Health Essentials from Cleveland Clinic

With some pregnancies, everything is fine — until suddenly it isn’t. You hear, “You’ve lost the baby.” And, just like that, you become one of 6.7 million women who are diagnosed annually with subfertility – impaired ability to get pregnant or carry a pregnancy to term.

It may be old-fashioned, but many couples pursue a dream similar to their parents and grandparents. They settle down and start a family. Soon, they’re sharing the news of a pregnancy with family and friends.

But there are many reasons why a pregnancy may be lost along the way.[Tweet “Recurrent #pregnancy losses require resilience, medical interventions to get and stay pregnant”]

“When patients suffer a pregnancy loss, it doesn’t mean that you won’t conceive or carry a baby to term. It could be any number of factors that are affecting your fertility and making it difficult for you to maintain the pregnancy,” says OB/GYN Rebecca Starck, MD, Department Chair, Regional Obstetrics and Gynecology at Cleveland Clinic.

It’s not unusual for a woman to miscarry. In fact, an estimated 10 to 15 percent of pregnancies in the first trimester — the first 13 weeks — end in miscarriages.

“It’s when a woman has recurrent pregnancy losses — typically three or more miscarriages in a row — that we start investigating,” Dr. Starck says.

Causes of pregnancy loss

Recurrent pregnancy losses tend to fall into these categories:

• Advanced maternal age — Miscarriage risks increase in women who are 35 years old or older.
• Problems with the womb – The uterus might have noncancerous growths, scar tissue or malformations a woman is born with that could affect a woman’s ability to get pregnant.
• Genetic issues — Genetic factors contribute to more than half of all miscarriages. If the egg or sperm cell has too few or too many chromosomes, a miscarriage can happen.
• Hormonal and autoimmune factors — Thyroid function and uncontrolled diabetes are among the reasons for pregnancy loss. Similarly, lupus or other autoimmune diseases can cause miscarriages.
• Antiphospholipid syndrome — Present mostly in young women, antiphospholipid autoantibodies cause blood to flow improperly and can lead to blood clotting and miscarriages.
• Lifestyle choices — Smoking and using alcohol or drugs are known to cause miscarriages.
• Unexplained — Unfortunately, 50 percent or more of women may never know what caused them to miscarry.

Treatment options

Women who suffer multiple miscarriages often grapple with finding the definite cause of their losses. In half the cases, the underlying reason remains a mystery. For those with diagnoses for their recurrent miscarriages, modern medicine offers hope and treatments:

• If an abnormality in the woman’s uterus is causing her to miscarry, her doctor may be able to offer outpatient treatment using a scope.
• For problems with a woman’s immune system or hormones, the doctor may prescribe oral medications.
• If a couple’s miscarriages are due to genetic issues, doctors often can use genetic counseling and genetic screening to diagnose the problem. 

Resilient couples keep trying

One thing is certain. Pregnancy losses are tough on the couple.

“It can impact the psychological health of the couple, even though most of the time it’s out of their hands,” says Dr. Starck. “Women who experience infertility go through grieving, hopelessness, loss and feeling like a failure.”

That’s how Nicole Herbst felt when she miscarried.

“We were both completely devastated, especially since the loss of our baby was happening just a week prior to my husband, Rob, being deployed to Afghanistan,” says Ms. Herbst, 40. “I was even mad at him that he had to go with the U.S. Army Reserve and would be gone a year.”

Couples can get help coping with a loss by seeking support from others, whether they are formal support groups or close friends.

The Herbsts tried multiple medical treatments in the process of overcoming infertility issues. Ms. Herbst got pregnant again after two rounds of in vitro fertilization. On March 4, 2014, the couple welcomed a baby daughter, Violet, at Fairview Hospital.

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