The Mysteries of Miscarriage

After a woman has miscarried two or more times, doctors may conduct tests of the woman and her partner (or of the miscarriage tissue) to detect chromosomal problems. They may also look for infection of the uterus. And blood tests can detect diabetes, autoimmune disease and hormone imbalance. About one in five women with recurrent miscarriage suffers from a clotting problem that can interfere with implantation; doctors can use blood thinners as treatment.
Many women who've suffered miscarriages think women should ask for a medical workup after a single loss. Darci Klein, founder of PreventPregnancyLoss.org and author of "To Full Term: A Mother's Triumph Over Miscarriage," lost three pregnancies (including a set of twins) before finding out through a blood test that she had a condition that resulted in abnormal clotting. She took a blood thinner--and delivered a healthy son. "The biggest cause of loss is that women aren't tested after suspicious miscarriage. That leaves women like me to lose pregnancy after pregnancy. Some of them stop trying." She considers factors like caffeine and cat litter "such a small part" of the miscarriage issue. "There may be a few people who cleaned a cat box every year who ended up having problems with their pregnancies," she says. "There are hundreds of thousands of women losing pregnancies to undiagnosed but treatable disorders."

Carrying twins or triplets increases the risk of miscarriage during that pregnancy. So do assisted reproductive technologies, such as in vitro fertilization. With follicle-stimulating drugs called gonadotropins, we may be pushing eggs that are sitting dormant in the ovary to mature," says Dr. Mary Stephenson, director of the recurrent pregnancy loss program at the University of Chicago's Medical Center. "In IVF, we make more than one egg a cycle. Maybe those eggs, we just should have left them alone." Prenatal testing for chromosomal disorders like Down syndrome can also causes miscarriage--one in 300 procedures for amniocentesis and one in 100 for chorionic villus sampling (CVS).

Fortunately, there's more to avoiding miscarriage than living a life of, well, avoidance. Enjoy exercise and sex, which research shows do not increase the risk of miscarriage. The usual advice for women who've miscarried is to try again. "If you keep trying, the odds are in your favor," says Minkin. Try not to give in to guilt and blame. Sadly, pregnancy loss is incredibly common--and often mysterious. Says Kaiser Permanente pernatologist David Walton: "Women should consider one miscarriage just a normal event that happens during their reproductive life."

© 2008