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Houston Fertility Journal

What You Need To Know About Miscarriage and Pregnancy Loss

[fa icon="calendar"] Sep 18, 2017 12:00:00 PM / by Center of Reproductive Medicine   

Center of Reproductive Medicine

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Your biological clock is ticking. Odds are good that you have heard this phrase before. In many cases it comes from a well meaning family member that thinks you should get pregnant before you get too old. The question is though, is your biological clock actually ticking to the point that you may be unable to achieve pregnancy?

And, if you can achieve pregnancy as an older woman, have the odds of you having a miscarriage increased with your age? Let’s explore what you really need to know about miscarriage and pregnancy loss.

Age in Relation to Risk of Miscarriage

We hate to be the bearer of bad news, but your well meaning relatives may have actually been onto something. Not only is there a literal clock on your ability to get pregnant, there is also a clock on your ability to bring a pregnancy to term. It may seem like a harsh truth of aging, but the chance for miscarriage does in fact increase as women get older.

The approximate rates of miscarriage by age are as follows:

  • 7-15% in women under 35
  • 17-28% in women age 35 to 39
  • 34-52% in women age 40 to 44
  • By age 45 and older, the rates can increase to as high as 80%

In short, the older you are when you achieve pregnancy, the higher the likelihood you could suffer a miscarriage.

Miscarriages by the Numbers

  • Approximately 80% of miscarriages happen in the first 13 weeks, or the first trimester. 

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  • Estimates suggest that of the women in the United States who achieve pregnancy, 15-20% of them will have a miscarriage regardless of age within their first 20 weeks. (This number is likely inaccurate because of the fact many women who have miscarriages never knew they were pregnant and according to most experts the percentage is probably much higher.)
  • After the first trimester, for most women, the risk of miscarriage drops to less than 10%.

Common Questions About Miscarriages and Pregnancy Loss

What is pregnancy loss? Doesn’t that just mean miscarriage?

Miscarriage is a pregnancy loss in the first 20 weeks. After 20 weeks, the loss of a pregnancy is called stillbirth. Stillbirths are much less common. The cause of nearly half of stillbirths are unknown, but they typically occur in relation to problems with placenta, issues with fetal growth and progression, infections, and genetic problems in the fetus.

What about the father’s age? Can that affect the mother’s risk of miscarriage?

According to the Mayo Clinic, yes. If the father is older than 40 there is an increased risk of the mother having a miscarriage. They also stated that the chances of the baby having autism, birth defects, or schizophrenia may also be elevated based on some research.

They went onto say, “Despite the increase in these risks, however, the overall risks remain small and less certain than those associated with being born to a woman over age 40.” The Mayo Clinic did admit though, further research is needed to determine just how much of an impact a man’s age would have on a woman’s likelihood of miscarriage, and any other potential problems that could occur with the fetus.

Aside from age, what causes a miscarriage?

  • Chromosomal Abnormalities - These are the cause of most miscarriages. The National Human Genome Research Institute says, “Chromosome abnormalities usually occur when there is an error in cell division.” and “There are many types of chromosome abnormalities. However, they can be organized into two basic groups: numerical abnormalities and structural abnormalities.”
      • Numerical abnormalities occur “when an individual is missing one of the chromosomes from a pair, the condition is called monosomy. When an individual has more than two chromosomes instead of a pair, the condition is called trisomy.”
      • Structural abnormalities occur when the chromosome’s structure is altered. There are several forms of structural abnormalities.
  • Infection and disease - The illnesses that have a higher likelihood of causing a woman to miscarry are those that can lessen the blood flow to the uterus. This blood flow restriction prevents enough oxygen from getting to the growing fetus. Just a few of the infections and diseases that can put a woman at risk of miscarriage include, but aren’t limited to:
      • Diabetes
      • Thyroid Disease
      • Uterine Infections
      • Lupus
      • Heart Disease
      • Sexually Transmitted Diseases (such as gonorrhea)
      • HIV
      • Measles, Mumps, and Rubella
  • martini-lifestyle-choices.jpgLifestyle choices - Smoking, alcohol consumption and the use of drugs can increase your chances of a miscarriage. Some experts believe a poor diet, too much caffeine and too much/too little exercise can also increase your risk. However, to be sure about whether or not these or any other factors can affect your pregnancy, you should discuss them with your doctor.
  • Abnormalities with the uterus and/or cervix -  Bryan Cowan, MD reported to Parents Magazine in its article on common miscarriage causes that “Uterine anomalies account for about 10 percent of miscarriages.” The article went onto say, “A weakened or incompetent cervix is another problem that can lead to miscarriage, because toward the end of the first trimester the fetus has grown large enough that the cervix starts to bulge. If the cervix is weakened, it can’t hold the fetus in.”
  • Hormonal problems - Low progesterone, high estrogen, and insulin resistance are just a few of the hormonal problems that can result in an elevated risk of miscarriage. One hormonal disorder that causes concern for some women is polycystic ovarian syndrome, or PCOS. The U.S. Department of Health and Human Services Office of Women’s Health says women with PCOS can lower their risk of problems during pregnancy by:
    • Reaching a healthy weight before you get pregnant.
    • Reaching healthy blood sugar levels before you get pregnant.
    • Taking folic acid. How much you should take varies, so ask your doctor what dosage is best for you.
  • Prenatal tests that are invasive in nature - Tests such as chorionic villus sampling (CVS) and amniocentesis are invasive and can cause an increased risk of miscarriage.  
    • CVS is a prenatal test that detects things like birth defects, genetic diseases, and some other problems that can occur during pregnancy.
    • Amniocentesis is another prenatal test that is used to detect chromosomal abnormalities, diagnose fetal infections, and determine the sex of the fetus. Amniocentesis is also used to examine DNA for genetic problems, and to determine paternity. If you are seeking to determine paternity, it’s better to wait until the pregnancy comes to term and do a DNA test after the birth of the baby.

How do you know if you’re having a miscarriage?

Common signs of a miscarriage include bleeding or spotting, abdominal cramping or pain, and passing fluid or tissue from the vagina. Other signs could be chills, fevers, sudden weight loss, and mild to severe back pain. If you feel like you might be having a miscarriage, you should talk to your doctor.

What should I do if I’m experiencing vaginal bleeding?

First, it’s important not to panic. Bleeding or spotting is sometimes referred to as threatened miscarriage, but it may not mean you are experiencing pregnancy loss. Light bleeding or spotting could be attributed to a variety of factors such as having sex, hormone changes, an infection, or something else. Contact your doctor, and they may suggest you simply rest and refrain from some activities. There may be tests or exams required to figure out exactly what’s going on.

Avoid the urge to use a tampon, and also refrain from having sex or douching while bleeding. You should also keep track of how heavy the bleeding is and the color of the blood. Take note of whether its bright red, brown or a dark color. This may be vital information that can help your doctor determine what is happening.

If however you are experiencing heavy bleeding, or bleeding with pain, cramping or dizziness, you might need to skip the call to the doctor and head straight to the emergency room.

Can I prevent a miscarriage?

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Unfortunately there are no guarantees that anything you do or don’t do will prevent a miscarriage. There are things you can do to minimize the risk, but sometimes a miscarriage can occur with no clear reason as to why.

With that said a few things that could help you lessen your chances of pregnancy loss are:

  • Get to a healthy weight, and make sure you’re up to date on immunizations before attempting to achieve pregnancy. It’s also not a bad idea to get a full physical before you start trying for a baby.
  • Once pregnancy is achieved, it’s a good idea to maintain a healthy diet of lean proteins, leafy greens and whole grains.
  • Take prenatal vitamins and folic acid (ask your doctor about how much and for recommendations on which prenatal vitamins are best for you).
  • As mentioned earlier, smoking, alcohol consumption and drug use are common causes for miscarriage. Therefore, if you are engaging in these behaviors, it’s in the best interest of you and the fetus that you stop.
  • Some experts recommend ensuring you get adequate sleep and keep your stress levels down as well. However, other experts believe that sleep and stress have nothing to do with pregnancy loss at all.

Again, it’s important to remember that you can do “all the right things,” and still have a miscarriage. Although we all want the most positive outcomes possible, there are just no certainties with things like pregnancy.

What happens during a miscarriage?

Provided the pregnancy loss is not causing fever, excessive blood loss, weakness or infection, once a miscarriage begins it can take as many as several days to run its course. On the other hand, if there is heavy bleeding or intense pain, there may be a need for prescription medication or even surgery to complete the miscarriage.

  • An incomplete miscarriage occurs when some or all of the fetal tissue stays in the uterus after pregnancy loss. You may have to simply wait it out, but your doctor may prescribe medication to speed up the emptying of the uterus. In some cases surgery is required, and this is the quickest way to complete a miscarriage. In the worst cases, a hysterectomy (removal of the uterus) is required for women who experience nonstop bleeding and/or an infection that is not responding to antibiotics. The good news is, hysterectomies as a result of miscarriage are a very rare occurrence.
  • A complete miscarriage occurs when all of the pregnancy tissue is emptied from the uterus. Once the miscarriage is complete, any pain or bleeding you are experiencing should cease rapidly. If you are still experiencing pain after the miscarriage has completed, you may need to see your doctor.

Once a miscarriage starts, can anything be done to stop it?

No, there is no medical treatment that can be performed to stop the pregnancy loss once it has started.

Does a miscarriage mean you’re now infertile?

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No, there is no known direct link between miscarriages and infertility. Just because you have a miscarriage does not mean you can not achieve pregnancy again, or even that you can not bring a pregnancy to term. On the other hand, having one miscarriage does increase the likelihood of a second miscarriage. It may be comforting to know however, that barring any underlying medical conditions, the risk of a second miscarriage after having a first one is considered to be only slightly elevated.

If I have a miscarriage, how soon can I try again?

Many experts agree that, following a miscarriage, most healthy women can try to get pregnant again as soon as they have had at least one normal menstrual period. However, as pregnancy loss can sometimes be a difficult experience, you may need to give yourself time to heal emotionally and mentally before trying to get pregnant again.

What causes infertility after a miscarriage?

Since miscarriages are not directly linked with infertility, the actual cause of infertility following pregnancy loss could be anything. If after experiencing a miscarriage you are struggling to achieve pregnancy again and have been trying for a year or longer, you may want to speak with a fertility specialist. If you are older than the age of 35 and have been trying for more than six months, or have experienced two or more miscarriages, you should consult with a fertility specialist right away.

A Free Resource to Further Your Knowledge

There are so many misconceptions about achieving pregnancy. Do yourself a favor and arm yourself with the facts. We’ve put together an eBook that tells you the truth about fertility and pregnancy, and dispels several of the myths we’ve heard as well. You can get a free copy of our eBook, "Getting Pregnant 101 : Facts, Myths and Secrets to Fertility" by clicking here.

Getting Pregnant 101: Facts, Myths, and Secrets To Fertility

Topics: Miscarriage, Health

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