Infertility, Miscarriage & IVF Treatment

Infertility, miscarriage, and the emotional toll of recurrent pregnancy loss are challenges faced by many individuals and couples on the journey to parenthood. October is Pregnancy and Infant Loss Awareness Month, a time to shed light on these issues and provide education and understanding. Dr. Lauren Murphy, a reproductive endocrinologist at Boston IVF, recently shared valuable insights about miscarriage, recurrent pregnancy loss, and the role of IVF in overcoming these difficulties.

Miscarriage: More Common Than We Think
Miscarriage is surprisingly common, affecting up to 1 in 4 pregnancies. Despite this, many miscarriages, especially early ones, may go undocumented as they often occur before an individual is even aware of being pregnant. Dr. Murphy explains that miscarriage can happen at any point in a pregnancy and includes both biochemical losses (early losses before anything is visible on an ultrasound) and clinical losses (those that occur after a pregnancy has been seen on ultrasound, usually after six weeks).

Biochemical pregnancy losses often manifest as a positive pregnancy test followed by a period, while clinical miscarriages involve visible pregnancy loss on ultrasound. Though these losses may feel different from a medical standpoint, every loss is significant for the patient and can be emotionally painful.

Causes of Miscarriage: Chromosomal Abnormalities
One of the leading causes of miscarriage is chromosomal abnormalities, or aneuploidy, where an embryo has too many or too few chromosomes. This is particularly common as an individual's age increases. Dr. Murphy points out that the quality of a person's eggs declines over time. In their 20s, an individual with ovaries may have about 75% chromosomally normal eggs, but by their 40s, the percentage drops significantly, making miscarriage more likely.

The longer eggs remain in the ovaries before ovulation, the greater the chance of chromosomal issues, which can lead to miscarriage. Although chromosomal abnormalities can happen at any age, they occur more frequently in people over 35. Despite these odds, many individuals and couples can still conceive healthy pregnancies with the right medical interventions.

Other Potential Causes of Pregnancy Loss
While chromosomal abnormalities account for most miscarriages, other causes may be at play, especially in cases of recurrent pregnancy loss (RPL). Dr. Murphy outlines several other potential factors:

✓ Thyroid Dysfunction: Elevated thyroid levels can affect early pregnancy and increase the risk of miscarriage.

✓ Glucose and Insulin Resistance: Poor blood sugar control, especially in patients with diabetes, may contribute to pregnancy loss.

✓ Structural Issues in the Uterus: Uterine abnormalities, such as fibroids, polyps, or blocked Fallopian tubes, can prevent a pregnancy from implanting properly or continuing to develop.

✓ Genetic Factors: A couple may carry chromosomal rearrangements, increasing the risk of abnormal embryos.

✓ Autoimmune Disorders: Certain conditions, like antiphospholipid syndrome, may cause micro-clots that disrupt pregnancy.

When Should You Seek a Fertility Specialist?
If you’ve experienced two or more clinical miscarriages, or multiple biochemical losses, it may be time to seek help from a fertility specialist like those at Boston IVF. Evaluating for recurrent pregnancy loss involves testing various systems, including hormone levels, blood sugar, uterine structure, and genetic factors. 

Dr. Murphy emphasizes that each case is unique, and the right treatment plan will depend on the specific cause of the losses. However, IVF (in vitro fertilization) with genetic testing is often a highly effective option for addressing chromosomal abnormalities. This allows the medical team to select only chromosomally normal embryos for transfer, increasing the chances of a successful pregnancy.

Treatment Options for Recurrent Pregnancy Loss
For those facing recurrent losses, treatment often focuses on addressing the underlying issues:

✓ Hormonal Imbalances: Conditions like hypothyroidism can be treated with medications like levothyroxine to bring thyroid levels into the normal range.

✓ Blood Sugar Control: Managing blood sugar through diet, medication, or insulin can improve pregnancy outcomes.

✓ Surgical Correction: Uterine abnormalities, such as fibroids or polyps, may require surgery to improve the chances of a successful pregnancy.

✓ Genetic Testing and IVF: For those experiencing multiple losses due to chromosomal abnormalities, IVF with preimplantation genetic testing (PGT) can help identify and transfer only healthy embryos.

In some rare cases, conditions like antiphospholipid syndrome may require anticoagulants like Lovenox or aspirin to prevent pregnancy loss caused by clotting issues.

Navigating the Emotional Toll of Recurrent Loss
Experiencing miscarriage, especially recurrent loss, can be incredibly difficult. It often takes an emotional toll on individuals and couples, affecting relationships and mental health. Dr. Murphy stresses the importance of seeking support during this time. Boston IVF offers various wellness options, including social work, clinical psychology, and acupuncture, to help patients manage the emotional burden of infertility and loss.

For those who struggle to carry a pregnancy to term, even after medical interventions, gestational surrogacy may be an option. While this is considered a last resort, it can offer hope for those who have exhausted all other options.

A Message of Hope and Perseverance
Dr. Murphy acknowledges that each loss is a profound and personal experience, and for many, recurrent loss is one of the most difficult aspects of fertility treatment. However, she encourages patients to persevere, noting that many people who experience multiple losses go on to have successful pregnancies. 

While infertility and pregnancy loss are challenging, the team at Boston IVF is dedicated to providing both medical and emotional support to help patients through their journeys. Whether through IVF, genetic testing, or other interventions, there is hope for those facing recurrent miscarriage.

If you or someone you know is struggling with infertility or pregnancy loss, don’t hesitate to reach out to a fertility specialist. With the right care, there are pathways to overcoming these challenges and achieving a successful pregnancy.