By Ernst Lamothe Jr.
For pregnant women, a miscarriage is an unexpected and emotionally devastating loss. Erin Masaba, an OB-GYN at UR Medicine’s Strong Fertility Center, understands the affects it can have on a person. Miscarriage, which is the spontaneous loss of a pregnancy in the first 20 weeks, is the most common type of pregnancy loss. About 10 to 20 percent of known pregnancies end in miscarriage, according to the Mayo Clinic. The risk of miscarriages can change with age and history.
Masaba, who moved to Rochester after completing a fellowship in reproductive endocrinology and infertility at Weill Cornell Medical College, talks about the top six things women need to know about pregnancy loss.
“Miscarriage is a relatively common occurrence among all childbearing women,” she said.
1. Causes of miscarriages
About 60 percent of pregnancy losses are caused by unforeseeable, sporadic chromosomal abnormalities. Some of those causes include increased age of the mother. A woman is born with all the eggs she will ever have. However, if you are over 35 or 40 and trying to get pregnant, the chances for an egg to have a chromosomal abnormality increases. And in some small cases, a miscarriage occurs when a genetic abnormality is found in the mother or the father and passed on to the fetus. “For women over age 40, the miscarriage rate approaches 50 percent.”
2. Abnormal Defects
Some women are born with anatomical defects in the uterus that can cause miscarriages in the early weeks of their pregnancy including a septate uterus. A uterine septum forms when the tubes that eventually become one uterus don’t fuse together properly. Having a septate uterus doesn’t affect a woman’s sexual pleasure or fertility, but it may add complications to pregnancy.
“Septate uterus is correctable with surgery, but the other defects are not,” said Masaba. “Still, many women with these conditions go on to have successful pregnancies.”
3. Aftermath of miscarriage
Many women form an attachment to their baby early on in the pregnancy, especially if they’ve been trying to conceive for some time. But after the grief, anger, depression or other emotions subside, many times parents want to know what went wrong. Physicians suggest parents to talk to an OB-GYN and perform certain tests. “When a woman comes in after a pregnancy loss, we test the mother and father for chromosomal anomalies and test the mother for anti-phospholipid syndrome,” Masaba said. “Imaging tests can detect a uterine anatomical defect.”
4. Seeking Support
It’s important for couples to know that when a woman has recurrent losses, it is not the woman’s fault. That’s a hard concept for women to accept because they often think they did something wrong or failed to do “everything” to ensure a healthy pregnancy.
“Miscarriage is a traumatic experience. The loss of a pregnancy should be grieved and dealt with, as with any loss,” Masaba said. “Women should feel free to reach out for the support they need. It takes a lot of courage for a woman who has lost a child to try again, but their chances of having a successful pregnancy are very good.”
5. Treatment options
About 50 percent of the time, physicians don’t identify a cause for the miscarriage. In those patients, it’s hard to hear the physicians advice to just try again. But the good news is that 60 percent of these couples will go on to a successful pregnancy.
“When we can pinpoint a reason for the miscarriage, we can offer appropriate treatment for the medical condition and ongoing management of the pregnancy,” said Masaba. “For couples who have an abnormality, we can test their embryo for the presence of a problem before implanting it in the uterus.”
There is the possibility that a woman will not have any eggs that make it to the stage to do genetic testing. “For these women, there is the option of using a donated egg to initiate pregnancy,” she said. “These donor eggs come from young women, so the chance of a successful pregnancy is higher.”
6. Recurrent Loss
Recurrent miscarriages — the loss of three or more consecutive pregnancies before the fetus is 10 weeks old — are not as common. The American Society for Reproductive Medicine recommends that if a woman has two consecutive pregnancies, she should see her OB-GYN or fertility specialist at a fertility clinic for an examination. If a woman has had a miscarriage, the likelihood of her having another one increases.
“After a first miscarriage, the risk of having a second is 15 to 20 percent. After two miscarriages, the odds of a third go up to 25 to 30 percent,” added Masaba. “Fortunately, less than 5 percent of women will have two consecutive miscarriages and only one percent will experience three consecutive pregnancy losses.
For women over the age of 35 with recurrent pregnancy loss, physicians recommend genetic testing of the embryos if no other explanation is found. It’s important to note that once a woman reaches 40, it can be harder to stimulate ovaries to release a quantity of eggs needed to find a healthy one.