The Center for Recurrent Pregnancy Loss
Director: Lora Shahine, M.D., F.A.C.O.G.
Welcome to the Center for Recurrent Pregnancy Loss at Pacific NW Fertility. Since the Center opened in 2010, we have helped hundreds of patients and furthered research in the field of miscarriage. If you have recurrent miscarriages – we are here to help.
The Recurrent Pregnancy Loss clinic at PNWF is Wednesday afternoons with Dr. Lora Shahine, Director of the Center. With time and word of mouth, the demand for being seen has increased significantly and wait times can be frustrating. In order to care for your best and meet your needs, we recommend an intake appointment with one of our experienced ARNPs who can review your personal history, explain the evaluation, and help coordinate testing.
When you meet with Dr. Shahine, you can focus on the interpretation of test results and make the right plan for you.
You may consider having the tests done by your medical provider and here is a list with codes.
Here is a brief review of each test and why we recommend it.
Want to learn more about what the tests mean, causes of miscarriage, and treatment options? Dr. Shahine has written a patient guide on miscarriage and recurrent pregnancy loss that you may find helpful: Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss.
Reader review: “Dr. Shahine takes the complex and emotional topic of miscarriage and explains it in a way that anyone can understand and learn. She reviews the evidence behind testing and treatment, controversies in care, a holistic approach, and the emotional impact of recurrent miscarriage. I’m so glad I have this resource.”
What is recurrent pregnancy loss?
A miscarriage is considered a spontaneous loss of a pregnancy before 20 weeks of gestation and recurrent pregnancy loss (or recurrent miscarriage) is usually defined as at least 3 consecutive miscarriages. Isolated miscarriage can be common and it is estimated that approximately 30% of all pregnancies end before 6 weeks gestation. Incidence of recurrent pregnancy loss is difficult to estimate, but some research suggests that at least 2-5% of women have had 3 or more miscarriages. The American Society of Reproductive Medicine encourages the evaluation of a patient with 2 or more miscarriages so that any issue detected may be addressed before a third loss.
What causes a couple to have recurrent pregnancy loss?
Several issues may lead to miscarriage and if they are not treated, may result in recurrent miscarriage. These treatable problems may be structural issues with the uterus like a septum or fibroid that may be surgically removed or hormonal imbalances like thyroid disease that may be treated medically. Although blood clotting disorders have been linked to recurrent miscarriage, very few women will actually test positive for a blood clotting disorder. In fact, approximately 50% of couples with a thorough recurrent pregnancy loss evaluation will not find an issue that may be treated surgically or medically. In these cases, as with the vast majority of miscarriages, the pregnancy stopped developing because of a genetic issue within the embryo itself. An imbalance in the number of chromosomes within the embryo (also known as aneuploidy) will often result in miscarriage.
What testing can be done for recurrent pregnancy loss?
The testing should be tailored to each individual couple and their history. In general, testing includes a uterine cavity evaluation and blood tests screening for ovarian reserve, hormonal imbalances, genetic issues (balanced translocation), and antiphopholipid syndrome (an immune issue associated with miscarriage).
What kind of treatment is available for recurrent pregnancy loss?
The treatment options depend on the results of the evaluation. If a hormonal issue is discovered through testing, the treatment is medical. If a structural defect is discovered in the uterus, the treatment is surgical. For the 50% of patients have all test results come back as normal, the most common reason for their losses is aneuploidy – an incorrect number of chromosomes within the embryo (a genetic issue that happens at the level of the egg and sperm by chance). In these cases, the options are trying again with the support of your team at PNWF or screening the embryos for a genetic defect before conceiving. Genetic screening of embryos requires in vitro fertilization (IVF). This technique may be referred to as chromosomal screening or preimplantation chromosomal screening.
What is the next step?
Contact our helpful patient care coordinators to get started with your evaluation and treatment. The demand for appointments can be high at times, ask how you can start the evaluation with your primary care provider. We are here to help!
I can't say enough about their (the doctors and staff at Pacific NW Fertility) level of expertise. I truly believe my success was due to the experience of the staff. Their confidence, communication, and highly systematic approach were key to ensuring the process was a success.