October is National Pregnancy and Infant Loss Awareness Month. This month is an opportunity to honor those who have lost a child during pregnancy or lost a child in infancy and to educate them on ways to deal with a miscarriage. A miscarriage is defined as losing a pregnancy within the first 20 weeks. According to the American Pregnancy Association (APA), approximately 10 to 25% of all clinically recognized pregnancies will result in a miscarriage. However, that percentage is much lower in surrogacy pregnancies as the gestational carrier has had healthy pregnancies to term, and in some cases the embryo has gone through genetic testing.
For those who have experienced recurrent pregnancy loss, it is important to understand your options on how you can alternatively expand your family. We understand these concerns and want you to know that support and medical options are available.
Common Causes of Miscarriage
The most common identifiable cause of miscarriage is a chromosome abnormality in a fetus (similar to Down syndrome, but usually with different chromosomes). The most common chromosome abnormality seen in miscarried fetal and/or placental tissue is 45XO (a missing sex chromosome, known as Turner’s syndrome). Other commonly seen chromosome abnormalities include extra chromosomes for 15, 16, and 22. These “aneuploidies,” as they are known, are random and usually occur in the egg cell just before ovulation. Therefore, they are generally not recurrent.
Age is also something to consider. The inability to produce healthy, viable eggs often results in lower pregnancy rates and higher rates of miscarriage in women in their late thirties and in their forties. Miscarriage rates over the age of forty are 50% and rise quickly with each advancing year.
Some pregnancy losses have no clear cause and fall in the very frustrating “unexplained” category. It is most likely, in these cases, that there is some other problem with the embryo or fetus. Because it usually happens in the first trimester, there is not enough identifiable fetal tissue to examine for cause (except DNA and chromosomes).
Much rarer identifiable causes:
- Balanced translocations (parental chromosomes at fault and can be detected with a karyotype on both parents)
- Autoimmune issues – much rarer and somewhat controversial as to cause and effect. Most agree there may be some association between thyroid autoimmunity and recurrent pregnancy loss.
- Thrombophilias (excessive blood clotting) – Abnormal tests for lupus anticoagulants, some of the blood clotting factors.
When Should You See A Doctor or Consider Your Options?
Most all Obstetrician/Gynecologists and Reproductive Endocrinologists recommend fertility testing for recurrent pregnancy loss after three losses, particularly after three consecutive losses. However, many specialists would initiate some less expensive tests after two miscarriages, especially if the female patient is over 35.
What Tests and Treatment Options Are Available?
After a doctor looks at all the possible causes listed above, it’s typically recommended to pursue in-vitro fertilization (IVF) by testing embryo chromosomes before implantation. This is known as Preimplantation Genetic Testing for Aneuploidy (PGT-A). With PGT-A, embryos are analyzed for the number of chromosomes each contains. Then, only those with a healthy number of chromosomes are transferred. This gives the embryo a greater chance of implantation in the uterus and decreases the risk of miscarriage. Another option is gestational surrogacy. This is a great option for those intended parents who experience recurrent pregnancy loss, the threat of high-risk pregnancy, uterine factor, or unexplained factors.
Who is at High Risk for Miscarriage?
Patients with balanced translocations (need IVF with very specific testing of embryo chromosomes) are at a higher risk for pregnancy loss. In addition, patients with thrombophilias may need baby aspirin or heparin to help avoid miscarriage.
It’s also worth noting that if you’ve had one or even two consecutive losses, a woman has no greater chance of having another loss in the next pregnancy. If there are three consecutive losses, the odds of a fourth start to rise and go much higher with subsequent losses.
Also, again, age can be a factor. For example, women in their late thirties and forties, due to a decline in egg quality, have a higher risk for chromosomal abnormality, which creates a higher risk for pregnancy loss.
Ultimately, you do have options. You are also not alone in this. Speak to a doctor to learn what options might be right for you. There are many ways to build a family, surrogacy may just be that one for you.