Recurrent Pregnancy Loss Or Recurrent Miscarriage

Hi, my name is doctor Arlene Morales. I'm the medical director and reproductive endocrinologist here at Fertility Specialists Medical Group in San Diego. I'm in practice with Doctor Wendy Shelly, who you may have seen in some of the earlier video sessions. Our topic for today is recurring pregnancy loss. When people hear this, a lot of people have colleagues or friends who've had frequent miscarriages, and it is obviously very emotionally painful for the female and for the spouse or partner. The definition of what is a recurrent pregnancy loss is defined as when a woman loses two pregnancies in the first trimester. If, for some reason, a woman has had a second trimester loss, meaning after fourteen weeks, after one such loss an evaluation should occur, but if the losses are early, before twelve weeks, after one loss the encouragement is usually to continue trying again and the large majority of women will be successful in their next attempt at conception. If indeed you are in that five percent of women who've had two consecutive now first trimester losses, it is important to go see your local reproductive endocrinologist and if you're here in San Diego, us at Fertility Specialists Medical Group. The good news, again is only five percent of women will have two consecutive losses and that work up is important to try to understand why these miscarriages are occurring. What we do know is that the large majority of first trimester losses are because the chromosomes are abnormal in the embryo and mother nature is doing what it is supposed to do and is getting rid of a pregnancy that shouldn't continue. For a lot of women out there, if they've had a D & C or an evaluation of their tissue by their local gynecologist, they'll have gotten back a report that shows in fact that the embryos that they were carrying had an abnormal number of chromosomes. So,for a lot of women and couples, it does give them some sense of relief, because a lot of women initially say "Oh my gosh, what did I do to have this loss?", and they are looking for a reason and that's why sometimes getting those chromosomes of the D&C products is an important piece for women and couples to help resolve. If you have had two or more losses, it is important to get an evaluation and the areas that we look at are the chromosomes or blood tests, both you and your partner, to make sure there aren't any unknown abnormalities in your chromosomes as well as looking at anatomical features of the uterus, to make sure that there is no evidence of fibroids or polyps that can be causing implantation abnormalities. In addition to that, there are other blood work that look at metabolic features such as your thyroid and evidence of diabetes and lifestyle factors such as cigarette smoking, obesity, and nutrition. A lot of women think that "Oh, I miscarried because I was stressed", and although stress does play an important role in lots of aspects of reproduction, there is no strong data that that, in itself, is enough to cause a miscarriage. And again the majority of these losses are because the embryo is chromosomally abnormal. There are some immunological factors that are also important to rule out with blood work. Things that are called Antiphospholipid syndrome that are categorized very succinctly with different kinds of blood tests. Again, it's important to get that evaluated by your local physician to make sure. Despite the work up, about 50 to 75 percent of couples will still not have any identifiable cause, except that the embryo itself is chromosomally abnormal. For those couples that have a complete work up and the results are not identifying of anything specific, there are treatment options. If you were either to continue on your own or to actually go through IVF and test embryos before they go back in you, this is called pre-implantation genetic screening, so you can actually identify which of the embryos are chromosomally normal, before implanting one or two embryos to help achieve a successful pregnancy. The good news, again, as far staying hopeful, is that the large majority of couples will be able to conceive on their own spontaneously, and, again, only five percent of women have two consecutive losses and less than one percent of women have more than three losses. But again it is important to make sure you reach out to get evaluated, to make sure you understand why there are certain reasons you may or may not be having the losses. When people do talk about the stress and psychological stress of having the losses, it is important to make sure you've looked at your lifestyle issues and see what are the stress indicators. It's also important to maybe work with your local acupuncturist, if you're in San Diego, obviously Zen Fertility, to try to obtain more of a balance as far as your reproductive cycles go and what you and your partner are looking for as far as when to try to achieve another pregnancy, but the bottom line message is you should be hopeful. You should be seeking care, if you've had two losses and a large majority of couples will be able to go on and have the family that they so choose. Please check us out on our website www.ivfspecialists.com and if you're in San Diego or abroad, we do see a lot of international patients, please feel free to come by and see us. Thank you.