Grappling with Pregnancy Loss
By: Bradford Bopp, M.D.
Oct 23, 2018
Losing a pregnancy is a devastating experience that no one can be prepared for.
Unfortunately, pregnancy loss is very common — approximately 15-20 percent of confirmed pregnancies end in a loss. This number likely increases when considering women who were unaware that they were pregnant to begin with.
However, having a miscarriage — even more than one — does not mean you cannot have a family.
What is a Miscarriage?
The point in time that a pregnancy is lost determines how we talk about it.
A miscarriage occurs within the first 20 weeks of a pregnancy, most commonly within the first trimester (first 13 weeks). A miscarriage can sometimes occur so soon after implantation of the embryo into the uterus that any associated bleeding may be mistaken for the woman’s normal period.
When a pregnancy ends after the 20-week point, it is considered a stillbirth. Stillbirths are much less common; the majority of lost pregnancies are miscarriages.
What Causes a Miscarriage?
Some women worry that they did something to cause their miscarriage, such as rigorous activity or a fall. This is rarely the case.
Some lifestyle factors have been linked to an increased risk of miscarriage, like smoking, excessive alcohol use and recreational drug use. Obesity and excessive caffeine intake have also been shown to have some correlation to miscarriage.
However, the most common cause of pregnancy loss is genetic abnormality, which is responsible for more than half of miscarriages.
A normal embryo formed by a normal sperm and egg will have a total of 46 chromosomes. If the embryo has any more or less than 46 chromosomes, it will not develop properly, which may result in a miscarriage. Many times, there is no known reason for these abnormalities.
The risk for genetic abnormalities does increase with age — jumping from 10-15 percent for women 35 and younger to more than 50 percent for women over 40 (American College of Obstetricians and Gynecologists).
What Do Multiple Miscarriages Mean?
Unfortunately, some women experience more than one miscarriage. When a woman suffers three consecutive, first-trimester miscarriages this is called recurrent pregnancy loss. However, we will often begin evaluating a patient for recurrent pregnancy loss after two losses to avoid a third loss that may have been preventable.
A number of things can contribute to recurrent pregnancy loss. These may include:
- Anatomical issues with the size or shape of the uterus, or tumors, such as polyps or fibroids
- Endocrine disorders, such as diabetes and thyroid disease, that have not been treated or managed
- Blood clotting issues, such as thrombophilia, which causes a predisposition to forming blood clots that can potentially lead to miscarriages
- Genetic abnormalities
In about half of cases, we are able to identify a treatable cause for miscarriage. Even without a diagnosis, however, many women go on to carry successful pregnancies.
Can I Have Children After a Miscarriage?
While every woman’s situation is unique, for many women, a successful pregnancy after a miscarriage is very possible. Often, a miscarriage is a one-time occurrence.
For women who have suffered more than one miscarriage, there are options to treat recurrent pregnancy loss. A fertility specialist can determine the best courses of treatment to help achieve a successful pregnancy.
How Do You Treat Pregnancy Loss?
There are a variety of ways we can help avoid future miscarriages. A woman’s specific situation will determine the course of treatment her fertility specialist recommends.
If an anatomic problem has been identified, we can sometimes correct this with reproductive surgery. If blood clotting is the issue, blood thinners can help to prevent clots that may be causing miscarriage. Correcting underlying endocrine disorders can also improve a woman’s ability to sustain a healthy pregnancy.
If a genetic abnormality has been identified in one of the parents, this can be overcome by genetically testing embryos. Testing embryos systematically can help us develop a focused treatment plan.
Because genetic abnormalities are a primary cause of miscarriage, genetic screening of embryos coupled with in vitro fertilization (IVF) is a common course of treatment. Preimplantation genetic testing for aneuploidy (PGT-A), also known as PGS, screens an embryo that has been created in the lab for chromosomal abnormalities before it is implanted into the uterus through assisted reproduction. This ensures a high-quality, genetically normal embryo is chosen, improving the likelihood of a successful birth.
Once a pregnancy is achieved, it is important for women with a history of pregnancy loss to take precautions to ensure a healthy term. A fertility specialist will continue to provide care and monitoring through the first trimester, when the risk for miscarriage is highest. Then, an OBGYN will continue close monitoring and care for the remainder of the pregnancy.
Staying healthy by maintaining a healthy weight through a nutritious diet and appropriate exercise, taking folic acid and a prenatal supplement, as well as other potential medications prescribed by a fertility specialist or OBGYN, will help ensure a healthy pregnancy.
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