5 Myths About Recurrent Miscarriage
The last thing you need right now is bad information
If you're one of the many women (like me) who have experienced recurrent pregnancy loss (RPL), you have probably heard a lot of misinformation about this medical mystery. I know I did. Some people told me I didn't need to ask for medical help until I lost three pregnancies. Others said if I could just stop stressing out and ingest boatloads of seaweed, I'd be guaranteed a full-term baby. Even my doctor told me that I could avoid future miscarriages by taking baby aspirin and progesterone supplements. (Two more miscarriages proved that wrong.)
So I went to the some of the country's top experts in obstetrics, maternal-fetal medicine, and genetics to get the straight story and save other women from making the same misguided efforts I made.
One truth to share is that you are not alone. Five percent of couples trying to conceive experience two or more consecutive miscarriages, and 1 percent of couples experience three or more miscarriages, according to the American Congress of Obstetricians and Gynecologists (ACOG).
Another frustrating thing to know is that no one, not even experts in the field, can explain why many of our pregnancies ended. That mystery adds to the agony we already feel, but at least we can let go of some of the most common – and persistent – myths.
Myth 1: You're doing something wrong.
When she miscarried shortly after a plane trip, Rachael B., a 42-year-old lawyer in Northern Virginia, vowed "to never set foot on a plane again when I am pregnant." Wendi Whittles, 46, of Pleasant Hill, California who lost a pregnancy soon after a pedicure at a spa, says she, "couldn't have a pedicure for years."
In reality, the majority of early miscarriages are simply cases of a genetic slip-up. As many as 70 percent of early pregnancy losses – recurrent or not – are due to chromosomal abnormalities, according to Charles Lockwood, MD, professor of obstetrics and gynecology and dean of the Morsani College of Medicine at the University of South Florida.
This usually means that the lost embryo carried an extra chromosome, was missing a chromosome (more rarely), or had chromosome defects (like deletions). All of these can cause a pregnancy to be nonviable. So regardless of whether you have your embryo tested, it's a fair assumption that an early loss is due to genetic causes – especially if you're older than 35 and trying to conceive.
A small percentage (4.5 percent) of couples with recurrent early miscarriages may be experiencing balanced translocation. In this condition, a healthy person's chromosomes are rearranged, meaning he or she could pass on too much of one chromosome and too little of another, creating a genetically abnormal embryo. (It is easy to diagnose with a blood test.) Treatment options include IVF and then testing embryos for chromosomal abnormalities before implantation.
Later recurrent losses (between 10 and 20 weeks) are less likely to be from genetic factors. If you have lost two or more pregnancies after 10 weeks, doctors are more likely to find clotting disorders, such as antiphospholipid antibody syndrome, or very rare abnormal immune reactions. They may also want to rule out certain medical issues including uterine fibroids, an abnormally shaped uterus, or a weak cervix.
Myth 2: You must lose three pregnancies in a row before seeing a doctor.
In the past, women were advised to wait until they had three successive miscarriages and no completed pregnancies before seeking help. That's no longer the rule. With the exponential improvements in genetic testing, couples can learn more about their losses – and possibly how to prevent them – than ever before. So there's no reason to have your heart broken three times before seeking those answers, or miss out on medical treatment because you had a live birth in the past. The current thinking, according to Dr. Lockwood, is to get help whenever you feel concerned about your recurrent miscarriages, especially if you're older than 35.
Myth 3: Just take [insert wonder drug here] and you will be cured.
Unfortunately, the tough answer to "What can I do to prevent another miscarriage?" is usually, "Nothing." Some doctors prescribe baby aspirin or progesterone supplements to patients with RPL, but most experts believe that unless you're one of the patients who have a definitive diagnosis (such as antiphospholipid syndrome) neither of these solutions is likely to help. And although there are no conclusive studies showing potential harm from these therapies, aspirin may increase the risk of maternal bleeding.
"Aspirin and heparin are prescribed even though there is little data to support it," says James D. Goldberg, MD, director of the Prenatal Diagnosis Center at San Francisco Perinatal Associates. "Couples are excited that 'it works'" if their next pregnancy results in a live birth, he says, even though the drugs may have had nothing to do with it.
It's also important that couples not be taken advantage of by companies marketing other potentially harmful "remedies" for RPL. According to Lockwood, unproven immunotherapies and biological therapies are sometimes sold to couples seeking to end the heartbreak. "The use of prednisone and IVIG to treat 'immunological' causes of recurrent miscarriage is not efficacious, can be potentially dangerous, and is financially wasteful," says Lockwood.
Myth 4: You must to wait [insert unbearably long time period] to try again.
While experts agree that you shouldn't feel pressured to get pregnant again before you're emotionally ready, opinions differ as to how soon to try again for best results. Some OBs ask their patients to wait at least 2 to 3 months before trying to conceive. Hugh Taylor, MD, chief of obstetrics and gynecology at Yale-New Haven Hospital, recommends that couples hold off that long because the uterus needs time to recover.
Others believe there is no reason to wait. Lockwood suggests that couples (especially those older than 35) try to conceive again as soon as they are ready because there's little medical evidence to suggest that waiting even one month to conceive after an early miscarriage has any impact on the health of future pregnancies. Although there are no clear answers about whether it's possible to try again 'too soon,' few doctors still recommend that patients wait between six to 18 months to try again.
Myth 5: You will never be a mom.
After multiple miscarriages, women like Stephanie Tomasco, a mom in the San Francisco Bay Area, observe with jealous wonder when other women plan for live babies moments after the second line appears on a pregnancy test. For women who have experienced RPL, a full-term pregnancy seems far from certain, and it feels much wiser to brace yourself for imminent heartbreak.
"I was nothing but a vessel that was going to fail," says Rachael after having five miscarriages, but she was astounded to give birth to two healthy boys in quick succession.
Rachael's experience is not unusual says Dr. Goldberg. "Even after multiple losses, the odds of a successful pregnancy are still greater than 50 percent," and ACOG puts them at 65 percent. "That's reassuring to some, but when couples are devastated, hearing 'try again' can be hard," says Goldberg. "But the fact remains that their chances of a full-term pregnancy – without any intervention – are good.”
Motivated by a desire to provide her 5-year-old daughter with a sibling, Tomasco says, "I just knew I had to try again." She is now seven months pregnant with a healthy baby boy.
For advice and support on coping with the emotions of recurrent miscarriage read The Emotional Rollercoaster of Recurrent Miscarriage.
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