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What are the reasons for my previous miscarriages?

Q: I am a 27 years old female. Before marriage I had normal periods and I never had any menstrual problems. I got married two years back and flew to USA just after a month of marriage. After landing there within a couple of days I got heavy abnormal vaginal bleeding for which I was hospitalised for a day and then I got better. Next month, I got pregnant but the doctors said that it was ectopic pregnancy and they terminated the pregnancy after three weeks. However, I got pregnant again in the next cycle and this time even after nine weeks the fetus had no heart beat. So, the doctors said that it is a miscarriage and they gave some tablets to remove the fetus. Since then I did not get pregnant and last year, after missed my periods by a few days, the home-pregnancy test was positive. But the HCG count decreased after a couple of days and the doctor said it was chemical pregnancy. I've undergone various tests (HSG, etc.) and consulted various doctors. Some said I have a Bicornuate uterus, others said it's Septate while another one said I have an Arcuate uterus. Another said that I have a big fibroid on the top of my uterus primarily on the outer side which gives it the shape of a bicornuate uterus. Which test will show conclusively what type of uterus (bicornuate, septate, arcuate) do I have? Is the fibroid really responsible for the previous miscarriages?

A:The problem is treatable. If it is a fibroid- it can be surgically removed through a laparoscope/ laparotomy. If it is a septate / bicornuate uterus - surgery to treat is possible - the septate through a hysteroscopic removal and the bicornuate through an open surgery. The results are good. Planning a repeat pregnancy after 6 months to a year after the surgical repair is recommended- to reduce chance of pregnancy loss, which is higher that in normal cases. When pregnancy does occur later on, the support throughout the pregnancy like rest, no stress, progesterone support / injection HCG till 4th month, avoiding heavy work and stress and sex till the 4th month would be necessary to achieve a term pregnancy. Normal delivery too is possible, if all goes well.

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