by Dr. Michael Blotner
As the recent news of the Zuckerbergs’ unfortunate recurrent miscarriages come to light , I would like to share some thoughts on the this problem that often gets overlooked or under treated.
Miscarriage tends to increase in frequency as a woman ages. This is because the oocyte, or egg cell is the oldest cell in the woman’s body. Over time the oocyte is more likely to exhibit chromosomal errors as it develops into an embryo, which most often ends in miscarriage.
While recurrent miscarriage is classically described as three or more losses, most couples seek help and evaluation after two losses, especially at 35 years or older. It can occur from the first pregnancy or after a successful one. Some disorders appear to surface as a woman ages, and when a woman becomes pregnant, her body undoes changes that may challenge the pregnancy. But when recurrent miscarriage occurs at a younger age as in the Zuckerbergs’ story, a systemic or structural problem is most likely present.
One of the most frequent problems, aside from chromosomal abnormalities, is that of hypercoagulation disorders. These are a large group of genetic mutations in the various proteins in the blood clotting system. The most common mutations can be found by a simple blood test, and the treatment may require daily injections, (much like insulin shots), throughout the pregnancy. These blood thinner medications can counter the woman’s tendency to make clots that would block the blood flow through the placenta, therefore be detrimental to the fetus, most often resulting in its demise. Baby aspirin in commonly used in this setting. While it will decrease the activity of platelets, which assist in forming a clot, it may not be enough to treat the underlying problem.
When a miscarriage is discovered, the doctor may offer a D&C. This will allow the advantage of testing the chromosomes. If the chromosomes are normal, there is a greater likelihood of a systemic problem. Other problems may involve the immune system, chromosomal problems in one of the couple, or structural problems of the uterus.
While it is unclear that sperm problems can cause miscarriage, it is certain that sperm plays a significant role in embryo development. This is seen quite often in the in vitro laboratory. The microscopic appearance of the sperm cells, or morphology, can be evaluated by a laboratory experienced in semen analysis. Abnormally shaped sperm are more likely to have abnormal chromosomes.
The most complete evaluation will be performed by a reproductive endocrinologist, who will try to help the couple establish a viable pregnancy before returning to their OB/Gyn for obstetrical care. The woman is often followed by a hematologist or maternal fetal medicine specialist.