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 where we combine a thorough evaluation and expert treatment with compassionate care. Patients often question why they are being referred to a “Fertility Center” for evaluation and treatment of recurrent miscarriage. Patients often state, “I am not having trouble getting pregnant – just trouble keeping the pregnancy – should I really come to an IVF Center?” The answer is ‘Yes!”
The providers at Pacific NW Fertility were all practicing obstetricians and gynecologists who went on to do specialty training in reproductive endocrinology and infertility. A significant portion of this training is in first trimester pregnancy complications, including recurrent pregnancy loss. Our director, Dr. Shahine, did her fellowship training at Stanford University which has its own Center for Recurrent Pregnancy Loss (one of very few in the United States). She combines the knowledge she gained in training with her on-going research in the field.
Some common questions:
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 of 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 if the wait time is more than 4-6 weeks for your appointment. We are here to help!
You so exceeded our expectations. We didn't expect a picture of our embryos, a personal conversation with the embryologist, the ability to see implantation with ultrasound, privacy during retrieval, warm blankets, and truly... kindness. Thank You.