The Testing Debate
If you’re in that one percent, there’s a good chance your miscarriages are caused by something other than chromosomal miscombinations. A medical work-up will include a chromosomal analysis of both parents to see if either one is a carrier of abnormal chromosomes, cervical cultures to test for infection, an X-ray of the uterus to determine its shape and whether there are fibroids, and complex hormonal and immunologic blood testing. Once the cause is determined, it can usually be treated with surgery or medication, depending on the specific problem.
The argument for waiting for three miscarriages before running tests is that the tests are expensive (and not always covered by insurance), uncomfortable, and rarely reveal anything useful (since most miscarriages are random events). Lerner says that the rate of testing revealing something specific even after a woman has had three miscarriages is only 10 percent; Dr. Ravnikar puts it as closer to 20 percent. Still, even among women who have had three or more losses, 60 to 70 percent will go on to have normal pregnancies.
Encouraging as that is, many women and some health professionals feel that it can be valuable to run certain tests earlier, depending on the situation. Carolyn Salafia, M.D., a perinatal pathologist in Larchmont, New York, offers tests to women after one miscarriage when the pregnancy was achieved through IVF or if the woman is over 35 or took a long time to conceive.
Dr. Salafia analyzes miscarried fetal tissue when it is available. By examining it under a microscope, she can usually determine if the miscarriage was the result of chromosomal miscombination or not. Currently, no treatment exists for preventing chromosomal miscombination, with the exception of in vitro fertilization (IVF) procedures, where a technique called PGD (preimplantation genetic diagnosis) allows for the chromosomal status of an embryo to be determined prior to implantation. But for those women whose miscarriages are shown to have treatable causes, early testing can potentially spare them another loss.
Dr. Salafia says that her patients seem to feel that the grass is always greener. “Some of them want it to be wrong chromosomes because they don’t want it to be their fault,” she explains. “Others desperately want it to be something they can have fixed.”
Trying Again
Emotional upheaval, in fact, seems to be the most difficult aspect of miscarriage. Some women, having had just one, are able to accept their bad luck and move on. But more often, women experience sadness, anger and pain, which intensifies with each loss.
Add self-blame to the mix too. “Women frequently think they miscarried because they once had an abortion or because they had a drink, or because they were ambivalent about being pregnant,” says Izetta Siegal Stern, CSW, a psychotherapist specializing in pregnancy loss. “They really need to understand that they didn’t cause it.”
Support groups can be enormously helpful for soothing the sense of isolation among women who’ve miscarried, as they tend to think that the general public doesn’t have much sympathy for them. “People understand grieving over a stillbirth,” says Dr. Ravnikar, “but not a miscarriage.”
Mind-body techniques like imagery, relaxation, massage and yoga also go a long way toward reducing stress and anxiety and restoring a sense of well-being so that a woman can muster the courage to try again. Commemorating the loss in some way, like planting a tree in the baby’s memory, may also be helpful.
But nothing can really assuage the anxiety that accompanies trying to conceive again. It’s frustrating to have no clear preventative measures to take the next time around (although smoking and drinking and certain environmental toxins should be eliminated, because there is some evidence linking them to miscarriage).
