Why Loss Happens

Researchers believe between 2.3 million and 5.4 million pregnancies are lost every year. Medical explanations could often be found, but because testing is so infrequent, most losses remain unexplained.

Infrequent Testing Means More Losses

One of the most common contributors to miscarriage is the lack of testing. Standard ACOG guidelines say that women should suffer multiple miscarriages before any testing is done. That means that women with treatable conditions are not tested after a single loss. They’re often not tested until three or four losses. With earlier testing, losses could be prevented.

img_stethWhy are medical guidelines so lax about miscarriage? It could be because they’re based on old studies that couldn’t reliably detect early pregnancy losses, so the results underreported these preclinical losses. It could also be the lack of research dollars.

The National Institutes of Health spends very little toward treatments to prevent miscarriage. For a condition that strikes over two million women every year, miscarriage is among the least funded conditions on a per capita basis. This means that rigorous studies that could result in new treatments aren’t completed. Obstetric care guidelines used to look for a cause of loss aren’t updated. And many couples endure the devastation of repeated loss unnecessarily.

Medical Causes of Loss

The most common cause of early loss is chromosome abnormalities, but this accounts for only half of all losses. The only way to be sure whether bad chromosomes caused your loss is to test the lost miscarriage. This basic test provides real information about the need for further testing. When chromosomes are found to be normal , over 60% of these patients have a medical cause for their miscarriage.4 But will their doctor find it?

Beyond Chromosome Abnormalities

When testing confirms abnormal chromosomes in a miscarriage, doctors consider the loss “explained,” meaning that the likely cause of loss was found. But should you consider further testing if you’ve experienced multiple losses?

img_testingDoctors disagree on this question. Multiple miscarriages can be caused by nothing more than bad chromosomes. However, miscarriages sometimes have several causes. Patients who lose a chromosomally abnormal pregnancy may also have an underlying medical disorder that contributed to their loss. Some patients- especially after multiple miscarriages- pursue further testing.

If you decide that more testing is needed, know that the depth of testing varies from doctor to doctor. One doctor may recommend just three tests. Another doctor might suggest ten. It’s critical to know exactly which tests you’re getting.

The “Standard” Evaluation

The standard evaluation for losses before 15 weeks includes three tests to look for a cause of loss. These three tests are important, but they’re often not enough. After this narrow band of tests, 50-75% of couples will still have no answers.5

ACOG’s suggested evaluation includes

  • Lupus anticoagulant and anticardiolipin antibodies to test for antiphospholipid syndrome
  • Parental balanced chromosome abnormalities. Please note that this is different from fetal chromosome abnormalities, thought to cause half of all losses.
  • Evaluation for uterine abnormalities

Beyond The Standard Evaluation

Many obstetricians expand the standard evaluation to include other tests. The following three additional evaluations are completed among many mainstream doctors.

  • Prolactin levels to test for luteal phase defect
  • TSH to evaluate thyroid function
  • Factor V Leiden mutation6

Other factors are thought to cause miscarriage. Some mainstream physicians do not test for these disorders because research is considered inconsistent, and treatments are controversial. The willingness to perform these evaluations varies by physician.

  • Polycystic Ovarian Syndrome
  • Bacterial infections
  • Viruses
  • Other uterine abnormalities including cervical incompetence
  • Inherited thrombophilias beyond Factor V Leiden
  • Reproductive immunology disorders

Note that the tests discussed refer to pregnancies lost before fifteen weeks gestation. While these evaluations are relevant for losses that occurred later, additional factors, such as cervical incompetence and others, should be considered when diagnosing losses after fifteen weeks.

A Final Consideration: Share Your Family Loss History

When undergoing any loss evaluation, it’s important to tell your obstetrician about your family’s history of pregnancy loss. When a woman’s close relative has endured multiple miscarriages, especially if the losses were late, this could suggest inheritable conditions, such as some thrombophilias. Inform your doctor about your family history of pregnancy loss.