Recurrent Miscarriage

Miscarriage is very common and occurs in as many as 26% of all pregnancies. An underlying issue may be at play when a loss happens more than twice. Uterine abnormalities, hormonal disorders, and chromosomal abnormalities are the leading causes of recurrent pregnancy loss. Intrauterine insemination (IUI) is an option for women who have experienced multiple miscarriages, but not a guaranteed solution.

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What is IUI?

Intrauterine insemination is a fertility treatment that places washed and concentrated sperm directly into the uterus. IUI is safe, non-invasive, and much more affordable than having in vitro fertilization (IVF) done. For women under age 35, the success rate is around 13%. In older patients, the chance of successful conception with IUI is lower.

Genetics at play

About 60% of pregnancy losses are due to chromosomal abnormalities. The baby should get 23 chromosomes from mom and 23 from dad. This outcome can occur when something goes wrong at the time of conception, and the baby ends up with one more or one less chromosome. Down syndrome is the most well-known chromosomal abnormality. Although IUI can’t prevent a chromosomal abnormality from happening, the additional monitoring offered with IUI may decrease stress for women who have previously experienced a chromosomal loss.

Uterine abnormalities

Some cases of recurrent miscarriage are attributed to uterine abnormalities. This includes fibroids, divided septum, or scar tissue. Unfortunately, IUI cannot help in most cases where the uterine environment is unsuitable for pregnancy. Instead, surgery would usually be recommended. The surgeon will use a tool called a hysteroscope to repair the inside of the uterus. For many women, this simple procedure can solve the pregnancy loss problem.

Unbalanced hormones

When a woman’s hormone levels are off, miscarriage can occur. An under or overactive thyroid, high levels of prolactin, and low levels of anti-mullerian hormone (AMH) are the most common hormonal causes of pregnancy loss. Again, IUI cannot solve this type of problem. However, patients undergoing IUI will have access to much more comprehensive pre-conception blood work than patients not using assisted reproductive technology (ART). Women planning IUI should typically have a complete blood count (CBC) done along with thyroid testing and any necessary hormonal testing. The results will allow the fertility doctor to treat any underlying problems before IUI is started, increasing the chance of a successful pregnancy.

Not a guaranteed solution

Unfortunately, IUI can’t help tremendously with the main causes of infertility. In cases of uterine abnormalities, surgical intervention is usually necessary. Not all hormonal disorders can be corrected, but getting blood work done is an essential first step to identifying the problem. Chromosomal abnormalities increase as a woman gets older. To avoid this outcome, IVF can be a more effective intervention. With IVF, testing can be done early on, and chromosomally healthy embryos can be transferred into the uterus to circumvent this issue.

Talk to your doctor

IUI can be a helpful procedure for many women, resulting in a healthy baby. However, for those with recurrent pregnancy loss, IUI is not the cure-all, as many patients hope. A healthcare provider can always determine when this procedure might be most beneficial.

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