Why Do Miscarriages Happen?
“Everything happens for a reason.” Tired of that old cliché? Yes, I am too - most of the time. The main problem with that philosophy is that it is essentially fatalistic in principle. If we assume that all events in life are unalterably pre-destined, then this can damper any will to analyze such events to see if such things can be averted in the future. No one likes getting bad news, but when bad news entails possibly something being wrong with you, and then the increase in your anxiety level is expectedly much higher.
Let’s shed some light on the issue of miscarriages. Often when I see patients in consultation to discuss a recent miscarriage the couples are questioning issues which are way too detailed and implicated in medical minutia to be of any logical use at that particular juncture in time. It is an amazing, and unfortunate, aspect of the human mind to instantly suspect ‘self-guilt’ (or guilt on someone else’s part) when bad things happen involving our bodies.
As I try to explain to all patients in such context, the very first consideration about a miscarriage, before entertaining far-fetched physiological theories, is the very important question - ‘why did this happen?’ Ultimately this very initial question will be answered by one of two scenarios– either a problem with (1) the embryo itself, or, (2) something was abnormal or disadvantageous in the environment in which the embryo was trying to implant and grow. A microscopic version of the age old query - ‘nature vs nurture’ if you will.
For either condition, the pregnancy will likely fail to continue developing, and eventually completely abort (the rejection of the pregnancy tissue from the uterus) at some variable timeframe. Research in this area shows that the vast majority of spontaneous miscarriages are usually due to some abnormality in the genetic / chromosomal make-up of the original embryo. In the remaining minority of cases, the embryo may have been normal however some underlying abnormal factor either in the uterine cavity, or perhaps related to some aspect of abnormal maternal physiology caused the rejection of the embryo’s development.
In the context of an ongoing troubled pregnancy, if you had a perfect crystal ball and could know which of these two scenarios was taking place, then you would obviously not want to intervene in the former case, whereas in the latter case, you would want to do whatever you could to fix or change anything going wrong on the maternal side to help optimize the pregnancy outcome. As you would expect, reality is not nearly as simple as this dichotomy.
To help provide clarity a consultation with your OB-GYN or with a reproductive endocrinologist will help you resolve that important question – why did this happen? All general OB-GYN physicians in the United States have plenty of experience in early pregnancy care as part of routine residency training and they are knowledgeable of the fundamental principles of early pregnancy dynamics to determine if a pregnancy is developing normally or not. Reproductive Endocrinologists / Infertility specialists also have completed general OB-GYN residencies, and then in addition have completed 3 year subspecialty fellowship programs focusing on infertility, which includes study of the principles of very early pregnancy development.
In the next installment, I will address how an infertility specialist may conduct a specialized evaluation for ‘recurrent miscarriages’ if a woman has had more than two miscarriages, or in any case where there is some obvious issue which may be a possible causative factor in repetitive pregnancy loss.