Miscarriage is common. So common that, according to the National Center for Biotechnology Information, "it is estimated that as many as 26% of all pregnancies end in miscarriage and up to 10% of clinically recognized pregnancies." Yet, even as they’re common, many women going through them and their doctors still don’t always know what to do when one happens.
Unfortunately, the standard response in the medical world after one or even two miscarriages is to advise women to try again, assuming that the next pregnancy will work out. Statistically, this is likely: according to the Mayo Clinic, miscarriage is usually a one-time occurrence. After having one miscarriage the odds of having another are 20 percent—the same for every pregnancy. After having two miscarriages, the odds of another loss increase to 28 percent, and after three, to 43 percent.
Only 1 percent of women will experience recurrent pregnancy loss. But if you’re in this 1 percent, or you’ve had two or more losses and are unsure of what could happen next, it’s natural to want more answers and more understanding of anything you could do, no matter how small, to prevent another pregnancy loss. Yet most doctors won’t really begin to investigate the potential underlying causes of miscarriage until three losses have happened.
We don’t know what we don’t know
If you’ve had miscarriages, getting answers begins with asking the right questions. Sometimes it involves a second opinion, or it could require finding a new doctor. As patients, we are consumers in the medical world. Many of us tend to feel that doctors have the final say, but you are the one living your life and dealing with the daily personal and emotional ramifications of health challenges, including pregnancy loss. If you don’t feel like everything is being done to help you, you get to make the choice to find someone else.
But knowing where to start, especially after pregnancy loss, can feel overwhelming. When you’re reeling from the loss of a baby it’s often hard to be organized and investigative, which is why many women don’t end up pushing for better care, more answers, or different doctors. The subject is so uniquely painful and mixed with complicated grief that it’s hard to view it as a medical issue that needs solving.
And yet, for most women, that’s exactly what it is. While 50 percent of miscarriages are due to random chromosome errors that no medical care could prevent, the other half are unknown. Beyond chromosome reasons, miscarriage can happen because of uterine issues, immune system problems, sperm problems, egg problems, clotting disorders, genetic mutations, autoimmune disease, thyroid problems, hormone imbalances, infections, and so on. Investigating all these factors can seem like an insurmountable task. But a doctor familiar with your health history should be able to pinpoint one or two key areas to start with, and often, these lead to likely answers, usually with at least something that you can change before trying to conceive again.
As someone who has had 16 losses, I can tell you that many times, I needed to feel in control by having something to address before trying again—something that gave me hope that this time would be different. That wasn’t always the case for me, as some of my losses were documented chromosome errors and couldn’t have been prevented no matter what I did. But after other losses, I was empowered to hope again by being given something to do, changes to make whether small or big or both.
If you don’t know where to start but want to advocate for more answers when it comes to your miscarriages, these might be the best questions to ask your doctor, a second opinion, or a new physician altogether:
- Are there any aspects of my health history that increase my risk for miscarriage? (Age, family history of miscarriage, infertility, thyroid disease, clotting disorders or blood clots, endometriosis, fibroids, autoimmune disorders, and so on.)
- Are any of my current medications increasing my risk for miscarriage, even if slightly?
- Are there any medications, supplements, or other protocols that I can try to increase my chance of a successful pregnancy next time?
- What tests should we run to rule out underlying causes for a loss?
Your doctor’s answers to these questions will give you a clue as to whether or not they’re invested in helping you solve this mystery, even if the investigation leads to no definitive conclusions. If they brush off your health history, don’t thoroughly examine your prescriptions, and won’t consider other options for testing and medications, then you’re not in the hands of a proactive physician. I know that many doctors are wary of less proven methods (like prescribing heparin or blood thinners for recurrent losses) for bringing about successful pregnancies, and they’re just going by research and statistics.
However, when I was faced with a doctor who didn’t want to try something less common, even though its efficacy was supported by smaller scale research, I knew I needed to find someone else. While I’ve still had losses since, that new doctor ultimately led me to a protocol that helped me have my two sons.
Addressing fertility issues and underlying challenges associated with recurrent pregnancy loss can feel like searching for a needle in a haystack but in the entire galaxy instead of just a haystack. Searching for that one answer can feel like a losing battle, but you shouldn’t have to feel alone. Having a doctor who will fight for you, and who you feel is personally invested in your pregnancy outcome, is half the battle. The rest is tenacity and a willingness to keep asking questions and to keep hope alive. There are no guarantees in the world of pregnancy loss. But as you quickly come to know when you’ve lost a little life inside of you, no two pregnancies are the same. I could always find hope anew when I was able to dig deeper, get more answers, and know that I had done everything within my power to give the next pregnancy the best possible shot at making it.
Editors' note: Do you want more Verily in your life? Join us at Verily Yours. Verily Yours subscriptions give you exclusive content, while also supporting our publication, including our efforts to develop a print magazine.