Recurrent Pregnancy Loss

A pregnancy loss is a devastating and heartbreaking experience with physical and emotional ramifications that are often poorly tolerated. The loss of a baby – no matter how early in pregnancy – is real, and so is the grief that comes with it. If you have ever rejoiced over a positive pregnancy test only to be coping with pregnancy loss weeks, or even months, later, you’re acutely, painfully aware of what’s happened. Regardless of whether the first sign of the loss of a baby was slight spotting or heavy bleeding, the end of pregnancy symptoms, or no sign of a heartbeat on an ultrasound, a loss during pregnancy will affect you profoundly, often leaving you feeling depressed, deeply sad, angry, confused, and alone.

Most early miscarriages aren’t random. Between 50 and 75 percent of miscarriages that take place within the first 12 to 14 weeks occur because the embryo or fetus was defective in some way. The fetus may have been unable to implant in the uterus, or implanted poorly; it may have suffered from a genetic aberration; there may have been significant chromosomal abnormalities that weren’t compatible with life. Whatever the cause, the result was that the embryo or fetus was unable to develop normally. Later miscarriages (between the end of the first trimester and week 20) are typically due to maternal health issues, PCOS, the condition of the uterus or cervix, or problems with the placenta rather than because of fetal abnormalities. It’s possible that what you and your practitioner learn from this experience can help a future pregnancy last to term.  

In clinical terms a spontaneous pregnancy loss during the first 20 weeks of pregnancy is considered a miscarriage. A miscarriage is when the embryo is expelled from the uterus before it’s able to live outside. One in five known pregnancies ends this way; however, some women suffer continuous recurrent pregnancy loss, leaving women to wonder if they will ever have a baby to call their own. 

A comprehensive work-up for pregnancy losses typically begins when two or more first trimester miscarriages, or one or more second trimester miscarriage(s), are experienced. The work-up often depends on the type (primary versus secondary; first trimester versus second trimester; chromosomal versus non-chromosomal…) and number of prior miscarriages, and usually begins with a careful history of the female and male partners. The work-up continues with a thorough investigation for specific autoimmune, anatomical, hormonal, chromosomal, infectious, thrombophilic and/or spermatogenic factors. If a specific factor is identified as a potential cause of miscarriages, a treatment protocol is customised. In the majority of cases, specialised treatments can significantly reduce a couple’s risk for another miscarriage. Even if no causative factor can be found (up to 50% of couples), empiric treatments do exist which have been shown to help. 

At Medfem Fertility Clinic we recognise the extraordinary impact recurrent pregnancy loss can have on a couple’s well being. We spare nothing as we investigate to identify potential causes for recurrent miscarriages, and employ only proven safe and effective treatment protocols to address each couple’s unique clinical situation. 

Coping With Loss

After the loss, you might be stunned or shocked. You might be asking, “Why me?” You might feel guilty that you did or didn’t do something to cause your pregnancy to end. You might feel cheated and angry. Or you might feel extremely sad as you come to terms with the baby that will never be. These emotions are all normal reactions to loss. With time, you will be able to accept the loss and move on. You will never forget your baby. But you will be able to put this chapter behind you and look forward to life ahead. To help get you through this difficult time, try some of these ideas:

• Turn to loved ones and friends for support. Share your feelings and ask for help when you need it. Friends and loved ones might not know what to say or how to help. Tell them when you need their support. If you want to talk about the baby or if you’d like help keeping the baby’s memory alive, let your friends and loved ones know how you feel.
• Talk to your partner about your loss. Keep in mind that men and women cope with loss in different ways. Don’t expect your spouse or partner to cope with grief the same way you do. One of you might want to talk about the baby and express emotions, while the other might prefer to withdraw. Be open and honest with each other as you deal with your feelings.
• Take it slow. Some days will be better than others. If you’re overwhelmed thinking about the future, focus on getting through one day at a time. 
• Take care of yourself. Eating healthy foods, keeping active, and getting enough sleep will help restore energy and well-being. Don’t turn to tobacco or alcohol to soothe your pain. Take medication only under your doctor’s guidance.
• Join a support group. A support group might help you to feel less alone. Sharing with others who’ve experienced pregnancy loss – either in person or online – can be comforting. 
• Seek help from a grief counsellor, especially if your grief doesn’t ease with time.
• Create memories of your baby. You might want to name your baby. You might also find comfort in holding a memorial service, personalizing a piece of jewellery, planting a tree or creating another memorial in your baby’s honor. 

Understand the grieving process

After a pregnancy loss, you might experience a range of emotions, including: 

• Denial. At first, it might be impossible to grasp what’s happened. You might find yourself in shock or disbelief.
• Guilt. You might wonder if you could have done anything to avoid the pregnancy loss.
• Anger. No matter what caused your loss, you might be angry at yourself, your spouse or partner, your doctor or a higher power. You might also feel angry at the unfairness of your loss.
• Depression. You might develop symptoms of depression — such as loss of interest or pleasure in normal activities, changes in eating or sleeping habits, and trouble concentrating and making decisions.
• Envy. You might intensely envy expectant parents. It might suddenly seem like babies and pregnant women are everywhere you look.
• Yearning. You might experience feelings of deep or anxious longing and desire to be with your baby. You might also imagine what you would be doing with your baby now.

Other loved ones, including the baby’s grandparents, might experience similar emotions — including anxiety, bitterness and helplessness. 

Grieving takes time. During the grieving process some emotions might pass quickly, while others linger. You might skip others completely. 

You might also experience setbacks, such as feelings of anger or guilt creeping back after you thought you had moved on. Certain situations, such as attending a baby shower or seeing a new baby might be difficult for you to face. That’s OK. Excuse yourself from potentially painful situations until you’re ready to handle them.