PCOS and Recurrent Early Miscarriage: Is There A Link?

One of the hardest realities women with polycystic ovary syndrome (PCOS) face is miscarriage. As difficult as it may be to face the reality at hand, it is important to talk about it so as to know how to drive around it. Miscarriage, hypertensive disorders of pregnancy, premature delivery, and birth of small for gestational age infant are all linked to polycystic ovarian syndrome. Despite the fact that statistics suggest women with PCOS have a higher chance of miscarriage, it is still possible to avoid miscarriage and have a safe pregnancy. This begs the question, what is the relationship between PCOS and recurrent early miscarriage? Can women with PCOS still avoid miscarriage?

What is Early Pregnancy Loss?

The most common complication of pregnancy is early pregnancy loss or miscarriage. It is the loss of a pregnancy due to natural causes during the first 13 weeks of pregnancy. Despite the fact that 15% of clinically recognized pregnancies end in miscarriage, total reproductive losses are closer to 50%. Sporadic and recurrent miscarriage are the two types of miscarriage.

It has been discovered that at least 25% of all women, and maybe as many as 50%, have one or more sporadic miscarriages, which are usually caused by random fetal chromosomal abnormalities, and the chance of which increases with maternal age. Recurrent miscarriage, on the other hand, is a less common occurrence, affecting only 1% of couples.

Recurrent Miscarriage

This occurs when a pregnancy is lost three or more times in a row. It’s one of a group of reproductive illnesses that all have the same underlying etiology.

Recurrent miscarriage is defined by many clinicians as two or more losses; this increases the prevalence of the problem from 1% to 5% of all couples trying to conceive.

Recurrent miscarriage has several characteristics. First, a woman’s chance of miscarriage is linked to her past pregnancies’ outcomes. Second, the observed rate of recurrent miscarriage (1%) is significantly higher than what would be expected by chance (0.34%). Sometimes, recurrent miscarriage is more common in women who have certain reproductive traits.

Is there a link between PCOS and recurrent early miscarriage?

Causes of Recurrent Miscarriage 

Historically, recurrent miscarriage has been found to be caused by the following: 

Genetic abnormalities 

The most common cause of miscarriage during 10 weeks of pregnancy happens when the fetus has one or more extra or missing chromosomes. At least half of all miscarriages are caused by cytogenetic abnormalities.

Recurrent miscarriage may happen in the presence of heterotrisomy, the repetitive trisomy involving different chromosomes, or homotrisomy, repetitive trisomy involving the same chromosome.

Couples with a history of recurrent miscarriage who had in-vitro fertilization may have more defective embryos than couples without a history of recurrent miscarriage, according to one screening research.

Structural abnormalities 

The exact prevalence of congenital uterine anomalies or uterine malfunctions in the general population is unknown, although it has been estimated to be between 18% to 37.6% among women who experience recurrent miscarriage. Patients with uncorrected anomalies have a significant probability of miscarriage and preterm delivery, according to a retrospective study.

Infection 

The prevalence of bacterial vaginosis in the first trimester of pregnancy has been linked to late miscarriage on numerous occasions. According to studies, screening women for bacterial vaginosis early in pregnancy and treating them with oral clindamycin reduces the risk of late miscarriage and preterm birth.

Immune dysfunction 

A mother who has a immune dysfunction is more likely to have a body which “rejects” the pregnancy. This is due to natural killer cells or lymphocytes, which help to manage trophoblast invasion or the battle between the fetus’ and mother’s survival interests. Natural killer cells are higher in women who experienced recurrent miscarriage.

In early pregnancy, the immunologic processes that occur at the maternal-fetal interface inside the endometrium are exceedingly complicated and include a wide range of immunoregulatory immune cells and substances.

Antiphospholipid syndrome 

The most common treatable cause of recurrent miscarriage is antiphospholipid syndrome. It is an immune system condition that increases the risk of blood clots. Complications such as preeclampsia, or high blood pressure, protein in the urine, and intrauterine growth restriction are more common in people with this syndrome.

Endocrine abnormalities 

Recurrent miscarriage has been linked to endocrine disturbance. For the past three decades, researchers have looked into the possibility of a link between polycystic ovaries and recurrent miscarriage. Those with PCOS were found to have a higher occurrence of recurrent miscarriage (40%) than women without PCOS.

PCOS and recurrent early miscarriage

PCOS and recurrent early miscarriage have been linked to each other. This is because women with PCOS are three times more likely to experience a miscarriage in the first trimester compared to women without PCOS.

PCOS causes a variety of reproductive difficulties, beginning with anovulatory periods or menstrual cycles in which an egg is not released from the ovaries, resulting in infertility. Women with PCOS have a higher chance of miscarriage after conception (EPL).

They frequently have later pregnancy issues such as gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia, premature delivery, and birth of small for gestational age (SGA) infants after successfully completing the first trimester.

The cornerstone of PCOS care is addressing metabolic and reproductive disorders related to pregnancy.

What Should You Watch Out For?

Despite PCOS and recurrent early miscarriage being related, this does not mean all women with PCOS would experience recurrent early miscarriage.

Women with PCOS who are pregnant should be extra cautious and should strictly follow their doctor’s prescribed practices. Like everyone else, it is best for women to watch for the following signs which may indicate a miscarriage:

• Backache
• Large clots or tissue discharge from the vaginal canal
• Cramping or pain in the abdomen
• Spotting or bleeding in the vaginal area. Bleeding, on the other hand, does not always indicate a miscarriage. During the first trimester, up to 25% of women will experience vaginal bleeding, but the majority of pregnancies will be successful.

How to Prevent Miscarriage?

It is strongly advised that women with PCOS who are attempting to conceive, as well as those who are already expecting, seek the advice of their doctor in coming up with plans and strategies to ensure a successful pregnancy. Some techniques, such as decreasing weight, eating healthily, and, in some situations, using medications, can help you get pregnant and reduce the risk of miscarriage.

Learn more about Pregnancy Problems here. 

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