Ask the Doctor: 10 Questions About Miscarriage

In honor of Pregnancy Loss Awareness Day on October 15th, we asked Dr. John Rapisarda, Director of the Recurrent Pregnancy Loss Center, the 10 most common questions he hears about miscarriage:

Q: How common is miscarriage?

A: Up to 50% of pregnancies will end in miscarriage, but half of these occur before a woman misses a period or is even aware of a pregnancy. These early miscarriages are called chemical pregnancies. Roughly one in four recognized pregnancies end in miscarriage with over 80% of miscarriages occurring within the first three months. The good news is that the next pregnancy is successful in 60-80% of those with unexplained pregnancy loss. Some additional comforting statistics - less than 5% of women will experience two consecutive pregnancy losses, and only 1% experience three or more.

Q: At what point in the pregnancy am I “safe” from a miscarriage?

A: Miscarriage, which is defined as a pregnancy that ends within the first 20 weeks of gestation, most commonly occurs before 13 weeks. The chances of miscarriage can range based on a variety of factors (age, multiple or single pregnancy) but with all pregnancies the chances of miscarriage decrease as the pregnancy progresses, particularly after eight weeks. After 13 weeks the chance of miscarriage can range from 3-5% for a singleton pregnancy in a woman of childbearing age. At this point, pregnancies are usually “in the clear.”

Q: How do I know if I am having a miscarriage?

A: The most common symptoms of miscarriage are cramping, bleeding, and abdominal pain. Additional symptoms can include fever, weakness and back pain.

Q: If I have a miscarriage, when should I see a doctor?

A: If you are experiencing a miscarriage for the first time, be kind to yourself and be sure your partner provides support for this sad time. Take time to heal emotionally and physically, and seeking the help of a fertility counselor can help you move through your grief. We advise that couples seek the expertise of a fertility specialist if they have experienced more than one miscarriage or if advanced maternal age is a factor.

Q: Is there something I could have done to prevent a miscarriage?

A: In short, no. Miscarriage is not your fault. The cause of miscarriage is rarely diagnosed, so it is best not to ponder on this question. It is important to remember how common miscarriage is and refrain from placing blame.

Q: What is the most common cause of miscarriage?

A: The most common cause for miscarriage is a genetic or chromosomal problem with the embryo. Many early miscarriages occur because the fetus has an extra or missing chromosome. These chromosomal abnormalities are a result of random errors that occur as the egg or sperm matures in the body prior to fertilization. This type of loss can happen at any age, and incidences occur more commonly as women get older.

Q: What are other causes of miscarriage?

A: Other causes of miscarriage include abnormalities in the shape of the uterus, fibroids in or near the uterine cavity, hormonal abnormalities, infection, Antiphospholipid Syndrome, immune system disturbances and untreated medical issues such as diabetes and thyroid disease. Lifestyle factors such as excessive tobacco, alcohol and caffeine use as well as drug use and excessive weight can contribute to the chance of miscarriage. With all of these factors at play, it is important to keep in mind that for more than half of all miscarriages there is no diagnosable cause.

Q: Are some women more at risk for miscarriage?

A: Those at higher risk for miscarriage are women over the age of 35, women who have experienced three or more miscarriages, couples with certain genetic issues and those experiencing any of the additional causes listed above.

Q: When can we start trying again?

A: After you have experienced a miscarriage, it is best to wait one to three menstrual cycles before trying again. If you have experienced more than one miscarriage, it is best to speak with a fertility specialist. A progesterone supplement, which helps an embryo implant in the uterus and provides early support during a pregnancy, may be prescribed.

Q: What treatment options are available for recurrent pregnancy loss?

A: Treatment options can vary based upon the diagnosis of pregnancy loss. For those with genetic carrier issues or immunological issues, IVF and genetic screening of embryos (known as preimplanation genetic screening) prior to embryo transfer may be recommended. If an infection, thyroid issue, hormone imbalance or other medical problem is discovered, treatment will be advised for that specific diagnosis prior to moving forward with fertility treatment.

Minor surgical interventions may be required to remove fibroids, cysts or scar tissue. Making lifestyle changes such as quitting smoking, limiting alcohol and caffeine intake and adopting a nutritious diet and regular low-impact exercise is also advised. For those with poor ovarian reserve resulting in genetic abnormalities with embryo development, donor egg may be advised.