Experiencing pregnancy loss and infertility is an emotionally and physically challenging journey. We hope this provides  some practical advice, drawing on the latest research and best practices, to help you navigate this difficult path.

Understanding Pregnancy Loss

Pregnancy loss, also known as miscarriage, is the loss of a pregnancy before the 20th week. It is more common than many realize, affecting about 10-20% of known pregnancies. The causes can vary widely and may include genetic abnormalities, structural issues, hormonal imbalances, infections, and immune system responses.

Common Causes of Infertility and Pregnancy Loss

Genetic Factors: Chromosomal abnormalities in the embryo are the most common cause of miscarriage. These abnormalities can occur by chance and are often not recurrent.

Hormonal Imbalances: Conditions like polycystic ovary syndrome (PCOS) and thyroid disorders can affect hormone levels, impacting fertility and pregnancy maintenance.

Structural Issues: Uterine abnormalities such as fibroids, polyps, or a septate uterus can interfere with implantation and pregnancy progression.

Infections: Certain infections, such as sexually transmitted infections (STIs), can affect the reproductive system and lead to pregnancy loss.

Immune System Responses: Reproductive immunology, a field that studies how the immune system interacts with reproductive health, has identified autoimmune conditions and immune system dysfunctions as potential causes of recurrent pregnancy loss.

Reproductive Immunology: A Key Factor

Reproductive immunology is a critical but often overlooked aspect of infertility and pregnancy loss. This field examines how the immune system can sometimes mistakenly attack the developing embryo, leading to miscarriage. Some key areas include: (For more detailed information on testing see this article.)

• Antiphospholipid Syndrome (APS): An autoimmune disorder where the immune system produces antibodies that attack the placenta, causing blood clots that can lead to miscarriage.
• Natural Killer (NK) Cells: High levels of NK cells can sometimes attack the embryo. Treatments to modulate NK cell activity are currently being researched.
• Cytokine Imbalance: Cytokines are immune system proteins that can influence pregnancy. An imbalance in these proteins can negatively impact pregnancy outcomes.

Best Practices for Managing Infertility and Pregnancy Loss

Seek Comprehensive Testing: If you experience multiple pregnancy losses, it’s essential to undergo thorough medical evaluations. Tests can include genetic screening, hormonal assessments, uterine imaging, and immune system evaluations.

Work with a Specialist: Reproductive endocrinologists and immunologists can provide specialized care. They can develop a personalized treatment plan based on your specific needs.

Consider Lifestyle Changes: Healthy lifestyle choices can improve overall fertility. This includes maintaining a balanced diet, regular exercise, avoiding smoking and excessive alcohol consumption, and managing stress.

Explore Treatment Options: Depending on the underlying cause, treatments may include medications (hormonal treatments, blood thinners for APS, or immunosuppressive drugs), surgical interventions to correct uterine abnormalities, and assisted reproductive technologies (ART) like in vitro fertilization (IVF) which can sometimes improve chances of a successful pregnancy.

Emotional Support: Coping with infertility and pregnancy loss can be emotionally taxing. Seeking support from counseling, support groups, or online communities can be invaluable.

Specialists for Recurrent Pregnancy Loss: Who to Consult

If you’re experiencing recurrent pregnancy loss, consulting the right specialists can make a significant difference in diagnosing the underlying causes and finding effective treatments. Here’s a guide to the types of specialists you should consider:

Reproductive Endocrinologist

Who They Are: Reproductive endocrinologists are obstetrician-gynecologists (OB-GYNs) with specialized training in infertility and hormonal disorders.

What They Do: They diagnose and treat hormonal imbalances, ovarian dysfunction, and other endocrine-related issues that can affect fertility and pregnancy maintenance. They often manage cases involving polycystic ovary syndrome (PCOS), thyroid disorders, and luteal phase defects.

When to See Them: If you have irregular menstrual cycles, known hormonal issues, or have experienced multiple miscarriages without a clear cause.

Reproductive Immunologist

Who They Are: Reproductive immunologists are specialists who study the interaction between the immune system and reproductive health.

What They Do: They diagnose and treat immune-related causes of recurrent pregnancy loss, such as antiphospholipid syndrome (APS), elevated natural killer (NK) cell activity, and cytokine imbalances. They may recommend treatments like immunosuppressive therapies or blood thinners.

When to See Them: If you have a history of autoimmune disorders, or your miscarriages have no clear explanation despite thorough evaluation.

Genetic Counselor

Who They Are: Genetic counselors are healthcare professionals with specialized training in medical genetics and counseling.

What They Do: They assess genetic risks, recommend appropriate genetic tests, and help interpret the results. They provide support and information on inherited conditions that may contribute to recurrent pregnancy loss.

When to See Them: If you or your partner have a family history of genetic disorders, or previous pregnancies have been affected by chromosomal abnormalities.

Maternal-Fetal Medicine Specialist (Perinatologist)

Who They Are: Maternal-fetal medicine specialists, or perinatologists, are OB-GYNs with additional training in high-risk pregnancies.

What They Do: They manage pregnancies with complex medical conditions and provide care for women who have experienced recurrent pregnancy loss. They monitor high-risk pregnancies closely and collaborate with other specialists to optimize outcomes.

When to See Them: If you become pregnant again after multiple losses, or if you have pre-existing medical conditions that could complicate your pregnancy.

Who are the Fertility Specialists? (Infertility Specialist)

Who They Are: Fertility specialists, are reproductive endocrinologists, where focus is purely on infertility.

Becoming a reproductive endocrinologist requires a significant commitment to education and training, spanning over a decade of rigorous academic and clinical preparation. If you are under 30 and haven’t conceived within a year of unprotected sex, get a referral to a reproductive endocrinologist. DO NOT STAY WITH YOUR OB/GYN. OB/GYNs do not have the expertise to diagnose and treat infertility.

Reproductive endocrinologists are highly specialized physicians who focus on diagnosing and treating disorders related to reproduction and infertility. The path to becoming a reproductive endocrinologist involves extensive education and training. Here’s a detailed overview:

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO): After earning a bachelor’s degree, aspiring reproductive endocrinologists must complete a four-year medical school program. The curriculum includes:

Residency in Obstetrics and Gynecology (Most RE’s are OB/GYNs first but beware an OB/GYN is not a fertility specialist.)

Obstetrics and Gynecology (OB-GYN) Residency: Following medical school, the next step is a four-year residency program in obstetrics and gynecology. This residency provides comprehensive training in:

• General Obstetrics: Care of pregnant women, delivery of babies, and postpartum care.
• General Gynecology: Diagnosis and treatment of disorders of the female reproductive system.
• Surgical Training: Performing gynecologic surgeries, including minimally invasive procedures.

During the OB-GYN residency, doctors gain experience in managing a wide range of reproductive health issues, preparing them for specialized training in reproductive endocrinology.

Board Certification in Obstetrics and Gynecology: After completing their OB-GYN residency, physicians must pass a rigorous examination to become board-certified in obstetrics and gynecology by the American Board of Obstetrics and Gynecology (ABOG).

The Key:  A Three-year Fellowship in Reproductive Endocrinology and Infertility

Reproductive Endocrinology and Infertility (REI) Fellowship: After completing an OB-GYN residency, physicians must undergo a three-year fellowship in reproductive endocrinology and infertility. The fellowship focuses on advanced training in:

• Hormonal Disorders: Diagnosing and treating endocrine disorders affecting reproduction.
• Infertility Treatments: Including in vitro fertilization (IVF), intrauterine insemination (IUI), and other assisted reproductive technologies (ART).
• Reproductive Surgery: Advanced surgical techniques for treating reproductive system disorders.
• Research: Conducting and analyzing research related to reproductive health and infertility.

Fellows work closely with experienced reproductive endocrinologists, gaining in-depth knowledge and hands-on experience in managing complex fertility issues.

Board Certification

Subspecialty Certification in Reproductive Endocrinology and Infertility: After completing the REI fellowship, physicians must pass an additional examination to become board-certified in reproductive endocrinology and infertility by ABOG. Visit the Society of Reproductive Endocrinology and Infertility.

Continuing Education and Professional Development

Continuing Medical Education (CME): Reproductive endocrinologists must engage in ongoing education to stay current with the latest advancements in their field. This includes attending conferences, participating in workshops, and completing CME courses.

Professional Organizations: Many reproductive endocrinologists are members of professional organizations such as the American Society for Reproductive Medicine (ASRM), which provides resources, guidelines, and continuing education opportunities.

When to See Them: If you are under 30 and trying to conceive for a year or more without success, or if you experienced 2 or more miscarriages, seek specialized professional help with a reproductive endocrinologist.

When to See Them: If you are struggling with the emotional impact of infertility and loss, or if you need support to navigate the psychological challenges of treatment.

Fertility Under 30

Peak Fertility Period: The 20s are generally considered the peak fertility years for women. During this time, the body is most biologically prepared for conception and pregnancy.

Egg Quality and Quantity: Women in their 20s typically have a higher quantity of healthy eggs. The risk of chromosomal abnormalities in eggs is lower, which translates to a higher chance of successful conception and a healthy pregnancy.

Higher Success Rates: Fertility treatments such as in vitro fertilization (IVF) tend to be more successful for women under 30. The chances of conceiving within a year of trying are about 75-80%.

Health Considerations: Generally, younger women are less likely to have chronic health conditions that can impact fertility, such as high blood pressure or diabetes.

Fertility Over 30

Gradual Decline: Fertility begins to decline gradually in the early 30s, with a more significant decline after the age of 34. This is due to a decrease in both the quantity and quality of eggs.

Increased Risk of Complications: Women over 30, especially those over 35, face a higher risk of complications such as miscarriage, chromosomal abnormalities, and pregnancy-related health issues like gestational diabetes and hypertension.

Extended Time to Conceive: The likelihood of conceiving within a year decreases to about 65-70% for women in their early 30s, and to about 45-50% for women in their late 30s.

Success Rates of Fertility Treatments: While fertility treatments can still be effective, success rates generally decrease with age. For instance, IVF success rates drop as women age, though they can still provide viable options for conception.

Male Fertility: It’s important to note that while men’s fertility also declines with age, the decline is more gradual compared to women. Sperm quality, including motility and genetic integrity, can be affected as men age, potentially influencing conception and pregnancy outcomes.

Psychologist or Counselor Specializing in Infertility and Loss

Who They Are: Mental health professionals with expertise in dealing with the emotional aspects of infertility and pregnancy loss.

What They Do: They provide counseling and support to help manage the emotional stress, anxiety, and grief associated with recurrent pregnancy loss. They offer coping strategies and therapeutic interventions to improve mental well-being.

While the journey through infertility and pregnancy loss can be fraught with challenges, advancements in medical research and personalized treatment options offer hope. By understanding the potential causes, especially the role of reproductive immunology, and following best practices, you can navigate this journey with greater confidence and support. Remember, you are not alone, and seeking help from specialists and support networks can make a significant difference. Do your homework and be sure when picking a clinic you find a reproductive endocrinologist that will work in a partnership to help you achieve your goal of building your family.