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Questions and Answers About Miscarriage
A miscarriage is a devastating event, no matter where you were in the pregnancy or whether you conceived naturally or with fertility treatment. If you’ve miscarried more than once, consider seeing a specialist to try and determine the cause and whether there is treatment to help you carry a pregnancy to term.
We spoke with Dr. Alison Peck to get answers to questions about medical care following miscarriage or recurrent pregnancy loss. Peck is a fertility doctor with HRC Fertility in Encino and West Los Angeles.
Question: If I've had more than one miscarriage, should I see a reproductive endocrinologist (RE) instead of my gynecologist?
Answer: Although a gynecologist can run the same tests and do the same evaluations as the RE in patients who are suffering from recurrent pregnancy loss, often the RE is more inclined to start a complete work up after two miscarriages instead of three. By definition it is not until you have had three miscarriages that a patient falls into the diagnosis of recurrent pregnancy loss (RPL). In all honestly, it is often a costly process which may yield no discernible “cause.” But from my perspective as a reproductive endocrinologist, it is not unreasonable to start the work up sooner than later.
One of the most common causes for RPL is a genetic abnormality in the developing baby. Many generalists will not send tissue after a pregnancy loss for a genetic evaluation, while a reproductive endocrinologist may. This helps patients understand why they lost the pregnancy if the pregnancy came from a genetically abnormal embryo. That knowledge helps the physician offer treatment options for the future. For example, patients that are losing pregnancies due to genetic abnormalities may be good candidates for preimplantation genetic screening (PGS) prior to conception, a treatment which the RE can offer and provide.
Q: What type of workup will I have to indicate why I miscarried?
A: There are many potential culprits that increase the chances of a woman losing a baby: genetic, hormonal, anatomic, immunologic, thrombophilic, and sometimes infectious.
How much or little to check is somewhat controversial and the evidence of which tests are more “indicated” has changed over the years. Most would agree that the male and female partner should have a karyotype test, the uterine cavity should be evaluated, and the female should have an endocrine or hormone evaluation. Whether to do an immunologic or thrombophilic evaluation is case by case dependent. These tests are looking in the blood to see if the female is “rejecting” the pregnancy or if she has an increased risk of forming blood clots that may interfere with the baby getting the appropriate nutrients for growth through the placenta.
Q: What might my medical records indicate about my miscarriage?
A: If any of the work up has been already done, some tests will not need to be repeated. Details about the lost pregnancies, such as at what moment in pregnancy it was lost or if there was a heartbeat can help point to a reason, limit the work up, or possibly offer preventive measures for the future.
Q: What are helpful questions I should ask my doctor?
A: Ask your doctor the following:
- Should I be seeing a high risk pregnancy consultant once I conceive to monitor me past the first trimester?
- Is there anything you can do to help prevent another loss? (Be prepared, sometimes the answer is no. But in 40 percent of cases there is a reason and that knowledge may prevent a future miscarriage.
If you need help finding a fertility doctor who specializes in miscarriage or recurrent pregnancy loss contact our Patient Care Advocates at 855-955-2229.