As a fertility doctor, I know there are few experiences more painful than pregnancy loss.
Sadly, about one in five pregnancies will end in miscarriage. But while those who suffer this loss are by no means alone, it's often something that's dealt with silently, and rarely shared with others.
That's why I applaud the recent examples of couples opening up publicly about their experiences with miscarriage — from Facebook's Mark Zuckerberg and Priscilla Chan to YouTube vloggers Sam and Nia. By sharing the honest reality of what comes with trying for a family and shedding the stigma around miscarriage, the healing process can begin.
After a miscarriage, I'm often asked by women if they did something to cause the loss. The truth is, miscarriage is rarely caused by the actions of a pregnant woman. While the reason for a pregnancy loss isn't always 100% clear, most miscarriages can be identified by one of these eight common causes:
1. Genetic Abnormalities
One of the most common reasons for early miscarriage is a genetic or chromosomal abnormality with the embryo. For example, in many cases, the fetus has an extra or missing chromosome.
The reason for genetic issues is unknown, but age does often play a role. For example, in women younger than 35, the risk of a chromosomal abnormality in the egg is between 10 and 15%. By age 40, the risk rises to more than 50%.
2. Hormonal Abnormalities
Certain hormonal imbalances — for example, low progesterone levels (or what's called luteal phase deficiency) — may cause miscarriages.
Your doctor can test for this, and through treatment, increase your chance of a successful pregnancy. That might include lifestyle changes (for example, too much exercise can lead to disturbances of hormone production), progesterone supplementation, and use of fertility medications.
3. Uterine Abnormalities
Some women are born with a septum, which is a band of tissue inside the uterus that makes the uterus too small. If you have repeated miscarriages, your doctor can test for this, and surgery can help to correct it.
Other women can develop fibroids in the uterine cavity. Fibroids are benign tumors and they're very common — as many as three out of four women may have them at some point. Fibroids can cause difficulty with an embryo attaching to the uterine wall, which can cause a miscarriage. These can also be treated surgically.
4. Untreated Medical Conditions
Before trying for a baby, it's helpful to have a full medical evaluation by a physician. That's because the risk of miscarriage can increase with untreated medical conditions like diabetes or thyroid disease.
There's also a higher risk of miscarriage for women with infections like measles, cytomegalovirus, listeria, rubella, mumps, gonorrhea, or parvovirus.
6. Antiphospholipid Syndrome
An elevation in antiphospholipid antibodies can lead to blood clots and interfere with implantation and growth of an embryo. Your doctor can test for this, and treatment with blood thinners can often improve pregnancy outcomes in this case.
7. Lifestyle Choices
Of course, there are certain factors to keep in mind when trying for a baby. Tobacco and alcohol can up the risk of miscarriage, as can obesity. Some studies have also found a link between high caffeine consumption and increased risk of miscarriage.
The good news is that these factors are often the easiest to address and rectify. Quitting smoking, dropping weight and steering clear of alcohol and tobacco can go a long way in improving the chance of a successful pregnancy.
Many patients have found that there's nothing more motivating than the desire for a little one, and through that goal they've been able to kick life-long bad habits.
8. Unexplained Factors
After Miscarriage: What's Next?
While a miscarriage is an extremely painful experience, it can be helpful to remember that even for women who suffer three miscarriages, 60 to 80% will have successful pregnancies in the future.
But before you start trying again, it's important to heal — emotionally and physically. Seeing a counselor or reaching out to loved ones for support can help. Lowering stress levels can also positively impact the body’s ability to retain a pregnancy, though stress doesn’t cause infertility. Giving yourself the time you need to heal can help your body prepare for what's to come.
But most of all, don't give up hope. With support, knowledge and medical help, your dreams of a child could still come true.