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This article originally appeared in the September issue of the Kansas City Infertility Awareness newsletter. KCIA is a nonprofit organization that provides support to those affected by infertility. Click here to learn more about their history and mission.
Pregnancy loss, also known as miscarriage, is common. Although many women will experience a pregnancy loss, miscarriage is never easy. It is estimated that approximately 20 % (1 in5) pregnancies end in miscarriage. This level rises to close to 50% in women age 40 and older.
More than one miscarriage is called “recurrent pregnancy loss” (RPL). Causes of RPL fall under 4 categories: chromosomal, anatomical, endocrine and autoimmune.
Chromosomal
Most pregnancy losses, particularly those in the early and middle first trimester, are caused by the presence of an unhealthy (chromosomally abnormal) pregnancy. Although Mother Nature typically does not allow a non-viable pregnancy to implant, sometimes this filter point is missed.
Only 5% of couples with RPL have one of the parents with a re-arrangement of chromosomes (translocation) that results in RPL. Most often, both parents have normal chromosomes in their parent cells. However, in the formation of the egg or sperm, a step called meiosis, where halving of the chromosomes occurs, errors can occur yielding abnormal gametes and resulting in a nonviable pregnancy.
Treatment for this cause of RPL is available. In vitro fertilization (IVF) with pre implantation chromosomal analysis is an incredibly effective tool yielding live births rates over 60% in one cycle.
Anatomic
Some women are born with a birth defect in the uterus. This can be detected by hysterosalpingogram. Many of these uterine birth defects are surgically correctible.
Blocked and dilated fallopian tubes, also known as hydrosalpinx (one tube) or hydrosalpinges (two tubes) can contribute to RPL. HSG is the test of choice. Because hydrosalpinges contain toxic fluid that is embryo toxic to an embryo within the uterus, surgery to block the junction of the tubes with the uterus or removing the irreversibly damaged tube (s) is an effective treatment.
Endocrine
Disorders of the thyroid gland, elevations of a hormone called prolactin and diabetes or pre diabetes are all treatable causes of RPL.
Auto Immune Factors
Some women carry in their bloodstream or uterus elevated amounts of factors which lead to RPL of a healthy pregnancy. Blood work is the test of choice, and treatment is with aspirin and/or blood thinner. Auto immune factors are seldom if ever the sole cause of RPL. There is no proof that infusion of blood products such as IVIG is effective.
If you have RPL, visit a doctor who will test for these four categories and devise a personalized treatment plan for you. Have hope – 2/3 of women with RPL will have a healthy pregnancy, often without special treatment. For those with one or more identifiable causes, effective treatment is available and almost all couples will take home a baby! Grief counseling and behavioral health guidance are available along the way. Don’t hesitate to ask for help – reaching out when you need help is a sign of strength, not weakness. Early consultation with a Board Certified Reproductive Endocrinologist can help get you on the pathway to success.
About the Author
Celeste Brabec, M.D., is Dual Board Certified, both in Reproductive Endocrinology / Infertility (REI), as well as in Obstetrics and Gynecology. She has been voted “Super Doctor” in Infertility by her peers the past 5 years in a row. Dr. Brabec received her Fellowship Subspecialty training in REI at Harvard Medical School in Boston, MA. She currently serves as Medical Director at Reproductive Resource Center of Greater Kansas City (RRC). RRC is a one of a kind Comprehensive Treatment Center for couples and individuals with issues in reproduction. RRC has a Team of over 20 specialists with over 100 years combined experience, and is the longest standing private practice fertility clinic in the region, serving the area since 1988. RRC was first in the region to offer donor egg IVF, ICSI, blastocyst culture, blastocyst freezing and pre implantation chromosomal and genetic screening. Their track record and caring Team speak for themselves. See why so many others have chosen RRC. Let us help you with your “First”!
*Dr. Brabec is a contributor to the KCIA newsletter as RRC was a platinum sponsor of their 2015 Annual Family Building Conference. For more information on the 2015 Family Building Conference click HERE.