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Multiple Miscarriage
Experiencing a miscarriage is a tremendous shock. Infertility is defined as 2 or more consecutive miscarriages. The joyful feelings resulting from a positive pregnancy test give way to feelings of disappointment and sadness. A feeling of unreality – “this can’t be happening to me” – is mixed with a deeper sense of having lost something precious – a baby. Medically, it is often bewildering and the couple asks, “Why?” To help with these questions, this article discusses the medical reasons for miscarriage. In addition, ask your doctor what you can expect during and after your miscarriage and if you get pregnant again.
Of all pregnancies, 15-20% end in miscarriage; 75% of these in the first 12 weeks of pregnancy.
Miscarriage can leave you with deep-rooted feelings of loss and sorrow. These feelings must be confronted and dealt with, not suppressed, as is often urged by friends and family.
Allow yourself to experience the grief associated with the loss not only of your baby, but also of your pregnancy. It is okay to feel angry and depressed. Release those feelings by talking about them. Talk to your spouse and remember, that men and women sometimes experience grief in different ways. Accept that and try to support each other. Join a support group. Friends and family may have trouble understanding your loss, but there are others out there who are experiencing similar tragedies.
Testing
- Hormonal Factors Tests. Ask to have a prolactin, thyroid and progesterone level taken if you haven’t had these already. If they are abnormal and treatment is given, make sure that you are re-tested to check your levels.
- Structural Factors Tests. A hysterosalpingogram is done to evaluate the shape and size of your uterus and to rule out possible scarring in the uterus, polyps, fibroids or a septal wall, which could affect implantation. If there is concern about the uterine cavity, a hysteroscopy (examination done in combination with laparoscopy or as an office procedure) can be done. In some women the cervical muscle is too loose causing pregnancy loss after the first trimester. A special exam is done when a woman is not pregnant to check for an incompetent cervix.
- Adequacy of the Uterine Lining Tests.* An endometrial biopsy is done on cycle day 21 or later and will document if your lining is getting thick enough for the fertilized egg to implant. If you have a lag of two or more days in the development of the lining, you will be treated with various hormones (Clomiphene, hCG, Progesterone). It is important to have the biopsy repeated after several cycles to make sure the treatment is helping. If you are on Progesterone, discuss the various advantages of the oral, vaginal gel creams or tablets or injection routes with your doctor.
- Tests for Chromosomal Causes. Chromosomal tests are rarely done on tissue from a miscarriage because it is difficult to preserve the tissue for adequate studies. If chromosome testing is needed, you and your partner will have blood tests to make sure there is no translocation of genes (a condition in which the number of genes is the normal 46, but they are joined together abnormally). This condition can result in pregnancy loss.
- Tests for Immunologic Causes. Blood tests to check for immunologic responses that can cause pregnancy loss include antithyroid antibodies (antibodies to thyroglobulin and thyroid peroxidase) the lupus anticoagulant factor and anticardiolipin antibodies. These appear to influence blood clotting mechanisms within the placenta as it develops. There are also blood tests that check for protective blocking factors. These are essential to protect the pregnancy from being rejected by the mother’s body.
*There has been recent interest in the use of vaginal ultrasound to measure the uterine lining. According to most reports, it is best if the lining measures 10 millimeters or more at mid-cycle. Some centers also are using special Doppler techniques to measure the blood flow to the uterus.