This popular claim, floated in many online fertility forums, does not appear to hold up.
One explanation for the claim is that after a miscarriage, levels of hormones like progesterone, which facilitates gestation, are still elevated, increasing fertility. But no studies have shown that to be the case.
Unsuccessful pregnancies, sometimes called missed pregnancies, are common, occurring in 30 to 50 percent of conceptions. (Some occur so early that the woman may not notice.) Many are caused by chance chromosomal abnormalities in the embryo that are unlikely to affect the next pregnancy. Others result from progesterone deficiencies; according to a 2007 review of other studies, the effectiveness of progesterone supplements in preventing future problems is somewhat unclear.
But the science is encouraging. According to a report by the Royal College of Obstetricians and Gynecologists, the probability of a second miscarriage is just 2.25 percent, and the odds of a third are less than 1 percent. Another study in The New England Journal of Medicine followed a large sample of healthy women seeking to conceive and found that of those who miscarried, 95 percent became pregnant within two years.
THE BOTTOM LINE
There is no evidence that fertility is greater after a missed pregnancy.Source: http://www.nytimes.com/2008/10/14/health/14real.html?ref=scienceRecent Keyword Searches: can i douche after a miscarriage, miscarriages first trimester stories, anger and miscarriage, miscarriage past life, chocolate and miscarriage
Photo by Andy Martin
Valerie and John Quinones, a Brooklyn couple in their mid-30s, were more than ready for a baby. Ms. Quinones had no trouble conceiving, but miscarried her first pregnancy at 6 weeks. Soon she was pregnant again, but this time no heartbeat was detected at 9 weeks.
After those consecutive pregnancy losses, her doctor suggested a blood test that showed a rare clotting disorder that, the doctor said, might, or might not, be responsible for the problem. He suggested that as soon as she conceived again she should begin daily injections with a blood-thinning drug and continue that throughout the pregnancy.
Nine months later, Carolina Quinones entered the world at 7 pounds 9 ounces, hale and hearty.
If you know or read about all the things that can go wrong in achieving and maintaining a successful pregnancy, you will no doubt wonder how so many healthy babies manage to be born. More than half of pregnancies are spontaneously lost even before the woman has missed a menstrual period and knows that she is pregnant, and about 15 to 20 percent of recognized pregnancies are miscarried in the next few months. For couples who want a baby, these are daunting numbers.
Quick on their heels, however, are very reassuring numbers. For 80 to 90 percent of women who lose one pregnancy, the next one, even with no treatment, results in a successful birth. But the devastation is compounded and the statistics slightly less hopeful when a woman has lost two or more pregnancies. After two consecutive miscarriages, there is a 75 percent chance that the next pregnancy will be maintained. After three miscarriages, there is a 65 percent chance.
Unproven or Useless Remedies
Myths abound as to why women experience recurrent miscarriages. The uninformed tend to blame factors like undue stress, too much exercise, being too thin or too fat, exposure to occupational or environmental toxins, excessive use of computers or cellphones and bad habits like smoking or drinking too much coffee. Affected couples, often desperate for a solution, sometimes grasp at unproven or useless remedies. What they need instead is factual information, emotional support and, if possible, treatment based on a medically established cause.
Helped by Dr. Sandra A. Carson of Brown University and Dr. D. Ware Branch of the University of Utah, the American College of Obstetricians and Gynecologists recently issued an updated report on what is known and not known about the causes of repeated miscarriage and its proper treatment.
Perhaps most telling is the bottom line. Approximately one woman of reproductive age in 100 will experience recurrent pregnancy loss, and in no more than half of couples will a definite cause be established. Furthermore, several reported causes are controversial, as are their treatments.
“Although a common concern of patients,” the report says, “environmental factors rarely have been linked to sporadic pregnancy loss, and no associations between environmental factors and recurrent pregnancy loss have been established.” It adds, “No association between occupational exposure or working itself and recurrent pregnancy loss have been established.” Neither have any infectious agents been proved to cause recurrent miscarriage, the report adds.
Dr. Carson said in an interview, “The overwhelming majority of recurrent miscarriages occur because something is wrong with the baby, most often a chromosomal abnormality.” This risk increases with the mother’s age and, some studies suggest, with the father’s age, because of genetic errors in the egg or sperm that result in embryos with too many or too few chromosomes.
In 2 to 4 percent of couples with recurrent loss, one partner is found with a problem, a genetically balanced rearrangement of chromosomes. He or she is normal, but when the egg or sperm is formed, it can end up with an extra chromosome piece or a missing segment, resulting in an embryo that cannot survive. In such cases, a couple may choose in vitro fertilization, with genetic analysis of the resulting embryos performed to select a chromosomally normal one for implantation.
Structural abnormalities of the uterus are found in 10 to 15 percent of women who have recurrent miscarriages, though experts disagree over whether these problems impede a successful pregnancy. Likewise, the role of fibroids and endometriosis is controversial, and surgery to remove such extra tissue may not prevent another miscarriage.
When a Blood Thinner Can Help
An autoimmune disorder that involves the production of antibodies to phospholipids, which are important components of blood vessel walls, can sometimes cause clots in the small blood vessels of the placenta. The resulting damage can cause recurrent miscarriage. In women with high levels of such antibodies, treatment with the blood thinner heparin and low-dose aspirin can reduce, though not necessarily eliminate, the risk of repeated miscarriage, Dr. Carson said.
While there is no good evidence that a woman’s immunity to her partner’s tissues is responsible for repeated miscarriage, suggestive evidence indicates that an immune abnormality may occur that interferes with producing the intrauterine growth factors needed for a successful pregnancy. But there is no proven treatment for such a problem.
One popular notion to explain recurrent miscarriage is inadequate production of progesterone, the hormone released after ovulation that prepares the uterus for pregnancy. This idea has resulted in many efforts to support an incipient pregnancy by administering progesterone, a treatment that Dr. Carson described as harmless but not likely to be effective. Some researchers suggest that if a hormonal problem exists it may begin before the egg is released and that drugs to stimulate ovulation may be more helpful.
Even after the most thorough work-up, half to three-fourths of couples with recurrent pregnancy loss “will have no certain diagnosis,” the report states. For such couples, the best medicine is good information and sympathetic counseling, combined with optimistic statistics. “Live birth rates between 35 percent and 85 percent are commonly reported in couples with unexplained recurrent pregnancy loss who undertake an untreated or placebo-treated subsequent pregnancy.”
A combined analysis of the best studies available in 1995 showed that 60 to 70 percent of women with unexplained recurrent losses would have successful next pregnancies.
Of course, every woman contemplating pregnancy would be wise to follow the recommendations of the March of Dimes to start prenatal vitamin supplements before becoming pregnant. Throughout pregnancy, eat healthfully, exercise moderately, avoid alcohol, eat fish (but avoid seafood high in mercury), limit caffeinated drinks to two a day and check with the doctor before taking medications or dietary supplements.
Source: http://www.nytimes.com/2008/03/25/health/25brod.html?ref=science Recent Keyword Searches: miscarriage rates, what are the chance of a child being born after a miscarriage, risk of miscarriage at 45, high fsh miscarriage rate, over 50 mothers natural conception, pregnancy after miscarriage, words to console the lost of a baby, will my next pregnancy be successful after 2 miscarriages?, once a miscarriage begins can it take weeks to complete, tips for preventing miscarriages
When Kori Morrison had her first miscarriage, she and her husband, Tom, were upset but still hopeful. After all, she knew that 15 to 50 percent of all pregnancies end in miscarriage, and most of these women who've miscarried go on to have healthy babies. But in the next eight years, Morrison had four more miscarriages. Sadness and self-blame set in. "I wondered if I was eating the wrong things, if I was overstressed, or, worst of all, if my body just wasn't cut out for pregnancy," she says.
Morrison was eventually found to have a hormone imbalance: Low progesterone during pregnancy kept her uterus from nourishing the embryo. With treatment, she went on to have four children.
Although Morrison went through agony for years before discovering what was wrong, her story illustrates that there are ways to identify what causes miscarriages and what can be done to prevent them. Important to know because, while most women will go on to have a successful pregnancy, about 5 percent are likely to lose another baby. And the use of assisted reproductive technology such as in vitro fertilization (common among women 35-plus) seems to boost miscarriage risks even more.
1. Do a little detective work
When you're planning to get pregnant, your first move should be a careful prepregnancy checkup to reveal potential risk factors like diabetes-related problems, high blood pressure, polycstic ovary syndrome, fibroids, or thyroid abnormalities -- all of which are mostly treatable, says Mary Stephenson, M.D., professor of obstetrics and gynecology and director of the recurrent-pregnancy-loss program at the University of Chicago Medical Center. Health.com: Simple steps can help when you're having trouble getting pregnant
Go over your medical history with your doctor, and also mention any medications, herbs, and supplements you are taking. You might learn something about potentially risky non-prescription meds such as ibuprofen or herbs such as ginkgo. Even taking a little time to discuss a family history of miscarriages with your doctor might uncover a correctable problem.
2. Stop the stress
We've all heard that being stressed isn't a good thing if you're trying to get pregnant. That's also true of trying to stay pregnant. British researchers recently found that feeling happy, relaxed, or in control is linked to a 60 percent reduction in a woman's miscarriage risk. What helps when you can't kick back with a glass of wine? Gentle workouts, dining with friends, or watching your favorite TV show might work (stick with The Office instead of nerve-janglers like 24 or ER). Health.com: The Pill is dangerous, and other myths
And what about sex? If you've had a miscarriage in the past, says Jonathan Scher, M.D., assistant clinical professor of obstetrics and gynecology at Mount Sinai Medical Center in New York, it's probably best to skip nookie during your first trimester, when a hormone in semen may stimulate contractions. It's OK later, after the embryo is fully implanted. Health.com: Is your fertility window closing?
3. Do some chromosome testing
After a miscarriage, a chromosome analysis of fetal tissue can provide some useful information, says Scher.
The test can reveal if there was an unavoidable chromosome problem -- the cause of as many as 50 percent of miscarriages. If the test result is abnormal (the tissue has an abnormal number of chromosomes), it's good news. This is a random event, and the chance of it happening again is no higher than normal. Time to try again. A normal test result, however, may require further investigation (there's more information on this in "Take a Few More Tests," below).
Unless you insist, you may not be offered chromosome analysis. "It's the most important thing we can do," Stephenson says, "But, unfortunately, it's very seldom done."
Why? Medical guidelines don't recommend it unless you've had multiple miscarriages. Even then, if you're healthy, doctors might beg off. But Scher and Stephenson advise any woman who has two or more miscarriages to get the test. Health.com: A calendar method that works
4. Take a few more tests
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If the chromosomes are normal and it's your second or third miscarriage, there's a good chance you have a fixable problem. But you won't find out without additional tests. You might be screened for a genetic tendency for blood clots, a weak cervix, a hormonal imbalance, or even an autoimmune problem such as lupus. If you have a blood-clotting disorder, anticlotting medication may cut your risk of miscarriage by up to 75 percent. If it's a weak cervix, a stitch applied at the end of the first trimester can prevent the cervix from opening early and starting premature labor.
To uncover these kinds of problems, you may need to go to a specialized, recurrent-pregnancy-loss clinic, Stephenson says. Most important, though, keep pushing for answers. That's what Darci Klein did after suffering three miscarriages, including the loss of twins at 20 weeks. Eventually, tests showed she had an inherited blood-clotting disorder and a weak cervix. After treatment -- injections of a blood thinner and a cervical stitch -- she carried a pregnancy to term and gave birth to a healthy baby boy. "You don't ever get over losing a child," says Klein, author of "To Full Term: A Mother's Triumph Over Miscarriage." "But you need to ask for testing."
Source: http://edition.cnn.com/2007/HEALTH/conditions/08/17/healthmag.baby.maybe/index.html
When Kori Morrison had her first miscarriage, she and her husband, Tom, were upset but still hopeful. After all, she knew that 15 to 50 percent of all pregnancies end in miscarriage, and most of these women who've miscarried go on to have healthy babies. But in the next eight years, Morrison had four more miscarriages. Sadness and self-blame set in. "I wondered if I was eating the wrong things, if I was overstressed, or, worst of all, if my body just wasn't cut out for pregnancy," she says.
Morrison was eventually found to have a hormone imbalance: Low progesterone during pregnancy kept her uterus from nourishing the embryo. With treatment, she went on to have four children.
Although Morrison went through agony for years before discovering what was wrong, her story illustrates that there are ways to identify what causes miscarriages and what can be done to prevent them. Important to know because, while most women will go on to have a successful pregnancy, about 5 percent are likely to lose another baby. And the use of assisted reproductive technology such as in vitro fertilization (common among women 35-plus) seems to boost miscarriage risks even more.
1. Do a little detective work
When you're planning to get pregnant, your first move should be a careful prepregnancy checkup to reveal potential risk factors like diabetes-related problems, high blood pressure, polycstic ovary syndrome, fibroids, or thyroid abnormalities -- all of which are mostly treatable, says Mary Stephenson, M.D., professor of obstetrics and gynecology and director of the recurrent-pregnancy-loss program at the University of Chicago Medical Center.
Go over your medical history with your doctor, and also mention any medications, herbs, and supplements you are taking. You might learn something about potentially risky non-prescription meds such as ibuprofen or herbs such as ginkgo. Even taking a little time to discuss a family history of miscarriages with your doctor might uncover a correctable problem.
Full article: http://edition.cnn.com/2007/HEALTH/conditions/08/17/healthmag.baby.maybe/
Could a heightened sensitivity to female hormones cause miscarriage? A small study found that women with recurrent miscarriage show a hypersensitivity to oestrogen and progesterone in skin tests.
The findings could lead to novel treatments for “unexplained” miscarriage, but they also call into question some current, controversial treatments for the disposition, including injecting women with progesterone.
Miscarriages often occur because the embryo has a genetic defect. But several consecutive miscarriages are unlikely to be the result of random genetic anomalies.
Instead, these can be caused by abnormalities in the uterus, unusual hormone levels, clotting disorders or lupus in the mother. “But in at least half of the cases, we can’t find the reason. It’s frustrating,” says Mark Walker at the University of Ottawa in Canada, who was not involved in the study.
Reaction time
Researchers at the Sheba Medical Center in Tel Hashomer, Israel, wanted to get to the bottom of these unexplained miscarriages. The team tested the immune reaction of women with recurrent early pregnancy loss to progesterone and oestrogen – the hormones that regulate pregnancy. Previous studies had shown a connection between miscarriage and unusual immune system responses, but none had looked at the role of these sex hormones, the researchers say.
The researchers injected the hormones into the skin of 29 women who had experienced at least three unexplained miscarriages, and 10 women who had successfully carried a baby to term and never had a miscarriage.
The injections sites, and the arm, were monitored for signs of redness and swelling. All but three of the women in the first group showed hypersensitivity to one of the two hormones, and 17 women showed hypersensitivity to both. None of the women in the control group had a reaction to the test.
“This is really novel,” says Walker. “It’s a small sample size but if the results are that profound, it definitely warrants more research.”
Killer cells
“It opens prospects as far as diagnostics and treatment,” says Alek Itsekson, who led the study. He thinks hypersensitivity to these hormones might be increasing the numbers of immune system cells called natural killer cells. These normally surround the embryo harmlessly as it grows, but an increase in their amount has been linked to early miscarriage (see Major flaw in miscarriage test).
Steroids have been tested as a possible treatment for this problem but they can have potentially dangerous side effects (see Is steroid treatment for miscarriage safe?). Knowing the mechanism behind the negative immune reaction to progesterone and oestrogen might lead to better options, the researchers say.
Itsekson’s team is looking at the same reaction in rats to try to understand exactly how the immune system is responding. They are also conducting follow-up clinical trials in humans.
The results call into question a practice sometimes used to treat recurrent miscarriage, in which injections of progesterone are given to women who have less of the hormone than normal. The usefulness of these injections is already controversial, the researchers say, and if the women are hypersensitive to progesterone the treatment may have unknown side effects.
Journal Reference: American Journal of Reproductive Immunology (vol 57, p 160)
Source: http://www.newscientist.com/article.ns?id=dn11159
Dear Dr. Shieh,
I had an HCG (Human Chorionic Gonadotropin) test done and it was 245 at about 3 weeks 3 days past ovulation. I had a second test done 48 hours later and it was 215. I had an ultrasound and they found nothing in the uterus. I have had some period-like cramping yesterday and today, and brown to red blood and some small clots pass. The bleeding is slowing and the cramping is not as bad as before. The doctor told me to take progesterone "Crinone." I took it the first evening after the first HCG test just as the spotting began and again the next evening, which by then was the first real day of cramping and bleeding. Now today I will not take the progesterone. Is it possible the Crinone made the HCG level not go down as fast as it might have over the 48 hours I used it, which coincided with the 2 HCG tests I had if I hadn't used it, or is it possible I may have an ectopic pregnancy? They saw a cyst on my right ovary, but I haven't had any serious cramping on that side. I am concerned. -- Christina
Dear Christina,
Usually the level of HCG is at least 1,500 before a pregnancy can be visualized in the uterus with an ultrasound. Your HCG is too low -- that's why your doctor found nothing in your uterus.
Now, your question is a complex one and majority of general readers would have a hard time understanding what we're discussing, but I will try to explain it in simpler terms.
For the general public, HCG is a pregnancy hormone that is positive if you are pregnant. Usually the number would increase at least 66 percent every two days. However, 15 percent of the time, the rise of this HCG can be abnormal, which can be frustrating. In addition, should your HCG rise be less than normal, there's need to be concerns about an ectopic (a pregnancy outside of the uterus) or a miscarriage.
In your situation, your HCG is decreasing, which is not a good sign. To compound your laboratory findings with symptoms of cramping and spotting, more than likely you are experiencing a miscarriage in progress. The progesterone or "Crinone" medication that's given to you usually would not have an effect on the level of HCG drop and how fast it drops in a miscarriage. Progesterone is a medication given to help maintain a pregnancy, but it would only help if your pregnancy is normal and not a miscarriage already in progress.
The cyst on your right ovary is probably a corpus luteum cyst, which is a cyst that usually appears when you are pregnant and helps maintain your pregnancy. In addition, you should know that the corpus luteum cyst usually produces natural progesterone for the maintenance of your pregnancy, but your doctor would have been able to tell you more during the ultrasound examination.
Your last question on the possibility of an ectopic is warranted. The reality is that any positive pregnancy test could be an ectopic, but in your situation, even if it is an ectopic, you probably will not need any medicine or surgery. Why?
Because your HCG is decreasing, which means it is resolving itself. Eventually your HCG should be zero. Whether an ectopic or a miscarriage, your body is handling it naturally. Just make sure you follow up with a negative pregnancy test to ensure complete resolution. If you really want to have a baby, don't give up. Keep trying, be patient and you'll be blessed with a little one someday.
Dr. Thomas Shieh is board certified diplomat of the American Board of Obstetrics & Gynecologists, and a fellow of the American College of Obstetricians & Gynecologists.
Source: http://www.guampdn.com/apps/pbcs.dll/article?AID=/20070723/LIFESTYLE/707230310/1024/CUSTOMERSERVICE02
Testing of pregnant women’s saliva could help predict if they are likely to give birth prematurely, according to a study to be published in the British Journal of Obstetrics and Gynaecology.
