Ms. H, 36, has been married for five years. From the beginning of their marriage, the couple hoped to have a child as soon as possible so that the elderly at home could have a grandchild soon. After trying hard for a year, they finally received the good news, and  happily prepared for the arrival of new life. Unexpectedly, less than two months later, they still couldn't see the heartbeat of the embryo. This short pregnancy has ended with disappointment. They have no choice but to expect the next pregnancy with a broken heart.

Unexpectedly, in the next two years, the same tragedy happened three times. She cannot understand why God was so cruel to her, causing her body and mind to suffer such ruthless blows repeatedly. Although it is inevitable to encounter setbacks in life, it is really painful to suffer this way! If it weren't for the support of her husband and family, how could she still have the confidence to continue on?

After a series of examinations, it turned out that Miss H’s chromosome structure was a little different from that of ordinary people. Although they both had 46 chromosomes, two pairs of chromosomes had exchanged, which made her embryo very likely to have chromosomal abnormalities. Embryo with chromosomal abnormalities results in the inability to continue development, leading to miscarriage. Knowing the reason, it must be a smooth pregnancy for her! However, the reality was not satisfactory. Unexpectedly, after embryo atrophy and induced abortion , the endometrium could not withstand three surgical injuries, resulting in the endometrium becoming thinner and the amount of menstrual blood becoming less and less. Now she was faced with two difficult problems, which made her feel powerless. The road ahead seemed to be getting harder and harder, and she really wanted to give up.

Fortunately, medical technology nowadays can help with embryo problems. Preimplantation genetic screening (PGS) can be used to know in advance if an embryo has normal chromosomes, greatly reducing the chance of miscarriage. At the same time, the endometrium must be evaluated to see if there is still a chance to be implanted. Fortunately, God took good care of her and she finally got three normal embryos. Through  H-scopy, it was confirmed that the endometrium had been affected by the previous surgery, causing adhesion. After three months of inserting the intrauterine device and taking hormonal treatment, the thickness of the endometrium finally returned to normal, and then she waited to see whether a real pregnancy would come to her.

Seeing two lines is no longer a surprise for her, because she has experienced the joyful mood four times. The important thing is whether she can overcome the hurdle of avoiding miscarriage. Miss H prays every day. Finally, after four months, the amniocentesis was confirmed to be normal. The excitement was really indescribable. She thanked God for not letting her give up hope and allowing her to persevere to the end for the arrival of that beautiful happiness.

The so-called recurrent miscarriage refers to three or more consecutive miscarriages before the 20th week of pregnancy, including when the embryo once had a heartbeat but then had no heartbeat, or when the embryo stopped developing before it developed a heartbeat, or when the embryo naturally flowed out of the body.

Possible causes of recurrent miscarriage include:

1. Abnormal uterine structure: 

Accounts for approximately 15% of recurrent miscarriages. Congenital structural anomalies of the uterus includeBicornuate uterus, unicornuate uterus, double uterus, uterine septum, submucosal uterine fibroids or endometrial polyps. Abnormal structures can be detected through Hysterosalpingography, hysteroscopy, laparoscopy or MRI, and then treated surgically.

2. Cervical atresia: 

Some are congenital, and some are caused by acquired surgery such as cervical conization. Once this problem is discovered, cervical cerclage surgery can be performed after 3 months of pregnancy to prevent it.

3. Chromosomal problems: 

Approximately 60% of early miscarriage embryos have chromosomal abnormalities. In other words, the abnormal embryo has suffered a fate of self-elimination, caused by factors other than those of both parents. However, in about 3% to 5% of miscarriage cases, some are indeed caused by abnormal chromosome translocation of one of the parents, and some are caused by a genetic abnormality on the Y chromosome of the husband.
4. Abnormal hormone secretion:

The most typical one is polycystic ovary disease. Because the body is resistant to insulin secretion or the male hormones in the body are too high, the quality of the eggs will decline, and the progesterone needed for embryonic development will be unable to be provided, and the chance of spontaneous abortion will increase. This type of patient needs time to adjust their physique. After controlling blood sugar for a period of time with hypoglycemic drugs, and then using drugs or injections to assist ovulation and strengthen the luteal function, most women can become pregnant smoothly. Women with other endocrine problems, such as hyperthyroidism or hypothyroidism, also need to pay close attention to the status of their thyroid function. If the function is not controlled within the ideal range, miscarriage is also likely to occur. Diabetic patients need to pay more attention to disease control. If blood sugar is not well controlled, not only the chance of miscarriage increases, but also the possibility of fetal malformations.

5. Immune system problems: 

Generally, the human body will naturally reject foreign objects, especially half of the genes of the embryo come from the husband. However, God has made perfect arrangements for the pregnancy process of higher animals, so most human embryos will not be attacked by their own immune systems. In a small number of people, the defense mechanism in the body is innately destroyed, so antibodies are produced that attack the embryo, leading to miscarriage. The most common is antiphospholipid syndrome (APS). This is a disease of abnormal coagulation function. The body produces antibodies and produces blood clots in small blood vessels throughout the body. Not only can it lead to miscarriage, but there is also a high chance of preeclampsia, premature birth, and early placental dissection after pregnancy. There were no special clinical symptoms. It was only after further examination after the miscarriage that it was discovered that the anti-phosphate antibodies in the body were high. As long as the diagnosis is confirmed, aspirin and steroids are usually treated for a period of time before pregnancy; in severe cases, anticoagulant injections of low molecular weight heparin are required; in a few cases, immune globulin is required. Other autoimmune problems, such as lupus erythematosus, rheumatoid arthritis, etc., if the condition is not controlled before pregnancy, miscarriage is also easy to occur.

6. Inflammation and infection:

If there are infections such as Toxoplasma gondii, German measles virus, chlamydia, bacteria or gonorrhea, it may also easily lead to miscarriage after pregnancy, so the infection needs to be treated first.

7. Lifestyle: Abnormal lifestyle, excessive stress, smoking, drinking, drug abuse, etc. can easily increase the chance of miscarriage.

8. Age: Since women’s reproductive function begins after the age of 35, as a result of egg aging, it is easy to produce abnormal embryos, thus increasing the chance of miscarriage.

There are many clinical causes of habitual miscarriage and they are very complex. It requires patient and careful evaluation to find out the exact factors. For Ms. H, after four tragedies of miscarriage, she had given up any hope and was unwilling to take the risk of a fifth miscarriage. Fortunately, with the help of medicine and her own persistence, she finally said goodbye to habitual miscarriage. Goodbye!