Infections and Recurrent Miscarriage
This should not be overlooked as a cause of RPL. In the 80’s and 90’s a lot of attention was paid to organisms such as urea plasma or mycoplasma as a cause of RPL. In truth the vagina is a veritable minefield of microorganisms. Any of them, if present in high enough concentrations can impair successful reproduction. These could include beta hemolytic streptococcus, e-coli (especially in those who practice anal intercourse), chlamydia, a variety of yeast species or trichomonas. The uterine cervix is supposed to create a barrier to the ascent of organisms from the lower genital tract into the upper tact.
Sometimes, the bacterial load can be so extensive as to overcome the natural barriers. An early pregnancy does not have a sufficiently developed immune system to effectively deal with these microorganisms, and the result can be RPL. If suspected, cervical cultures should be taken and appropriate antibiotic therapy instituted if deemed appropriate. Any patient who has had a past history of significant pelvic infection or IUD use, or a therapeutic termination of pregnancy with complications, should be evaluated to determine if infection could be at the root of this problem.