Pregnancy loss and miscarriage are an incredibly difficult reality to cope with. The emotional and physical distress a woman must go through at this troubling time may make one feel there’s no hope. It’s important for all prospective parents to know that there are effective solutions to heighten the chances for a successful pregnancy and to handle the unfortunate grief. Dr. Lauren Weissmann from the South Jersey Fertility clinic is here to discuss your options and answer any questions you may have to promote a healthy, live birth.
Understanding Pregnancy Loss with Dr. Lauren Weissmann
Hello everyone! I’m Dr. Weissmann. I recently joined South Jersey Fertility in July of this year. I’m very happy to be part of this really fantastic group. I’m a reproductive endocrinologist and infertility specialist. I’m also a trained OB-GYN and did sub-specialty training in this particular field. I look forward to answering any questions you might have.
Managing Pregnancy Loss
Today is pregnancy loss and infant loss awareness day and it’s a very important time to think about people in your life, or yourself, who have experienced these very traumatic events. Unfortunately, pregnancy loss is incredibly common – about 25% of all pregnancies end in pregnancy loss. Because it is so common, I think a lot of people can feel that they are lucky if they haven’t experienced some kind of pregnancy loss. For those who have, there are answers and we’ll talk about some of those solutions, why this happens and the things we can do about so it doesn’t happen in the future.
Coping with a Miscarriage
With pregnancy loss and how common it is, you’ll first want to recognize that the event itself can be incredibly traumatic for the person, for their family or for their loved one who they are going through it with. Unfortunately, it ends up being something that many people go through alone because most of the time pregnancy loss happens before many people are even aware that the person was pregnant. It can be very troubling to pretend that everything is fine on the outside when they’re struggling with the grief and potentially the depression that goes along very commonly with this. It’s very important for those who experienced pregnancy loss – and those who are struggling with the grief and trauma that surrounds it – seek help from either a professional or loved ones. It can help the future in terms of your future pregnancy outcomes.
The Most Common Cause of Pregnancy Loss
Besides being common, we know that most pregnancy losses do occur actually –about 60% – happen because of what’s called Sporadic Chromosomal Events. The chromosomes are what hold all the genetic material that contains the makeup of the baby. You get half your set of chromosomes from the mom in the egg and the other half from the sperm. They meet to create a new set of chromosomes that become the genetic material that develops in the baby. It’s important that the egg has a complete and normal set of chromosomes as well as the sperm. If either of those does not occur, then the chromosomes are abnormal when they come together and won’t produce a normal pregnancy. When the body recognizes that, it typically ends in a loss. About 10% of pregnancy losses under the age of 35 are due to this opposed to more than 50% over the age of 40.
Age Affects the Chromosomes
Unfortunately, age is the biggest determining factor in terms of the frequency of pregnancy loss from chromosomal or genetic issues. The reason for that is because the egg quality or the quality of the genetic material in the egg deteriorates as one ages. Before you ovulate, so that it can receive the sperm, each egg actually contains the full set of chromosomes in your body – so 46 chromosomes. It actually needs to spit out or get rid of half of them so that the sperm can come in and make up a new set of chromosomes for the baby – and as the eggs age, it doesn’t do this as efficiently. There’s a little machinery that splits apart the chromosomes – and when this doesn’t happen correctly, you can end up with little pieces of genetic material that are extra or little pieces that are missing. That’s what causes most of the chromosomal abnormalities that occur with greater frequency when one gets older. What can help in terms of both peace of mind and in an understanding of it, is that most OB-GYNs will offer a chromosomal testing on the pregnancy tissue
There are several other reasons that we do look into patients who have what’s called a recurrent pregnancy loss. Recurrent pregnancy loss is any person who has had at least two losses. This pregnancy loss can be defined once we can see the pregnancy on an ultrasound or if there’s tissue that’s been identified by the pathologists on the specimen after a procedure. In this case, it’s very important for a lot of women to see a specialist so that we can potentially do some testing that is indicated for those who do have recurrent pregnancy loss. The good news is that we do identify a reason for about 50% of the women who come in with this history. That does mean that about 50% of the couples walk away with potentially not a better understanding or at least we’ve ruled out certain things that could have caused the miscarriage.
Testing for Chromosomal Abnormalities
There are still a lot of unanswered questions, but the testing, though not perfect, does help. We’ll then know how to address certain conditions if certain tests are positive so we can address the pregnancy outcome in the future. Most of those tests include blood tests and another test is something we call the “workup,” which is the cavity of the uterus. This is where the pregnancy implants and then grows, so we make sure that it actually is normal, but it may not be for several different reasons. There could be something called the Septum in the uterus, which is basically a piece of tissue that’s been there since birth and can cause a miscarriage. We look for any kind of pubic polyps in the lining of the uterus, a fibroid, or any kind of abnormality that would affect the growth of their pregnancy. The blood tests that I’ve mentioned is how we look at the chromosomes of the mom and father. While I mentioned that most of the cases of chromosomal errors, or genetic errors, that cause pregnancy loss are sporadic, there are cases where if we cannot identify a particular reason or if we think there is no recurrent concern, about 5% can have what’s called a Translocation. This is an issue in the chromosomes of the parents themselves. The good news is that if we detect this with looking at the chromosomes of the mom and dad, we can actually avoid going through a loss in the future through IVF or in-vitro fertilization. We test the embryos with preimplantation genetic diagnosis and make sure the embryos that we do put back in the uterus are chromosomally normal.
Blood Testing to Decrease Miscarriage Rates
The other blood tests look for something called Antiphospholipid Syndrome. This is a variation of an autoimmune disease or autoimmunity. There are a variety of antibodies that we look at – and if those are present, there are very good treatments. The treatment is taking a baby aspirin every day as well as a blood thinner while trying to conceive during pregnancy. That has shown that a combination of the two in patients who have this Antiphospholipid Antibody Syndrome can increase the live birth rate in the next pregnancy up to 75%. People with the syndrome who only took aspiring instead of both, only increased it about 40%. It can also be a risk if you experienced preterm delivery with Preeclampsia in a previous pregnancy that could even warrant testing for this particular syndrome. The last few parts of the blood work, including checking for different endocrine things such as thyroid function with the TSH, a prolactin level, as well as making sure there’s no diabetes that wasn’t previously identified – because uncontrolled diabetes can lead to miscarriage.
IVF Implantation Failure
There are a few questions so I’m going to read those. So, having a few losses during IVF and not being able to figure out a cause – unfortunately, that is not uncommon. I don’t know if they were early losses, like biochemical losses, but if we weren’t able to do any testing or if we did carry some out through chromosomal testing, sometimes that doesn’t give a perfect result. It can come back normal or can have contamination of the cells, meaning that we can’t detect exactly which genes are the mom’s and which genes are from the pregnancy.
Egg Quality Supplements
Are there any natural supplements that can assist with egg quality? I would say the primary thing we do recommend be something you can get over the counter called Coenzyme Q10. We usually suggest taking 300 milligrams twice a day. It has been shown in some studies to help with egg quality, but it doesn’t necessarily fix or reverse the aging process and the associated concerns.
The Forming of the Uterus
Interestingly, most people don’t know that when a woman was inside their mom’s womb when all their organs were formed, the uterus was in two pieces on each side of the pelvis. During the growth in your mom’s belly, the sections essentially join together. Then the tissue in between that kept them separate gets reabsorbed. Instead, you have these two pieces together, but if they don’t disintegrate correctly, that’s how you end up with pieces of tissue that protrude from the top of the uterus. There are different abnormalities, not just the septum that can happen. You can have what’s called a bicornuate uterus or an arcuate uterus, a heart shaped uterus, or even two uteruses that didn’t come together at all.
What is a Normal LH Level?
What should your LH levels look like on cycle day three? The LH and estradiol levels aren’t as important. It’s not necessarily what we look at or look for on day three. We would expect the LH and FSH, which are the two hormones that remade by the pituitary gland in your brain. You’d expect them to be low and in most laboratories that would be under 10. The estradiol should also typically be low at the beginning of your cycle to 60 or less. DHEA is something that I wouldn’t just take unless you have talked an OB-GYN or a specialist about. Typically for DHEA, it’s not necessarily helping the quality of eggs but helping the quantity that might be there. There is what’s called diminished ovarian reserve, meaning that there are just a few eggs available to begin with.
Getting your karyotypes checked is also appropriate – and most of the time they are normal. Again, it’s only about 5% of this group of people who have a recurrent loss that ends up being abnormal. It’s still worth checking because those 5% could make difference by offering particular treatment.
Potential Causes of Miscarriage
Other things to mention include lifestyle tendencies and changes. Something that has been shown to be associated with miscarriage is smoking. Certainly, tobacco use or any other kind of smoking is strongly discouraged. If you have experienced a miscarriage and you use tobacco products then that would be a risk factor for sure.
Obesity and Pregnancy Loss
Next is obesity. Anyone with a body mass index over 30 is associated with miscarriage as well. Diabetes I mentioned a little bit earlier – so mostly uncontrolled diabetes. Caffeine is another commonly associated trait of miscarriage but not usually. There are some studies to suggest that if you have more than three servings or cups of a drink containing caffeine a day, that may potentially be the causation of miscarriage. That’s one of the reasons why we suggest limiting caffeine intake to essentially one cup a day if possible. People also come asking if we should check for what’s called Thrombophilias or blood clotting disorders. The guidelines have changed over the years and there isn’t really strong enough evidence to check for the possibility of any blood clotting disorders unless a patient has a personal history of having had a blood clot. Testing is also important for patients who have what’s called unexplained recurrent miscarriage or unexplained loss in general. I alluded to it before, when detecting chromosomal losses since the majority of the reason why pregnancy loss happens is that of abnormal chromosomes. A lot of times to ease the suffering and trauma of going through another pregnancy, loss patients will elect to go through the process of IVF and genetic screening on the embryos. This will help us eliminate the possibility of having a chromosomally abnormal embryo as a reason for the future loss – therefore potentially increasing the chances of live birth. It’s a good treatment option for many people who potentially can endure another loss for a particular reason.
Checking Thyroid Levels
A topic that has been discussed a lot lately is checking thyroid levels. Particularly in the last few years, the group that helps oversee how all the reproductive endocrinologist give care. The American Society of Reproductive Medicine worked with the endocrine society and revised all the guidelines. Normal range can be all the way up to 4.5 to 5. It can be a 3 or 4 and that would be a normal level so the patient wouldn’t have Hypothyroidism. Patients who are trying to conceive or have had a pregnancy loss, it’s recommended that the levels of TSH will be checked and be less than 2.5. Typically in those situations, we start a low dose of Synthroid or thyroid medication. It generally has no side effects and then we monitor it during the pregnancy. Most women will come off of it and not have any thyroid issues beyond that.
Increasing Chances for Successful Pregnancy
Sometimes, even if we can’t find any reason, there are a few things that have a very little risk but do host some potential benefit that may not be quantifiable. That includes taking baby aspirin every day and as well as supplementing progesterone in the second half of the cycle, which is usually through vaginal suppositories. There’s really no harm in either of those interventions, but a lot of times we do test for that during an early pregnancy.
Study on Miscarriage Rates
There actually have been a lot of studies looking into how women are supported after having a pregnancy loss. By supporting, I mean early monitoring the pregnancy with ultrasounds from the beginning of five, six, seven and eight weeks. Essentially, the arms of the study are interesting. There was just the normal care arm where they called their OB-GYN at the usual time of 10 weeks and had an initial appointment – then calling the TLC or tender love and care arm. The people who were in the arm had a bit more handholding and emotional support did better in terms of their pregnancy outcomes. The study itself wasn’t perfect and there’s a lot of things that could make one better than the other, but it was interesting to see that information. A lot of the reason why most centers like ours do really think it is important that all your concerns are addressed. We’ll listen to you very closely and see you frequently to help ease some of the anxiety and other reasons why that can make going through an early pregnancy difficult.
Explaining Unexpected Pregnancy Loss
For those with unexplained pregnancy losses, are the success rates with any other donor programs better? There is a concept that two people’s egg and sperm – that particular combination – has some kind of immune or autoimmune reaction that could be the potential reason for pregnancy failure. There haven’t been any real studies that have looked at that answer, but the scenario usually took place with the donor egg or sperm. A donor egg can be helpful if the losses are potentially due to the chromosomes or the gene issues that we mentioned before are affected by age. If we see someone who is in their early forties – or even later or earlier – and we find that they’re having a lot of repetitive losses due to chromosomal abnormalities but we think it’s related to egg quality, then the donor egg can sometimes help when we’d like to do IVF with genetic screening of embryos. Sometimes that does offer closure if we’re not able to detect any chromosomally normal embryos.
DNA Fragmentation Test
I did also mention sperm, but there’s not really a whole lot to talk about. It’s not at all to say that there aren’t issues with the sperm that contribute to pregnancy loss because there are, there just aren’t great tests for them. There is one test called the sperm DNA fragmentation test. It looks at a sample of sperm and the percentage of sperm that have pieces of DNA that aren’t attached correctly. The test isn’t great enough to be offered widely across the country, but it is offered. We do have access to it if patients want that test done. The treatment is to decrease DNA fragmentation with the possibility of taking supplements. Similar to women taking coenzyme Q-10, things like that. There is a formulation of several different supplements that can help with antioxidants that could decrease the rate of DNA fragmentation.
The Answer to Robitussin and Cervical Mucus
Does Robitussin help increase cervical mucus? It doesn’t necessarily increase cervical mucus. It can actually affect it to almost decrease it some ways by actually changing its content. It’s not a very common thing that there’s much data to say that it does work to the point of it being effective enough to increase sperm mobility so it can get through the cervix. A lot of times instead of doing that, something that is more direct and much more effective is doing something like an insemination where we bypass the cervix entirely and inject the sperm into the uterus. Some people can use Robitussin to change the microenvironment of the cervical mucus in some cases potentially making it easier for sperm to get through, but it’s not the most effective thing that I would say could be done.
Ask An OB-GYN About Pregnancy Loss
I’m happy to answer any types of questions, not just as it relates to pregnancy loss. We’re going to start wrapping up, so if anyone has any more questions feel free to message the South Jersey Fertility Center on the contact form on our website or contact one of our doctors. Thanks for joining me, everyone. Take care!
Prevent Pregnancy Loss in New Jersey
Remember that there’s always a viable solution to pregnancy loss. Preventing a miscarriage is not as difficult as it may seem, however it will require patience and a positive attitude. If you’d like to speak with a South Jersey Fertility pregnancy loss expert to explore your options and learn more about the topic, please contact us today. We’d love to lend a hand to mothers and couples in need of pregnancy loss support. For more information about the fertility treatments and solutions, we hope to see you for our next live video stream on our Facebook page.