My Journey with Cushing’s disease
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
Miscarriage can be a profoundly difficult and emotionally devastating experience and affects millions of women worldwide.
Approximately 20-30% of all pregnancies end in miscarriage, most before 10 weeks of pregnancy. Despite this prevalence, many who experience this loss still feel a lot of shame and guilt, and are left with unanswered questions surrounding miscarriage, including its causes, potential impact on fertility, and what women need to know about navigating pregnancy after experiencing a miscarriage.
Understanding miscarriage is a complex process, but the key thing to remember is most miscarriages are beyond a woman’s control. The most common cause of miscarriage is a chromosome abnormality in the pregnancy, accounting for up to 50-60% of cases. As a woman ages, both the number and quality of her eggs decrease. Chromosome abnormalities in the egg, which can occur in females at any age but increase with maternal age, are the most common factor leading to miscarriage.
Other factors that can contribute to miscarriage include abnormalities of the uterus like uterine fibroids, as well as conditions such as hypothyroidism, diabetes, and autoimmune disease. In addition, behaviors such as smoking and drug use can lead to miscarriage.
According to the American Pregnancy Association, approximately 85% of women who have had one miscarriage and 75% of women who have experienced two or three miscarriages can go on to have a healthy pregnancy in the future.
Recurrent pregnancy loss, defined as the loss of two or more pregnancies, is a less common occurrence and happens in only about 5% of women. Three or more miscarriages occur in less than 1% of women. While recurrent pregnancy loss may indicate other underlying issues, there are many ways to help mitigate risk and go on to have a successful pregnancy.
Typically, women under age 35 should attempt pregnancy for about one year before scheduling an appointment with an infertility specialist. Women older than 35 should consider being evaluated after attempting pregnancy for six months without success.
Women with the following issues may want to speak to a fertility specialist without delay: irregular menstrual cycles, a family history of early menopause, a history of cancer, polycystic ovarian syndrome (PCOS), endometriosis, extreme body weight (high or low), abnormal thyroid function, or a complicated medical history.
In addition, women who have had two or more miscarriages would benefit from seeing a fertility specialist to evaluate if any risk factors may be contributing.
Ongoing advancements in reproductive medicine have improved the accuracy and safety of genetic testing, diagnostic tools, and treatments, resulting in improved pregnancy outcomes.
It’s natural for women who have experienced a miscarriage to be cautious and look for assurance when attempting their next pregnancy. Understanding miscarriage isn’t easy. Below are several options to explore and potentially find answers, increase knowledge, and feel empowered:
Blood tests can evaluate for hormonal disturbances such as an elevated Thyroid Stimulating Hormone or Hemoglobin A1c. In addition, a blood test for antiphospholipid antibody syndrome can detect autoimmune disease linked to miscarriage. Karyotypes of both parents can be done to detect genetic translocations that increase the risk of miscarriage. Identifying abnormalities allows optimization prior to pregnancy.
A hysteroscopy or saline ultrasound can be performed to evaluate the uterus for abnormalities that increase the risk of miscarriage. These include fibroids, uterine septum, polyps, or retained pregnancy tissue from a prior loss. During this procedure, doctors can also take samples to be tested for other risk factors. This added step can go a long way toward mitigating miscarriage risk.
Women may be prescribed certain medications during pregnancy. For example, some doctors may prescribe progesterone during pregnancy, which can be taken orally or vaginally.
Opt for a healthy lifestyle prior to, and during, pregnancy that includes good eating habits, exercise, a prenatal vitamin, and eliminates alcohol and smoking.
For those undergoing IVF (in vitro fertilization), fertility doctors are able to do chromosome testing on an embryo prior to implantation. This allows doctors to transfer only normal embryos and eliminates the most common cause of miscarriage.
Women with recurrent miscarriages should seek counsel and specialized testing to identify potential causes and explore treatment options. They should consider asking their fertility doctors for a uterine cavity evaluation, and tests for antiphospholipid antibody syndrome, an immune disorder associated with an increased risk of blood clots and pregnancy loss, along with basic endocrine testing to rule out diseases like Type 2 diabetes and thyroid or prolactin abnormalities.
In addition, these women and their partners can seek out karyotype testing to assess whether either of them carries a chromosomal abnormality that may increase their chance of miscarriage or ask to be evaluated for immunological imbalances that may be leading to losses.
While understanding miscarriage can be emotionally challenging, it is important for women to know they are not alone, miscarriages are common, and they are not always preventable. Women can, and should, empower themselves to get help as needed and know that most women with recurrent pregnancy loss do go on to have a successful pregnancy.
References:
Pregnancy After Miscarriage. American Pregnancy Association. americanpregnancy.org/getting-pregnant/pregnancy-loss/pregnancy-after-miscarriage
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