There are extreme highs and lows in the typical work week of a Reproductive Endocrinologist. Throughout my career, in one manner or another, I’ve had the chance to share in the joys of families as they have welcomed over eight hundred happy healthy babies into their lives. I’m ever thankful for these experiences. However, along with those “good” pregnancies, there have been hundreds of other times when I’ve endured alongside my patients their utter sorrow as they suffer a pregnancy loss. Many of you may yourselves have had one or more miscarriages before. And only you can understand the many thoughts that run through your minds during these tragic events.
So many questions come to your mind. Was it something I ate? Was it that argument I had at work with that difficult client? Should I not have lifted that bag of groceries? It’s normal human nature to search for a reason or cause for events. However, in the case of an isolated first miscarriage, there is usually no reason other than for the cruel truth that miscarriages “just happen”. Even the healthiest women will suffer miscarriages. The rate in the general population is about 1 out of 6 pregnancies ending in a loss. For women over 35, that risk is even higher. This is usually due to the fact that sperm and eggs are not always perfect. If the specific sperm or egg that happened to create this pregnancy was in any way imperfect, it could be just good enough to conceive, but not good enough to thrive and survive. Nothing in the world could have prevented it. Yes, there are other miscarriages that arise from maternal factors. In these cases, a genetically perfect conception fails to survive because of a bad environment inside the uterus. This might be due to a physical defect, such as a fibroid or polyp or it might be due to a hormonal abnormality.
After sufficient grieving, the most important thing to do is to make the right decision. For most people, the right decision is to just go back to trying on your own again. For others, the right decision is to go seek help.
Many factors influence what is the right decision:
AGE: If you are younger, then it is not as crucial that you get a thorough workup and are you usually told to wait and get checked only if it happens again. OB/Gyn textbooks classically use three miscarriages as the threshold at which you should launch an investigation. However, if you are over 35, you might want to seriously look into it even if you’ve had two miscarriages. The reasoning is because if there is something treatable, then you need to take action before you run out of precious time in your lifetime of fertility.
NUMBER OF MISCARRIAGES: If this is your first miscarriage, most doctors would not recommend a workup. If this is your third or greater miscarriage, then most doctors would agree that a full workup is in order.
NUMBER OF HEALTHY PREGNANCIES: Someone who has six healthy children with three miscarriages interspersed between those healthy pregnancies is not in as great a need of a thorough workup as someone who only has three miscarriages and no other pregnancies.
SUSPICION OF A SPECIFIC PROBLEM: Women who have other clues for health problems, such as abnormal bleeding, known uterine problems, chronic medical issues or a significant family history of genetic or medical problems should consider getting help sooner rather than later.
FERTILITY: A woman who gets pregnant once every two years and has three miscarriages over six years has greater urgency to seek help than one who had three miscarriages in one year and seems to get pregnant quite easily.
KEY POINTS TO CONSIDER:
- Isolated miscarriages, while very sad, are part of normal human reproduction. The focus should be on getting as healthy as reasonably possible (diet, exercise, weight control, avoidance of smoking and other bad habits, stress management) and getting emotionally ready to conceive again.
- After a miscarriage, avoid searching for ways to blame yourself or looking for some real or imagined reason that caused it.
- If time is not urgent for you, then wait two to three months to emotionally recover. Spend that time catching up with the things in life that got put on hold during the weeks of dealing with the miscarriage. Take a break and enjoy activities that you may have put off for a time. However, if time IS urgent for you (if you are older, for example), then it’s probably better to just keep trying right away rather than wait three months. Don’t necessarily seek medical assistance, but don’t use contraceptive measures to avoid getting pregnant.
- Contrary to popular belief, for the majority of women who have had miscarriages, odds greatly favor that the NEXT pregnancy will be a healthy one rather than another miscarriage.
- Recurrent miscarriages should be seriously addressed as there might be a treatable cause.
Watch for future posts that discuss some of the causes of habitual miscarriage.