October recognizes Pregnancy and Infant Loss. If someone you know or yourself have experienced the loss of a child to stillbirth, miscarriage, SIDS, please join Donor Nexus in raising awareness around pregnancy loss.
Below, we will explore pregnancy loss, potential causes for miscarriage, what Recurrent Pregnancy Loss is, and various options to explore.
As per the APA, approximately ten to twenty-five percent of all clinically recognized pregnancies will miscarry. While this statistic lets you know that it is more common than you may think, it can still feel isolating when you experience a loss.
Pregnancy losses within the first trimester may be caused by autoimmune, endocrine, or uterine anomalies, however, most typically due to genetic or chromosomal abnormalities with the embryo. According to the March of Dimes, fifty percent of first trimester miscarriages are due to chromosome abnormalities.
In addition, the risk of pregnancy loss can increase with the number of previous miscarriages you may have experienced. This is why if you've endured two miscarriages or more, seeking a doctor's help may be in order!
Recurrent Pregnancy Loss (RPL) was previously defined as three or more pregnancy losses or more. In 2013 however, the American Society of Reproductive Medicine (ASRM) updated it to "Two or more failed pregnancies." So if you've had two miscarriages, this means that you would be considered someone who is symptomatic of RPL.
If you are concerned that you have RPL, seeing a reproductive endocrinologist (RE) can provide valuable insight. They will look at the timing of the loss and the visualization of developmental milestones before the loss (for example, fetal heartbeat on ultrasound). They will also take a thorough history and perform a physical examination. This may be followed by a series of diagnostic tests, including blood work on both partners and evaluating the uterus, usually with a specialized ultrasound study (sonohysterogram) to look for fibroids, scar tissue, or polyps that might compromise embryo implantation.
Some potential reasons for pregnancy loss are a balanced translocation or a blood clotting issue. Blood clotting factor genes can influence whether you have a predisposition for pregnancy loss. Your Reproductive Endocrinologist (RE) can address this with the help of therapeutic blood thinners. Blood thinners also reduce the risk of thrombosis when you are pregnant. Unfortunately, most doctors only test for blood clotting after women have two miscarriages.
Other factors include age. Suppose the mother is over thirty-five, the risk of miscarriage increases while egg quality and quantity decline. This means there's a higher risk of chromosomal issues – which in turn means a higher risk of pregnancy loss.
Research shows that the frequency of early pregnancy loss for women between twenty to thirty years old is nine percent to seventeen percent. At age forty, this rate increases to forty percent, and then at age forty-five, it jumps to a high of eighty percent chance of a miscarriage. This is why some explore the option of donor eggs as they are donated from women who are younger with high-quality eggs.
Other reasons include autoimmune or endocrine issues or uterine anomalies. As mentioned in our introduction, though, the most common cause is a chromosomal abnormality.
Your reproductive endocrinologist can best advise you on what your next steps are. They will most likely review your health history, perform initial blood work, an ultrasound, reproductive workup, and ask about your family goals. Still, knowing what options are available can help you advocate for your care.
IVF with Preimplantation Genetic Testing for Aneuploidy (PGT-A, previously known as PGS) is recommended if there is a genetic concern. Since chromosomal abnormalities cause roughly 70 percent of miscarriages, PGT-A Aneuploidy can decrease your chances of a miscarriage and increase your chances of having a healthy baby by selecting chromosomally healthy embryos.
If your partner or yourself have a genetic condition diagnosis or a family history of a genetic disorder, something else to consider. This includes Tay-Sachs, Sickle Cell Anemia, Huntington's Disease, which puts you at an increased risk of passing onto offspring. A genetic test your doctor might suggest is Preimplantation Genetic Testing for Monogenic Diseases (PGT-M).
Another option could be working with an egg donor. The majority of women are born with around two million eggs. This is known as an ovarian reserve. As you get older, your reserve will decrease. If you're a healthy reproductive woman, your reserve will have reduced to approximately 300,000 eggs by your mid-twenties. While it can vary for everyone, the age thirty-five is when a woman's egg quality and quantity begin to diminish. Women over the age of thirty have around a twenty percent chance of conceiving. By age forty, it can decline to a noteworthy five percent.
While there's always a chance of miscarriage, the good news is that, when using donor eggs, the risk of miscarriage is much lower. For example, in 2015, the average miscarriage rate for women using in vitro fertilization (IVF) over forty was thirty-one percent. For those using donor eggs, the miscarriage rate decreased to approximately sixteen percent.
In addition, patients with decreased egg quality give themselves the greatest opportunity for a successful pregnancy when using donated eggs from a younger woman due to better quality eggs and a greater quantity of eggs.
While few imagine needing medical intervention when building a family, we hope it's a comfort to know you have options to increase your chances of having a healthy family.
Please get in touch with us at any time if we can be of assistance!