Coping with Recurrent Pregnancy Loss

Medical contribution by Jeffrey L. McKeeby, M.D.

Experiencing a miscarriage, or pregnancy loss, can be a very traumatic time, and harder still when a couple experiences multiple miscarriages. Studies have shown that miscarriages occur in nearly 1 in 4 pregnancies—often before a woman even knows she is pregnant. However, when a woman experiences multiple miscarriages, there may be more to the story.

What is recurrent pregnancy loss?

Recurrent pregnancy loss—often called recurrent miscarriage—is defined as two or more consecutive clinical pregnancy losses before 20 weeks gestation. It is important to consider clinical pregnancies rather than biochemical pregnancies, as biochemical pregnancies are usually not included in a diagnosis of recurrent pregnancy loss:

• Clinical Pregnancy: A pregnancy that can be seen via ultrasound, typically as early as 5 to 6 weeks gestation, or 1 to 2 weeks after a missed period.
• Biochemical Pregnancy: A pregnancy that has only been detected via hormone testing (urine or blood) prior to the loss.

How common is recurrent pregnancy loss?

A single miscarriage is very common, occurring in nearly 25 percent of all pregnancies. Recurrent pregnancy loss is seen less frequently. According to the American Society for Reproductive Medicine, less than 5 percent of women will experience 2 consecutive miscarriages, and only 1 percent will experience 3 or more.¹

Where can my partner and I find emotional support after a miscarriage?

While miscarriage happens within the woman’s body, the emotional pain happens to both partners. It is important to know you are not alone when it comes to miscarriage or recurrent pregnancy loss. At Shady Grove Fertility, our patients—men and women alike—find support via online communities like our Facebook page (with over 16,000 members) or free, local support groups.
Beyond that, we encourage patients to take the appropriate steps in order to grieve the loss in ways that work for them. Our psychological support team offers these tips to help patients overcome the grief and take steps towards healing and building their families:

• Find a safe space to express your feelings. If you are feeling angry, find a private room to yell or a pillow to punch.
• If you find it difficult, give yourself a break from attending baby showers or spending a lot of time with pregnant friends.
• Educate yourself about miscarriage through reading materials and talking with medical professionals.
• Be your own advocate. Become proactive on your own behalf within the healthcare system by asking questions, bringing up concerns with your medical team, bringing a support person along with you to your medical appointments.
• Acknowledge your pregnancy in some way. This can take many shapes, including: writing about your pregnancy and loss experience, putting together a memory book and including important dates from your pregnancy, planting a tree or creating something in memory of your child, naming the baby, or purchasing something such as a necklace or bracelet with special charms.

• As a couple or individually, become actively involved in a grief and loss support group, attend a mind/body relaxation group, treat yourself to massage, Reiki, or some other complementary treatments.

For some couples, understanding more about recurrent pregnancy loss—how it’s diagnosed, its causes, treatments, and outcomes—provides hope. Therefore, we offer the following information.

How is recurrent pregnancy loss diagnosed?

Due to the nature of recurrent pregnancy loss, many couples may not immediately seek help to treat this condition, as they are able to conceive. However, the underlying cause of the miscarriages should be addressed.  Some couples experience infertility as both delayed conception and recurrent loss.

As part of the initial fertility work-up at Shady Grove Fertility, all women undergo a blood hormone test, an ultrasound, and hysterosalpingogram (HSG). These diagnostic tests help the physician determine if there are hormonal imbalances or anatomic abnormalities. In the case of multiple miscarriages, these tests may determine the cause of the miscarriages.

If a couple does experience multiple miscarriages, it may be advised that they perform genetic testing to determine if there are chromosomal abnormalities that may be causing the miscarriages. Autoimmune testing for the female partner is also recommended.

What causes recurrent pregnancy loss and how can it be treated?

There are many factors that may lead to recurrent pregnancy loss, including genetic, anatomic, and medical conditions, as well lifestyle factors.

• Genetic Conditions: Miscarriages occurring within the first 3 months of pregnancy are often due to genetic abnormalities in the embryo or fetus. It is commonly seen that there is an extra or missing chromosome.
  • Treatment options: A physician may recommend preimplantation genetic screening (PGS) with in vitro fertilization (IVF) treatment. This allows the medical team to screen all available embryos and determine which have abnormalities and which are cytogenetically normal.

• Anatomic Problems:  The shape and size of a woman’s uterus may affect her ability to carry a pregnancy. If a woman’s uterus is too small due to a septum (a band of tissue formed inside the uterus), or fibroids are found in or around the uterus, a miscarriage may result.
  • Treatment options: Depending on the nature of the anatomic problem, surgery may be recommended.
• Medical Conditions: There are many medical conditions not directly related to a woman’s reproductive health that could lead to miscarriages, including: thyroid disease, diabetes, hormonal imbalances, certain immune system conditions, and blood-clotting conditions.
  • Treatment options: A physician may need to treat these medical conditions prior to or in conjunction with infertility treatment.
• Lifestyle Factors: Smoking, certain recreational drugs, excessive alcohol, excessive caffeine, and being overweight have all been linked to an increased risk of recurrent pregnancy loss.
  • Treatment options: Many couples experience a decreased risk of miscarriage when certain lifestyle factors, such a smoking, are addressed.

How does age affect the risk of miscarriage?

Although the overall incidence of miscarriage is 1 in 4 pregnancies, this increases as a woman ages. For women over the age of 40, the rate of miscarriage climbs to 1 in 3 pregnancies.¹ Most often, this increased risk is linked to genetic abnormalities. For women under the age of 35, the chance of miscarriage due to genetic abnormalities is 10 to 15 percent; however, the rate of miscarriage due to genetic abnormalities rises to over 50 percent in women over the age of 40.²

Women who previously had children who are now experiencing miscarriages due to advancing maternal age would fall under the category of secondary infertility. Secondary infertility accounts for nearly half of all infertility cases in the United States.

• Treatment options: The best course of treatment for advancing maternal age is often through donor egg. While the woman’s eggs may be decreasing in quality, her uterus is often still able to carry a healthy pregnancy to term.

If I experience recurrent pregnancy loss, will I ever be able to carry a healthy baby to term?

For many women, the answer is yes. Even after multiple miscarriages, the majority of women will be able to conceive and carry a pregnancy to term with proper treatment and medical care. For those experiencing recurrent pregnancy loss, Shady Grove Fertility’s Shared Risk 100% Refund Guarantee Program may be a good option. Under Shared Risk, patients receive up to six cycles of IVF treatment and any subsequent frozen embryo transfers (FETs) for one flat fee. In the event the patient does not take home a baby, SGF provides a full refund. There may be additional expenses for genetic testing incurred that are not refundable and some exclusions do apply. It’s best to speak with one of our financial counselors for program details.

There are many resources available to you and your partner if you are experiencing recurrent pregnancy loss. By attending support groups, speaking with our psychological support team, or even looking through online forums or communities like Facebook, you will know that you are not alone.

If you are ready to speak with a physician, you can call our New Patient Center at 888-761-1967 or schedule an appointment here.

References

1. ASRM Patient Fact Sheet: Recurrent Pregnancy Loss. Available at: http://www.asrm.org/FACTSHEET_Recurrent_Pregnancy_Loss/ (Accessed: 13 March 2015).
2. ASRM Fact Sheet and Information Booklets: What is recurrent pregnancy loss (RPL)?Available at: http://www.reproductivefacts.org/factsheet_what_is_recurrent_pregnancy_loss/ (Accessed: 13 March 2015).