to check for.