Recurrent Pregnancy Loss
People fail to understand that pregnancy is a very complex process. Even after obtaining healthy eggs and sperms, combining them successfully in a laboratory and putting an apparent healthily dividing embryo into the uterus, there is much that can go wrong.
Only about 40%-50% of the people who try to get a baby do so after the very first chance. There are a few specific factors that have been identified to cause IVF failure.
Definitions:
For the purpose of appropriate evaluation of RPL, the pregnancy is classified as clinical pregnancy recorded by ultrasound, or histopathological examination. According to American Society of Reproductive Medicine (ASRM), there have to be two or more than two miscarriages to be RPL. The European Society of Human Reproduction and Embryology says that three or more miscarriages should be considered as RPL. With the ASRM definition, incidence of RPL is 2-5%, while with ESHRE definition RPL affect 1-2% of pregnant women.
Types of RPL
Primary RPL: Women who have lost two or more pregnancies in a row, but no further than 20 weeks.
Secondary RPL: Women who have lost two to three or more pregnancies after a pregnancy past 20 weeks of gestation that may have resulted in stillbirth or live birth.
Tertiary RPL: Women who have suffered multiple pregnancy losses prior to a pregnancy that was past 20 weeks of gestation, after which there were at least two or three more pregnancy losses.
Biochemical pregnancy and RPL:
There has been much debate about whether biochemical pregnancy loss must be included in the definition of RPL or not. The ASRM (American Society of Reproductive Medicine) suggests that pregnancies that can be recorded through ultrasound or histopathology only should be considered as RPL.
However, a study from the European Society for Human Reproduction and Embryology (ESHRE), which examined RPL patients, revealed that any early loss that was confirmed by a positive Beta hCG testing had a negative prognostic significance equal to that of a medical miscarriage. Each additional non-visualized pregnancy decreases the chance to have a live baby by at most 10%. Hence, biochemical pregnancy should be included in the RPL diagnosis.