Patients prone to miscarriage should know there are many ways to help mitigate risk and go on to a successful pregnancy. While In Vitro Fertilization (IVF) treatment and genetic screening offer safer routes to pregnancy, diagnostic testing, exploratory procedures, medications, lifestyle factors and advanced treatments and protocols also play a major role in mitigating risk of miscarriage.
Here, in addition to offering solutions and hope, we share some important facts about miscarriage, which is more common than people think. If you have questions, one of RMA’s experienced and knowledgeable physicians would be happy to meet with you to provide answers. You may make an appointment at any of our 19 locations across the country.
According to the American Society for Reproductive Medicine, 1 in 4 women suffer miscarriage, and those are usually a result of chromosomal abnormalities in the embryo.
Recurrent pregnancy loss (RPL) however, defined as two or more miscarriages, is significantly less common, occurring in approximately 5% of women. Three or more miscarriages occur in less than 1% of women.
Mitigating Risk of Miscarriage
The age of a patient correlates with risk of miscarriage since poor egg quality—which increases with age—can lead to problems with implantation or an ongoing pregnancy.
Unlike males who are always making new sperm, females are born with all the eggs they will ever have in a lifetime, usually between 1 and 2 million. But as a woman ages, both the number and quality of her eggs decrease and, by age 35, her fertility begins to drastically decrease. And while ovarian reserve testing can help determine the approximate number of eggs a woman has available at any given stage of life, little can be done to improve egg quality.
The only way to know whether an egg is chromosomally normal is to fertilize it and then do genetic testing on the resulting embryo.
Because genetic abnormalities in the embryo are the most common cause of miscarriage, genetic screening is an extremely helpful tool. In 2013, RMA developed and validated a groundbreaking embryo screening technology called CCS.
Our newest platform, NexCCS, allows doctors to screen for chromosomal problems and identify the healthiest embryo for implantation with a high degree of accuracy.
This qualifying technology, coupled with RMA’s standard of care, which is Frozen Embryo Transfer (FET) and Single Embryo Transfer (SET), not only mitigates risk of miscarriage but increases chances for a successful pregnancy.
Fertility care offers additional benefits since tests prior to treatment can determine whether a patient is at risk for miscarriage and, if so, what the contributing factors might be.
In many cases, RMA fertility specialists can either resolve related issues or work around them in order to optimize chances for an ongoing pregnancy and live birth. The close supervision and monitoring that comes with fertility care also helps mitigate risk.
Here are other ways patients concerned about miscarriage can find assurance before attempting pregnancy naturally or with IVF.
Hormones affect every stage of pregnancy. This is why blood tests are so important before trying to get pregnant. Test results help identify any imbalances or areas of concern, many of which can be treated in advance.
Blood tests will also check for any infections in the body that may harm the baby or increase risk of miscarriage. At RMA, fertility specialists assess an IVF patient’s overall health and possible risk factors before building a treatment plan around her unique profile, with the health of mother and baby at the center of care.
Medications During Pregnancy
IVF patients tend to pay more attention to their medication schedule while trying to get pregnant. But in some cases, patients may be prescribed certain medications during pregnancy.
For example, a healthy progesterone level is key to keeping a pregnancy going. If levels are low, doctors will prescribe progesterone medication, which can be taken orally or vaginally. Testing during pregnancy to make sure all hormone levels are normal is important.
If medications are prescribed, patients must take them on time and without skipping a dose, until they are weaned off them, usually by week 12. Creating a calendar in advance is helpful.
Avoiding Physical and Emotional Stress
This may seem obvious, but some patients may be tempted to continue their routine activities after becoming pregnant. To optimize chances for a successful pregnancy, would-be moms should keep stress levels down and activity levels light, opting for low impact workouts at the gym and more relaxation time, including meditation and yoga if schedules allow.
And of course, a healthy lifestyle prior to pregnancy – one that includes good eating habits, exercise and eliminates alcohol, smoking, and stress – offers added insurance.
If a patient has known issues within the cervix or uterus, such as endometriosis or uterine fibroids, or previous surgeries that may have left scars, a hysteroscopy can help doctors determine if conditions are optimal for pregnancy.
This simple, outpatient procedure allows doctors to look for blockages and inflammation that may prevent pregnancy or lead to miscarriage. During this procedure, doctors can also take samples that can be tested for other possible risk factors.
If identified, many issues can be addressed with medication or minor procedures prior to attempting pregnancy. This added step can go a long way toward mitigating miscarriage risk.
If a woman’s cervix has been damaged as a result of a previous pregnancy or surgery, it can be more prone to miscarriage.
Patients should ask their specialist to assess any risk factor. Sometimes a cervical stitch is all that is needed. Doctors should also make sure the womb is not abnormally-shaped as that too can increase miscarriage risk.
“One miscarriage is completely devastating. When it happens more than once, it can be unbearable,” said Dr. Temeka Zore, fertility specialist at RMA’s Los Angeles clinic. “While the cause of early miscarriages is usually due to chromosomal abnormalities, there are other causes that need to be assessed in recurrent pregnancy losses.”
RMA fertility specialists recommend women with recurrent miscarriages have specialized tests done to try to determine the cause and offer treatment.
In addition to a uterine cavity evaluation, testing for antiphospholipid antibody syndrome (an immune disorder associated with an increased risk of blood clots and pregnancy loss) would be done, along with basic endocrine testing to rule out diseases like Type 2 diabetes and thyroid or prolactin abnormalities.
Additionally, women and their partners are offered karyotype testing to assess whether either of them carries a chromosomal abnormality, such as a balanced translocation, that may increase their chance of miscarriage.
“We’re also focusing on the immune systems in women with RPL to determine whether immunological imbalances may be leading to losses,” added Dr. Zore.
Improving Pregnancy Outcomes
Ongoing advancements in the field of reproductive medicine—many of which have been driven by pioneering research conducted at RMA—have improved the accuracy and safety of genetic testing, diagnostic tools and treatments, resulting in improved pregnancy outcomes.
At this year’s annual American Society for Reproductive Medicine (ASRM) conference, attended by over 90 RMA doctors from around the world, RMA saw unprecedented success with 68 scientific abstracts accepted for presentation, 28 of which were selected as orals.
In addition to receiving several awards, IVIRMA Global won the top honor of the event: the prize paper for its research into extended embryo culture and the origins of aneuploidy.
Such RMA-driven research and resulting technologies, combined with the opportunity for closer supervision, are the primary benefits of IVF treatments at RMA for patients who want to mitigate miscarriage risk and increase chances for a successful pregnancy.
Learn more about how you can improve your fertility with some simple lifestyle changes.