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Family Solutions

Myths abound as to why women experience recurrent miscarriages. Stress, too much exercise, being too thin or too fat, exposure to environmental toxins and bad habits such as smoking or drinking too much coffee have all faced blame.

However, a report released by the American College of Obstetricians and Gynecologists shows that although environmental factors are a common concern of patients they have rarely been linked to sporadic pregnancy loss and no associations between environmental factors and recurrent pregnancy loss have been established.

As a reproductive immunologist and IVF specialist, I know that miscarriages are not uncommon and are believed to occur with as many as one out of every four pregnancies. Often the woman will miscarry very early in pregnancy, sometimes even before she knows that she has conceived. However, for couples who have experienced a miscarriage this can be of little comfort. They are often desperate for a cure-all, sometimes grasping at unproven or useless remedies. What I offer instead is factual information, emotional support and, when possible, treatment based on a medically established cause.

Although many women experience one or two losses, most are able to conceive and carry a child to term. However, in cases of recurrent pregnancy losses, women continue to miscarry over and over again.

Although genetic abnormalities of the embryo are identified as the cause for 60 percent of these cases, it’s not necessarily true once the heartbeat is detected.  I advise patients who have not gotten pregnant with high quality embryos, experienced miscarriage of a genetically normal fetus or suffered a loss after the heart beat has been detected and those with a family history of auto-immune diseases and miscarriage to seek a consultation with a reproductive immunologist or fertility doctor who specializes in immunologic causes of infertility.

There are different types of miscarriage, different treatments for each, and different statistics for what your chances are of having one. Most miscarriages occur during the first 13 weeks of pregnancy.  Pregnancy can be such an exciting time; however, with the great number of recognized miscarriages that occur, it is beneficial to be informed about the causes and treatments of recurrent miscarriages.

Today we know a great deal about the workings of the immune system and how it affects a pregnancy.  In fact, the mother’s immune system plays a critical role in the acceptance of an embryo. 

Immune Disorders

Immune disorders are a hot topic in reproductive medicine. The immune system is made up of a large network of cells, tissues, and organs working together to fight off germs and infections and respond to allergens in the environment.  But the immune system doesn’t always work the way it should.

In some, immune system disorders prevent the body from fighting off infections. In others, the system incorrectly identifies parts of the body as a threat and attacks the body’s cells the same way it would attack an invading germ. Allergic reactions fall to one side of this spectrum, with life-threatening diseases such as lupus and multiple sclerosis, at the other end of the scale. What happens in all of these disorders is that the immune system loses its ability to distinguish between safe and harmful.

Some couples trying to conceive may be diagnosed with immunologic incompatibility or allogeneic issues, which are detrimental to fertility. Genes from both of the parents that are passed on to their growing embryo may not properly communicate to the mother’s immune system and her body may mistake the embryo as a foreign invader. As a result, the embryo may not implant or may miscarry.

Many doctors assume the cause of miscarriages is genetic or chromosomal abnormalities dismissing all other possible causes and in many cases putting the mother through unnecessary repeated episodes of pregnancy loss. Identifying the root cause is the crucial starting point in miscarriage prevention. If we know that immune disorders are causing a woman to miscarry, there are preventive measures we can take. It’s precisely when an embryo is chromosomally normal that we need to look at the maternal immune system.   Her immune system needs to be investigated as a cause.

Immunologic Infertility

A number of factors can impact a woman’s ability to carry a healthy pregnancy. Predisposition to immunologic abnormalities such as autoimmune disease, abnormal development of inflammatory cytokines in the mother’s blood, elevation of activated immune cells, immune response to proteins in sperm or failure to generate protective cells that a mother makes when pregnant can be associated with improper immune tolerance in the mother for the embryo. Celiac disease, Crohn’s disease, multiple sclerosis, polycystic ovarian syndrome, endometriosis and lupus are all examples of conditions that can lead to rejection of an embryo if not properly treated. Stress and dietary factors also may play a role in the mother’s immune tolerance of the pregnancy.

Patients who suffer from recurrent miscarriages should first be sure there are no genetic causes of the miscarriage. By identifying the likely source of the problem, treatments can be given that help to correct them. The goal is trying as much as possible to assist in the immune tolerance that must be created.  Most important is to rule out genetic issues as the only cause for the failures and miscarriages. Once this is done, I can focus on the immune system as one of the most likely causes of the failures or losses and help couples welcome a healthy baby.

Dr. Braverman is the founder and medical director at Braverman Reproductive Immunology. An internationally known and respected physician, Dr. Braverman specializes in the treatment of recurrent miscarriages and reproductive immunology.

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