The Science of Making Babies

• Early Pregnancy Loss/Miscarriage
• Early Pregnancy Loss-Introduction
• Diagnosis and treatment of miscarriage
• Possible causes of recurrent miscarriage
• Ectopic Pregnancy
• Molar Pregnancy

POTENTIAL CAUSES OF RECURRENT MISCARRIAGE
Recurrent miscarriage can happen because of any of many possible reasons.

Lifestyle Factors
We’ve all heard about the dangers of tobacco, alcohol, and street drugs. They just aren’t part of a healthy lifestyle. This is especially true as you try to conceive and also during your pregnancy. If you smoke during pregnancy, you are more likely to experience vaginal bleeding and miscarriage. Women who drink excessive alcohol or engage in illicit drug use have a defi nite increased risk of miscarriage.
If you participate in these activities, especially during pregnancy, stop doing so. It’s not always easy to discontinue these activities on your own. Please speak with your doctor about a safe program that is tailor-made with your issues in mind.

Chromosomal Problems
Medical experts believe that the majority of all miscarriages are caused by chromosomal problems within the fetus. Chromosomes are tiny structures within the cells of the body that contain genes. These genes are what determine a person’s characteristics, such as sex, hair color, eye color, blood type, and so on. Both egg and sperm contain vast amounts of this genetic material. When the egg and sperm unite, a detailed series of intricate and complex steps must occur for them to form a fetus. When you stop to consider the elaborate series of events that must ensue with absolute perfection, it’s not surprising that accidents and mistakes can happen and result in an abnormal fetus. In most cases, the abnormality is severe and not compatible with life. Therefore, when the miscarriage occurs, many people see it as nature’s way of ending a pregnancy that would not have survived. Even so, it is still usually a very sad and emotional event.

Low Progesterone Level
The relationship between hormonal imbalance and miscarriages is uncertain. However, many medical experts believe that low progesterone levels during early pregnancy can lead to miscarriage.
To better understand this, you should know how progesterone works. When you ovulate, your ovary releases an egg. That egg was originally held within a follicle. The follicle becomes empty at the time of ovulation. The empty follicle is called your corpus luteum. Under normal circumstances, after ovulation, your corpus luteum begins to secrete progesterone. If no pregnancy occurs, the corpus luteum fades away and is absorbed by the body, and your menstrual period will come as usual. However, if a pregnancy happens, the corpus luteum serves as a temporary supplier of progesterone. That’s important for the pregnancy because progesterone thickens the lining of the uterus to support and nourish the fertilized egg.
When progesterone levels are too low, the fertilized egg may have diffi culty implanting itself within the uterine wall. In other cases, the fertilized egg may implant but the pregnancy cannot be properly supported because of low progesterone levels. In either case, bleeding and early miscarriage may result.

Abnormalities of the Uterus

In some situations, you could be experiencing recurrent miscarriage because of abnormal anatomy within your own uterus or cervix. Medical research estimates that this occurs in approximately one in 700 women. If you do have an abnormally shaped uterus or cervix, chances are it happened during your own fetal development. Perhaps you were unaware of this condition until you tried to have a baby of your own. Having an abnormal uterus or cervix does not mean that you can’t have children, but it may increase the odds of you having a miscarriage.

Several problems of the uterus have been linked to recurrent miscarriage, including the following:
• Septate uterus
• Uterine fi broids
• Incompetent cervix
• Endometrial polyps

A septate uterus is a rare abnormality that means your uterus is divided into two sections by a wall of tissue. This happened during your own fetal development. The two uterine cavities are abnormally shaped and smaller and are thus less capable of carrying a full-term pregnancy. Therefore, miscarriages and preterm birth are more likely with a septate uterus.

Fibroids are another potential structural problem of the uterus. Uterine fi broids are benign muscular bulges of tissue that grow within the uterine wall. It’s certainly possible to have uterine fi broids and enjoy a completely normal pregnancy. However, sometimes these growths make it diffi cult for the egg to securely implant itself within the uterine lining. In such a case, an early miscarriage is likely. Uterine fibroids typically run in families.

An incompetent cervix is a condition where your cervix widens and opens too soon and loses the pregnancy. Incompetent cervix usually results in a somewhat later pregnancy loss, typically during your second trimester. That’s when the pregnancy has grown a suffi cient amount and the weight is too much for the weakened cervix to hold. Incompetent cervix could be a condition that you were born with, but most likely it is the consequence of a past surgery to your cervix.

Endometrial polyps are (usually benign) growths of fl eshy tissue that protrude from the lining inside of your uterus. They may cause no symptoms. However, somewomen experience abnormal bleeding. If they become large or if multiple polyps exist, they may interfere with your ability to conceive or increase your risk of miscarriage.

Abnormalities of the uterus and cervix are sometimes detected before your pregnancy. However, regrettably, they are usually discovered during an evaluation after you’ve already suffered recurrent miscarriages. If your doctor suspects abnormal anatomy of your uterus, you will most likely undergo a hysterosalpingogram (HSG) for diagnosis. This is an x-ray test that involves injecting a dye into the uterus through the vagina. Your reproductive tract will be highlighted on the x-ray, and a diagnosis can usually be made. The diagnosis for incompetent cervix is more difficult. Usually, a prior history of second-trimester pregnancy loss is required.