Miscarriage and Pregnancy Loss: Causes and Approaches
First off, I’m deeply sorry if you have experienced a miscarriage. Despite it being common, that fact only helps so much in coping with the loss and consequent fears that come with it. This article is not an aggregate of statistics to help you understand your likelihood of miscarrying. It is simply an effort to help you understand the common causes so that you might find additional solace. If you have experienced more than one pregnancy loss, my heart goes out to you. I hope the content of this article may additionally assist you in understanding what tests to seek out and how to best mitigate the chances of this happening again. Or, at the very least, gain some insight.
The most common cause of miscarriage–about 50%–is chromosomal abnormality. Although testing is available, it is not commonplace to use the test, unless there have been multiple losses. Instead it is just assumed that the problem was chromosomal abnormality. In New York, women’s pregnancies are monitored relatively closely (depending on your OB). In Canada, where I’m from, there seems to be a lot less monitoring. A friend of mine didn’t even know she was having twins until 21 weeks! I’m not saying that we need to monitor everything, BUT, if there are tests available and you know to ask for them — ASK! The worst answer you’ll get is a “no.”
In the case of chromosomal testing, collect the tissue you lose during the miscarriage in a sterile jar and bring it to your doctor. They won’t always be able to get anything from the sample you bring, but it’s worth a shot to ask. If you schedule a D&C, then most definitely ask them if they can test the tissue they retrieve (this way is obviously a tad easier). If you are doing IVF, ask about doing PGD/PGS to chromosomally screen your embryos.
Other causes of miscarriage include hormonal issues such as thyroid irregularities, low progesterone, and diabetes/insulin resistance.
Doctors will usually do a basic test of the thyroid by testing “TSH” and possibly “T4.” If the TSH falls within normal range (which is really too wide) then they don’t look much further. Keep in mind that normal range for fertility is different than for more “general health” standards. Look for a number between 1-2 for TSH on your test results. It’s also worthwhile to do a full thyroid panel that includes the tests above as well as: T3, Free T3 and T4, and thyroid antibodies. Synthroid is generally given in these cases and can be effective if we are not also looking at the autoimmunity against the thyroid. Autoimmunity is addressed later in this article.
Diabetes & Insulin Resistance
Blood sugar and insulin dysregulation can have a major impact on the growth and development of the baby if not managed well. However, for early miscarriage we will draw the attention to the fact that the endometrial lining does not mature and thicken properly. Inadequate blood supply and endometrial thickness can lead to early pregnancy loss. Metformin is often prescribed in these cases. For a thorough workup, see an endocrinologist. Diet and lifestyle are important factors in regulation of blood sugar and insulin.
Progesterone is the hormone that thickens and prepares the uterus for implantation. It is the dominant hormone during pregnancy. Many women have low progesterone during the luteal phase (after ovulation) due to lifestyle factors such as stress, over exercise, and excess caffeine. In most cases, this can be treated naturally by herbs such as vitex and lifestyle modifications. Practitioners can also prescribe progesterone topically, orally or in suppositories. You can test for it on day 21 if you have a regular cycle.
In recurrent miscarriage, we start looking at factors relating to immunity and blood clotting.
Immune related miscarriages can occur as a result of the bodies cells attacking a “foreign object” — in this case, the embryo. Reproductive immunology is becoming a hot topic. In the alternative medicine field we talk a lot about gut health. This is outside the scope of this article and will be addressed in another post. Some of the top fertility clinics are starting to include considerations in nutrition and lifestyle to safeguard the “microbiome” (digestive system) in order to improve immune related infertility.
Reproductive immunology is still a controversial topic (some doctors “poo poo” it and some swear by it). In practice, I have seen this approach be successful for the women who have been through everything else without success. Suffice it to say, I am a believer. A deep dive into the topic is impossible in this article because it is a complex topic involving its own subcategories such as: histocompatibility, antiphospholipid antibodies, natural killer cells, inflammatory cytokines and so on. Testing and treatment requires the attention of a doctor or group who know the topic well. Treatment options involve: intralipids, prednisone, and in some cases IVIG. Stay tuned as this topic will be further explored in subsequent posts.
Blood clotting factors can be genetic or related to hormonal or immune conditions. In essence the blood can have more of a tendency to clot, which would prevent the fetus from getting adequate blood flow. These issues, as with many others, can increase with age. Mild cases can be treated with baby aspirin, while others may involve the use of drugs such as heparin. Similar to the topic of immune related miscarriage and infertility, this is an area that is not always given a ton of attention and may be better examined with someone who is specialized in the lesser known causes of miscarriages. Interviews and info on these specialists to follow in later posts.
Structural abnormalities such as a small or oddly shaped uterus could deprive the pregnancy of adequate blood flow and nutrients, leading to miscarriage. Surgery is sometimes recommended in these cases. I had a patient who went through years of fertility treatments only to find out from a doctor on a routine scan that she had a “septate” uterus. She was referred to a surgeon who performed the operation
Another issue related to structure is an “incompetent cervix.” This occurs when the cervix shortens prematurely. This would be discovered by your doctor during a routine scan. First line of treatment is usually progesterone and rest (sometimes bedrest). If it is severe or has caused a pregnancy loss, a “cerclage” surgery may be indicated.
Other things to consider are your exposure to toxins such as environmental chemicals in your living or work space, smoking, excess alcohol or drug use. All of these may contribute to pregnancy loss. Toxic exposure (assuming you are not smoking and drinking) is even more important to consider in cases of pre-existing immune or hormonal imbalance. Toxins will greatly worsen these issues.
Throughout this article I’ve outlined the conventional approach with a tidbit here and there on how your overall health and toxic exposure can affect your reproductive health. Your own lifestyle and decisions can play a big role in the treatment of these issues. At Naturna, our goal is to provide a comprehensive education through info on the website and personalized consultation and treatment programs at our clinic. The belief in an integrative approach is central to our philosophy and we will continue to connect with the best of conventional and alternative treatments for better care. Please feel free to send feedback or requests on the topics discussed.