So when a patient comes in to discuss a problem of recurrent miscarriage, they typically have had, as I mentioned previously, two or three clinically apparent miscarriages occurring after a missed menstrual period, and most typically, before around 10 or 11 weeks from their last period. So I start by telling the patient that the cause of her problem is probably multi-factorial, as is the cause of most human diseases. That is to say she probably, she and her husband or partner, probably don't have one single glaring problem that should be identified and fixed, so to speak, but likely have a combination of several problems, or perhaps even many problems that are relatively small, not single dominant issues, but that conspire to predispose the patient, or the couple, to miscarriage. By the way, male contributions to this issue are poorly understood. That's a burgeoning area of science right now. Almost certainly, there are important male contributions, but as of right this minute in medicine, they are poorly understood, and evaluations of recurrent miscarriages do not typically involve male factor evaluations. That's in contrast to, say, infertility.
I then go on to explain to the patient there are a couple of fairly dominant causes of recurrent miscarriage that should be ruled out. And typically, they're ruled out, not ruled in. One would be a uterine malformation, something the patient was born with, probably doesn't recognize, but in her case, the uterus is malformed from birth. And uterine malformation is identified by an imaging study that enables physicians to look at the interior contours of the uterus, like a sonohysterogram or a hysterosalpingogram. Another dominant reason that experts agree on is antiphospholipid syndrome. And that's an autoimmune condition in which the patient's immune system seems to attack the placenta, or that's the best way to think about it. It's an area of active research. Patients are identified as having that by the mother, the woman, having blood tests to look for autoantibodies. Experts also agree that, rarely, a couple with recurrent miscarriage will have a chromosome abnormality either in the female or the male partner, and that chromosome abnormality isn't affecting their status as an adult in terms of activity or intellect, but rather has a dramatic effect on the chromosome complement of the gametes, that is the sperm or the eggs. So that's an infrequent (but real) cause of recurrent miscarriage.
What's important for the average couple to recognize is that recurrent miscarriage is usually of no single dominant reason, something I mentioned at the beginning of my comment. Patients with no single dominant reason found in their evaluation are in good stead, and that's very important to recognize. Something like 65% or 70% of relatively young couples, under age 35 or so, who have recurrent miscarriage of the sort I've described will have a successful next pregnancy. Those are pretty good numbers. People need to understand that so they'll feel better about their next pregnancy attempt, I would argue. They may be disappointed that medicine doesn't have that single focus explanation and treatment to provide them, but the reality of the science is that they'll likely do well and be able to have a family. Part of the reason I see couples with recurrent miscarriage is to encourage them to think clearly about their reproductive future.