Many women are struggling in their quest for motherhood. Let’s be sensitive to them. Here are the top 10 critical considerations about miscarriage.
Fertility Logia: Miscarriage
As we enjoy May and Mother’s Day with Mom and Yiayia, we must remember that some women are struggling with the heartache of a miscarriage. We’re grateful for our moms, but some also want so badly to join that club. Let’s review 10 critical considerations about miscarriage — and be sensitive to women still dreaming of motherhood.
10 Things to Know about Miscarriage
1) What’s the most common cause?
The majority of miscarriages have to do with a genetic mistake, where the growing embryo has too much or too little DNA. The DNA is stored in little containers called “chromosomes.” Both the egg and sperm each give 23 chromosomes, providing a total of 23 pairs of chromosomes for a normal human. Up to 25% of pregnancies will miscarry, but as women age, the risk of miscarriage increases dramatically.
2) What if someone keeps miscarrying?
When at least two miscarriages have occurred, it’s referred to as Recurrent Pregnancy Loss (RPL) — although the classic definition is three losses. Five percent of women may have two miscarriages in a row and 1% may have three.
Causes of RPL may include genetics, woman’s age, antiphospholipid syndrome, uterine anomalies, thrombophilias (thicker blood), hormone imbalances, infection, autoimmunity, sperm quality, and lifestyle issues. For patients that continue to miscarry, RPL testing will be conducted, including:
- karyotype of the parents (genetic test)
- lupus anticoagulant, anticardiolipin antibodies and anti-b2 glycoprotein I
- sonohysterogram, hysterosalpingogram, and/or hysteroscopy to examine the uterus
- thyroid or prolactin abnormalities
- karyotype of the miscarriage tissue
Treatment may include hormone medicine, baby aspirin, blood thinner shots, surgery, or IVF with genetic testing of the embryos.
3) What about an embryo that is physically abnormal?
Some embryos miscarry because they are physically abnormal, such as a heart or brain defect. In these cases, Mother Nature identifies that something is wrong and miscarriage occurs. In one study, 18% of patients who miscarried had a baby with normal chromosomes, but still had physical abnormalities making the baby nonviable. This reminds us that a human being is a very complex organism, and therefore, an embryo must be “normal” in many different aspects in order for it to become a baby.
4) If you see the heartbeat, is there less chance of miscarriage?
Chance of miscarriage decreases when we see the heartbeat by ultrasound. By the time we see a heartbeat and the pregnancy passes 6-8 weeks, the chance of miscarriage can drop to less than 10%.
5) Should hormone levels, like progesterone, be checked?
Low progesterone can be a cause of miscarriage, but it also may be a signal of an impending miscarriage, or a sign miscarriage already happened. In other words, low progesterone may be like the chicken or the egg — the cause or the result. At Vios, we use progesterone levels over 5-10 to show ovulation and we like levels of 15-20 with pregnancy. Often patients who keep miscarrying are given progesterone medicine to supplement their own body’s production. The research on proper blood levels as well as progesterone supplementation to prevent miscarriage is in progress and answers remain unclear.
6) Once a miscarriage is diagnosed, what happens next?
One option is to have a surgery called a dilation and curettage (D and C), which is typically done with anesthesia. One of the advantages of this is that it can be done and then the miscarriage is over. In other words, sometimes it is faster and some women want it finished and behind them. Another option is to take medicine called misoprostol that can make the miscarriage start. Last, just waiting for it to pass on its own is also an option. Tissue that is passed can be tested to check for genetic abnormalities. Some of the special miscarriage testing can also tell that the cells came from the baby. This is important when the test shows a normal female, to confirm that the cells were indeed the baby’s and not mixed up with the mother’s blood sample. Lab companies, like Natera, can tell the difference.
7) Do activities like working, exercise, or sex lead to miscarriage?
While pregnant, going to work is fine but pay attention to the body’s signals for rest. Sex, as well as low impact exercise, are fine as long as there is no cramping or bleeding. If this occurs, then stop the activity and consult with the doctor. It’s important to always stay well- hydrated while pregnant.
8) Could the shape of the uterus lead to a miscarriage?
Some women have a dent inside the uterus called a septum. Some studies suggest that if it’s present, it may be wise to remove it, especially if there have been repeated miscarriages. Chance of preterm labor, cesarean section, as well as the baby not coming out head first increase when there is a septum. That being said, not all septums need to be removed. Many women have a normal pregnancy with them in place.
9) Can fibroids and polyps cause miscarriage?
Fibroids and polyps are common. Though it is not definite that these can cause a miscarriage, most physicians advise removal if they’re present inside the uterine cavity where the baby grows. Some fibroids are smaller or not in the deeper part of the uterus. These typically are not removed.
10) Can in vitro fertilization help lessen the chance of miscarriage?
With IVF, there is an extra test on the embryo called preimplantation genetic diagnosis or screening (PGD/S). This can identify embryos that are destined to miscarry so that only normal embryos are transferred back into the uterus. This can decrease the chance of miscarriage. This is very important to consider as miscarriage is not only taxing on physical and emotional resources, but also uses up precious time. Some women have a short window before their eggs stop working and not losing time can make the difference between having a baby or not. Furthermore, miscarriage can also scar the uterus which can make it harder to get pregnant again. Therefore, anything that can help lower the chance of miscarriage is a consideration. On the other hand, sometimes just trying again naturally can be all that is needed to get to success with less medical care and cost.
The majority of miscarriages occur as a fluke and the DNA is abnormal. Often, this is influenced by maternal age. The chance that this happens increases as the woman ages.
Recurrent pregnancy loss is 2 or more miscarriages. Over half of patients with RPL will have normal testing and no clear cause can be identified.
Even after the first loss, the tissue should be checked for genetic abnormality. However, after 2 losses, RPL testing should be done. Extra medicine and treatment like IVF PGS may be considered. The other option is just to try again.
Miscarriage takes an emotional toll on a couple. Hope and patience, mixed with grief and frustration are part of going through a miscarriage. Psychological counseling and support should be offered to couples with RPL.
Be sure to talk through all of this with your doctor. Contact us at Vios Fertility Institute if you have further questions.
“Fear cannot be without hope nor hope without fear.”
~ Baruch Spinoza
Angeline N. Beltsos, MD is CEO and Medical Director of Vios Fertility Institute. She is board certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility (REI), practicing medicine since 1991. Dr. Beltsos is also the Clinical Research Division Director of Vios and participates in a number of research projects and scientific publications. She has received numerous awards in teaching and has been honored as “Top Doctor” from Castle Connelly for several years. She is a popular speaker, both nationally and internationally, and a frequent media resource on the topic of infertility. She is the executive chairperson for the Midwest Reproductive Symposium International, an international conference of fertility experts. Dr. Beltsos is also a contributor to Thrive Global.
As the REI Division Education Director for the Obstetrics and Gynecology residency programs of Illinois Masonic Medical Center, Lutheran General Hospital, and St. Joseph’s Hospital Chicago, Dr. Beltsos helps educate future OB/GYN doctors. She is a Clinical Assistant Professor for the Department of Obstetrics and Gynecology at University of Illinois at Chicago.