No Easy Answers for Recurrent Miscarriage
Heather Maloney Beth Israel Deaconess Medical Center staff
SEPTEMBER 01, 2012
It took Gretchen Siletto, 38, about seven months to get pregnant for the first time in 2002. Back then, she and her husband Joe thought that would be their biggest hurdle.
They were wrong.
In the eight years that followed, the Silettos endured a total of seven miscarriages, including the loss of that first pregnancy. But almost as devastating was the lack of diagnosis: Gretchen's doctors weren't sure why this kept happening.
"They couldn't give me a definitive diagnosis," says the Needham resident. "At the time, there wasn't a lot of information out there about my situation or why it was happening." According to the American Congress of Obstetricians and Gynecologists (ACOG), a miscarriage is the loss of a pregnancy before 20 weeks gestation, and occurs in 10 to 15 percent of all known pregnancies. When pregnancy loss occurs two or more times in a row, it may be called recurrent miscarriage.
And even with all of the medical advancements surrounding fertility, recurrent miscarriage remains somewhat of a mystery.
"In only about half of our patients will we find a cause for recurrent miscarriage," says Dr. Mary Vadnais, a maternal-fetal medicine specialist at Harvard Vanguard Medical Associates
(HVMA), an affiliate of Beth Israel Deaconess Medical Center. Dr. Vadnais practices at HVMA's Burlington, Boston (Kenmore) and Wellesley offices..
Some conditions in the mother have been linked to a greater risk of repeated miscarriage, including Lupus and other autoimmune disorders, severe kidney disease, diabetes, thyroid disease and polycystic ovary syndrome. It does not seem to be related to advanced maternal age (though the mother's age is associated with spontaneous miscarriage), and rarely is it something hereditary.
Dr. Vadnais recommends that a woman who has experienced two consecutive first-trimester miscarriages (or a late second-trimester miscarriage) see a specialist for further testing. This often includes a physical exam and blood work on both partners to look for clotting anomalies, autoimmune disease, and to evaluate endocrine function and thyroid levels, among other things.
"It's important to remember that these tests will provide answers in only about 50 percent of cases," Dr. Vadnais says. "But even if you don't get a definitive answer, most couples with recurrent miscarriage will go on to have a successful pregnancy."
In fact, according to the March of Dimes, about 60 to 70 percent of women with recurrent miscarriages will have a successful next pregnancy even without treatment.
But Dr. Vadnais stresses that knowing what is not the cause of recurrent miscarriage is crucial as well.
"This is a really important point," she says. "There is no good evidence that recurrent miscarriage is linked to exercise, intercourse, stress, cleaning products, paint, or low-level exposure to almost anything in the environment."
"What I hear most often from my patients is, 'I've been under a lot of stress lately, could that be the cause of my miscarriages?' and the answer is no," she says. "It's important for women to know it's not their fault."
Gretchen credits her doctor for providing much-needed emotional support as she struggled to have a baby. Support, she says, that is crucial.
"At our first meeting, she asked 'What do you need from me to make this process easier?'" Gretchen says. "It's so important to find a doctor that is truly sympathetic to the physical and emotional toll of your losses. Only a medical environment that understands and nurtures that disposition will allow you the strength and optimism to keep trying."
Gretchen and her husband did keep trying, and today they are the parents of three healthy girls, aged 4, 2-and-a-half, and 8 months.
"Don't give up hope," she says. "We are more grateful parents for the path that got us here. The miracle of our family is not one we take for granted!"