By Dr. Duru Shah
Thirty-five-year-old Sameera Matankar (name changed), VP, Strategy and Development of a leading MNC was envied by all for her sterling success as a corporate woman. However, hardly anyone had an inkling of the deep pain that Sameera had bottled up for failing to become a mother, despite her six-year-long marriage.
Over a span of four years, Sameera conceived five times, but every time she had a miscarriage. For the first miscarriage, she was not that affected. However, after the second miscarriage, she became emotionally distraught as her treating gynaecologist told that she belongs to less than 5% of women who experience two consecutive miscarriages.
Sameera’s disturbed state of mind made her successful career came to an abrupt end. She became so sensitive about her ‘shortcoming’ that she started avoiding all social functions, where she feared she would inevitably be asked about the ‘good news’.
Sameera plunged into depression, when she heard about even her own friends becoming pregnant. Every time, she ended up asking herself, “Why do I end up having miscarriages, when everyone else around me is even having their second or third babies? What can I do to end my trauma?”
After her fifth miscarriage, she was determined to take expert help. She no longer wanted to subject herself through this trauma, time and again. Her search for treatment began with her assessment at Mumbai’s Gynaecworld.
Sameera was diagnosed with Recurrent Pregnancy Loss (RPL), also known as habitual abortion, a disease that is distinct from infertility and defined by two or more failed pregnancies.
Says Dr Duru Shah, Chairperson, Gynaecworld, who diagnosed Sameera, “Although approximately 15% of all recognized pregnancies result in miscarriage, only 1% experience three or more. RPL usually occurs before 20 weeks of gestation.”
Recurrent Pregnancy Loss Causes
So, what led to Sameera’s RPL? Her assessment revealed that the cause was a chromosomal abnormality. However, the possible causes that could led to RPL are:
- Genetic/Chromosomal Abnormality
A chromosome analysis performed from the parents’ blood identifies an inherited genetic cause in less than 5% of couples. Translocation (when part of one chromosome is attached to another chromosome) is the most common inherited chromosome abnormality.
“Although a parent who carries a translocation is frequently normal, their embryo may receive too much or too little genetic material. When this occurs, a miscarriage usually occurs. In contrast to the uncommon finding of an inherited genetic cause, many early miscarriages are due to the random (by chance) occurrence of a chromosomal abnormality in the embryo. In fact, 60% or more of early miscarriages may be caused by a random chromosomal abnormality, usually a missing or duplicated chromosome,” adds Dr Shah.
The chance of a miscarriage increases as a woman ages. After age 40, more than one-third of all pregnancies end in miscarriage. Most of these embryos have an abnormal number of chromosomes.
- Hormonal Abnormalities
Progesterone, a hormone produced by the ovary after ovulation, is necessary for a healthy pregnancy. Some experts point out that low progesterone levels may cause repeated miscarriages.
- Metabolic Abnormalities
Poorly controlled diabetes increases the risk of miscarriage. Women with diabetes improve pregnancy outcomes if blood sugars are controlled before conception. Women who have insulin resistance, such as obese women and many who have polycystic ovarian syndrome (PCOS), also have higher rates of miscarriage.
- Uterine Abnormalities
Distortion of the uterine cavity may be found in approximately 10% to 15% of women with recurrent pregnancy losses. Diagnostic screening tests include hysterosalpingogram, sonohysterography, ultrasound, or hysteroscopy.
Congenital uterine abnormalities include a double uterus, uterine septum, and a uterus in which only one side has formed. Asherman’s syndrome (scar tissue in the uterine cavity), uterine fibroids, and possibly uterine polyps are acquired abnormalities that may also cause recurrent miscarriages.
- Antiphospholipid Syndrome
Blood tests for anticardiolipin antibodies and lupus anticoagulant may identify women with antiphospholipid syndrome, a cause for 3% to 15% of recurrent miscarriages. A second blood test performed at least 6 weeks later confirms the diagnosis.
Inherited disorders that raise a woman’s risk of serious blood clots (thrombosis) may also increase the risk of fetal death in the second half of pregnancy.
- Male Factor
Evidence suggests that abnormal integrity of sperm DNA may affect embryo development and possibly increase miscarriage risk.
No explanation is found in 50% to 75% of couples with recurrent pregnancy losses.
Recurrent Miscarriage Investigations
Transvaginal ultrasonography has become the primary method of assessment of the health of an early pregnancy. In non-pregnant patients evaluated for RPL may need to undergo parental chromosome testing after 2 or 3 pregnancy losses. Blood tests for thrombophilia, ovarian function, thyroid function and diabetes are also performed.
If the likely cause of recurrent pregnancy loss can be determined, treatment is directed accordingly. In certain chromosomal situations, like that of Sameera’, Assisted Reproductive Technology (ART) is recommended.
In vitro fertilisation (IVF) with pre-implantation genetic diagnosis may be able to identify embryos with a reduced risk of another pregnancy loss which then would be transferred.
The Preimplantation Genetic Diagnosis (PGD) technique requires the use of the test tube baby technique (IVF) to test embryos for genetic disorders before they are transferred to the womb. It offers the couple at risk the chance to have an unaffected child and avoids the need for abortion.
IVF is a process by which egg cells are fertilised by sperm outside the body: in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed.
The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy.
Thanks to IVF, two months back, Sameera has become the mother of a healthy baby girl. “I can’t thank Gynaecworld and Dr Shah enough for this bundle of joy,” grins Sameera, while cradling the baby.
© Dr Duru Shah
Dr Duru Shah is Chairperson of Gynaecworld and Gynecworld Fertility Clinic, Mumbai, India and a prominent and well-known gynecologist in India. She is not only known to be the best gynaecologists but also as one of the prominent social activists. Through her profession she has contributed towards girl child and rural women in society. She is the voice of gynaecological community, for propagating the best practices in her field and for championing multiple social causes pertaining to women’s health.
A consultant to Breach Candy Hospital, Jaslok Hospital and Sir Hurkisondas Hospital, even at the age of 62, Dr Shah is intrinsically engaged in setting new benchmarks for her profession and unflinchingly lends support to an array of social causes through various professional and social organisations.
Image: graur codrin / FreeDigitalPhotos.net & scienceproject2706.wikispaces.com
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