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Coping with a Miscarriage

According to the American College of Obstetricians and Gynecologists (ACOG), about 15 to 20 percent of pregnancies end in miscarriage. For couples this can be a devastating event. Dealing with a miscarriage can cause a roller coaster of emotions, doubt, and discouragement on your ability to conceive.

Listen in as Dr. Alan Martinez shares resources to help couples cope with a miscarriage, the recovery process, and that there are options for couples who want to try to conceive again.
Coping with a Miscarriage
Featured Speaker:
Alan Martinez, MD
Dr. Alan Martinez is a specialist in reproductive endocrinology and infertility. He was drawn to this specialty because it is an ever-evolving field of medicine that allows him to partner with patients and provide personalized treatment plans. He also appreciates that the field is filled with the latest laboratory technology, which continues to advance success rates.

After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.

Learn more about Dr. Alan Martinez
Transcription:

Melanie Cole (Host): According to the American College of Obstetricians and Gynecologists, about 15% to 20% of pregnancies end in miscarriage. For couples, this can be a devastating event. My guest today is Dr. Alan Martinez. He's a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Dr. Martinez, explain to the listeners what a miscarriage actually is.

Dr. Alan Martinez, MD (Guest): So there are several types of miscarriages, and one of them is- it is essentially when egg and sperm get together, they make an embryo, and that embryo tries to implant or establish a home environment in the uterus. And so miscarriages can be as early as a missed period with a low level of positive pregnancy hormones, or it can be later on in pregnancy, past the first trimester which is greater than twelve weeks. So there's early miscarriages that are just of a laboratory nature, there's clinically recognized miscarriages where you have done an ultrasound, you've proven that the pregnancy is in the uterus, and there's evidence of a pregnancy. And then there are miscarriages that even happen up to the time period of like the second trimester and well into the middle of the pregnancy.

Melanie: Is this a pretty common occurrence? Because we've heard women talk and say, "Oh, I had a miscarriage." Or, "Oh I had a few miscarriages but went on to have wonderful babies." Is this pretty common? What do you tell women about the chances of this happening?

Dr. Martinez: Yeah so miscarriage, it's a common part of trying to conceive and start a family. The lowest rates of miscarriage kind of start out in the 10% to 15%, and usually that's in healthy male and female couples with no problems that are really kind of less than thirty-two or thirty-three years of age. And then as the woman ages, or as other medical problems are introduced into the picture, that rate can go up. So the maternal age is specifically a major risk factor for miscarriages, and that is just baseline.

So I'd say like a thirty-five year old has probably 15% to 20% chance of a miscarriage. A forty year old probably has 30% to 35%. A forty-three year old can have 50% chance of a miscarriage. So you can see that the medical condition of individual patients themselves as well as their age is a predictor of miscarriage, but miscarriage is quite common and many women will experience a miscarriage and they'll go on to have several live births after their initial experience.

Melanie: Do we know the reason that they happen? You mentioned age as one of them. Is there a genetic predisposition? Do we know any of those? Because some women get nervous in the first trimester to exercise too hard, or to- these kinds of things. Do we know causes?

Dr. Martinez: There are identified causes. So the identified causes can potentially be either inherited or genetic conditions of the patients themselves through laboratory testing with blood that are associated with pregnancy loss or recurring miscarriages, and that is a major concern. You can have an intermittent spontaneous miscarriage, but if you have two or three in a row, then really further testing needs to be done.

And so there can also be structural things within the uterus. Women- everybody knows about fibroids that are in the uterus. Well if they're lining the inside of the uterus where the baby implants, then it can directly affect them getting and staying pregnant, as well as uterine polyps which is like an overgrowth tissue inside of the uterus, as well as other things like previous surgeries on the uterus, like removal of fibroids, C-section, miscarriages with what we call D&E. Having any sort of surgery on the uterus itself can directly affect the miscarriage rate. And then we even have some evidence that from a genetics perspective, the sperm source, the partner can have conditions that can predispose individuals to having miscarriages as well. So there are several sources.

Melanie: So then let's talk if a woman has had a miscarriage it can be devastating, as I said in the intro, and they're looking at this as something that could make them infertile, or loss of hope. Dr. Martinez, how do you work with couples who have experienced miscarriage, and what do you tell them about the next steps, when they can try again and hope for the future?

Dr. Martinez: So I sit them down and I say, "Listen, if you've had an isolated miscarriage, especially before twelve weeks early in the pregnancy," I say, "In the end you really don't have to worry about that too much. Spontaneous miscarriage exists, and oftentimes there's no identifiable cause." We know that early on, the losses that happen in the earlier part of pregnancy, about 50% to 90% of them can be to chromosomal issues, and those are often spontaneous of just egg and sperm getting together, combining to make an embryo, and it's not the healthiest of embryos. So the way I describe it to my patients, and I've found that this is really the best way, is to say, "Your body has checks and balances, and at the end of the day, if egg and sperm get together and they don't make a healthy baby, then the body sometimes rejects that. So it's the way the body is ensuring that people have a healthy pregnancy overall."

And so once I get past that, then my conversation shifts into evaluate things. "Okay, well what are the extents of that miscarriage? When did it happen? Did you have an ultrasound with your OB/GYN? Did they see evidence of the fetus? Did they see a heartbeat? No heartbeat?" So there's many different points where the pregnancies can fail early on, and then we'll transition into talking about the testing. So we always prefer to get a uterus test that's called a saline sonohysterogram or part of a hysterosalpingogram, which is an x-ray procedure, and we can actually look at the inside of the uterus itself to make sure that structurally that environment should be hospitable to an embryo. And then we can in some cases of recurring miscarriages and other conditions that may affect the ability to get pregnant or stay pregnant, we may do some additional blood tests, and we may evaluate for genetic causes or immune system causes.

So I tell my patients to just kind of take a step back, realize that this is a natural occurrence, to identify if there's any sort of a pattern and then sequentially go through the steps to figure out the cause.

Melanie: And what about the emotional aspect of this? You know, what do you tell them, and how do you get couples to feel that hope again? Because it can be devastating, and that devastation can last for a very long time.

Dr. Martinez: Yes, much of the counseling that I have with these patients is just reassurance, and getting them to understand why miscarriages occur, to get them to understand their body, how old they are, their medical conditions, and how they may contribute to miscarriage. And I reassure them that we're going to do a lot of fertility tests, and we're going to figure out about your body, and we're going to maximize your chances of getting pregnant. And in most of the reproductive endocrinology practices such as ours, we watch things very carefully. So if a period is missed, instead of just saying, "Oh you might be pregnant," maybe you could check in with my office at seven or eight weeks and we can do an ultrasound. We will be more involved in that. We can check some hormone levels like progesterone and make sure that those are good earlier in pregnancy, we can follow the laboratory values of the pregnancy value, and see the trend, and make sure that, "Okay these numbers are going up nicely. It looks like you have what's a good early pregnancy."

So we get very involved. We let the patients know to stay happy, stay healthy, have all the right lifestyle habits, but also believe in the process, and then we can often minimize their stress that way. And these tests, knowledge is power, and that's what they get from all these tests. They get answers in many cases or they get reassurance that they're not alone, and then we help them navigate that process.

Melanie: Dr. Martinez, as you wrap this up for us, it's really great information. When does somebody come to see a fertility specialist? If they were just having a normal pregnancy with a normal obstetrician gynecologist and they have a miscarriage, when is it that they would come to see a fertility specialist as opposed to just trying to get pregnant again or going back with their OB/GYN?

Dr. Martinez: Well like I said earlier, an isolated miscarriage is probably not of concern, especially if it's in the first trimester. If you get to later, second trimester or third trimester losses or miscarriages, then that is a more concerning thing, or repetitive miscarriages like two miscarriages in a row, three, you definitely should probably get some additional evaluation. And most of the OB/GYNs that are out there, they will usually recommend that you see a fertility specialist such as our practice at that point in time. However, some of the patients come to us right away after a miscarriage because they can be devastating, and I think that there's nothing wrong with initially sitting down and having a consultation, and you can learn a lot about your body, you can learn a lot about the likelihood of miscarriages surrounding your particular patient case, and that oftentimes alleviates a lot of the worry. And then some patients go and they try on their own and they do fine, and others then proceed into some fertility treatment. But there's a lot we can do, there's no right or wrong time, it's just what's right for the individual patient.

Melanie: Thank you so much, Dr. Martinez, for sharing your expertise with us today on this very sensitive topic. Thank you again. This is Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information, please visit www.FertilityNJ.com. That's www.FertilityNJ.com. This is Melanie Cole, thanks so much for tuning in.