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Celebrities Bring Miscarriage into the Spotlight

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by Leigh Ann Woodruff, June 14, 2012

In recent weeks, there have been several celebrities opening up about miscarriage. Talk show house Bethenny Frankel, a former "Real Housewives of New York" star, talked to Glamour magazine about her miscarriage at age 41 after having a high-risk pregnancy with her daughter Bryn, now age 2. Country singer Joe Nichols' and his wife Heather also recently revealed that the couple had had five miscarriages.

Whether it is one miscarriage or five, the emotions of miscarriage are similar. Women often blame themselves. Bethenny Frankel told Glamour she asked her doctor: "'Is it because I’m busy? My lifestyle? Is this my fault?' I asked. 'Absolutely not, absolutely not,' he replied before I could dump all my neuroses on his desk. 'You’re 41. You had bleeding. There’s nothing you could have done.'"

Heather Nichols wrote in her blog, "After my first miscarriage, the doctors informed me 1 in 4 women would suffer a miscarriage and that if I got pregnant again we had every reason to believe all would be fine. After miscarriage number 2, I knew something had to be wrong." Nichols tried IVF, and she said after her fifth miscarriage she sunk into a deep depression.

Many experts believe that most women will experience a miscarriage at some time during their reproductive years. Celebrities talking about miscarriage can help women understand more and bring hope to those who have had multiple miscarriages.

What Is Miscarriage?

A miscarriage is a pregnancy that ends on its own before 20 weeks. Studies have shown that 10 to 25 percent of all clinically recognized pregnancies will end in miscarriage, so anywhere between one in four or one in five women may experience one.

Chemical pregnancies may account for 50 to 75 percent of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of her expected period. The woman may not realize that she conceived when she experiences a chemical pregnancy. A very early miscarriage — one that is lost shortly after implantation right around the time of a woman's period — is called a chemical pregnancy.

Approximately 60 percent of early miscarriages are due to a random chromosomal abnormality, such as a missing or duplicated chromosome, in the embryo, according to the American Society for Reproductive Medicine (ASRM). Age plays a role in this, as the chance of a miscarriage increases as a woman ages. After age 40, more than one-third of all pregnancies end in miscarriage, and a majority of these embryos have an abnormal number of chromosomes.

Frankel was 41, but tests after her miscarriage revealed that there were no chromosomal abnormalities, she told Glamour In the seventh week, the day after she had seen the babies heartbeat, she began really bleeding.A few weeks after her dilation and curettage (D&C), she got a call from the doctor who told her it was a "female fetus, normal." Frankel told Glamour: "And then it was simple: We were very, very sad. There was a baby there who’d had a heartbeat. She was life. She was hope. She was the future. And then she was gone."

Recurrent Miscarriage

Heather Nichols experienced five miscarriages, which is known as recurrent miscarriage or recurrent pregnancy loss (RPL). The definition of recurrent miscarriage is not always clear. According to the ASRM, recurrent pregnancy loss is defined by two or more failed clinical pregnancies (pregnancies documented by ultrasound or histopathological examination). Other entities define recurrent miscarriage as three or more consecutive failed pregnancies. ASRM recommends that after three or more losses, a couple should have a full evaluation; however, many fertility doctors recommend testing sooner rather than later.

"We would recommend a work-up after two losses and not wait for a third," says Brad Miller, M.D., with Reproductive Medicine Associates of Michigan. "There is no difference in waiting for the third loss in terms of diagnosis."

According to ASRM, less than 5 percent of women will experience two consecutive miscarriages, and only 1 percent will experience three or more. According to reports, Nichols was eventually diagnosed with two genetic blood disorders that were causing her problems.

At RMA of Michigan, Dr. Miller says tests for women who have recurrent miscarriage include a cavity evaluation such as a saline ultrasound or an HSG (hysterosalpingogram). "We will also recommended karyotype for both the husband and wife," he says. "In addition the patient would have blood drawn for lupus anticoagulant, factor V Leiden mutation, anti-thrombin 3 mutation, anticardiolipin antibody and protein C and protein S. Basically these tests are to determine if there is a clotting disorder or underlying autoimmune disease."

Six was the magic number for Nichols, who delivered a healthy baby girl at 38 weeks this past April. On her blog, she wrote: "A couple weeks later I walk into the kitchen where my husband was and said for the 6th time those two words that had brought us both so much joy only to leave us with so much pain: 'I’m pregnant!'... Before I knew it, we were told I was out of the woods and I could be happy and have reason to believe this baby would make it... "


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