Advances: Medical News for Patients

Treatment options for infertility and recurrent pregnancy loss

couple frustrated at pregnancy testMany women find joy in the ability to conceive, carry a pregnancy and, after nine months, deliver a healthy baby. But there are times when complications arise that can derail this natural process, ones that carry with them a heavy emotional toll.

“A woman may discover that she cannot conceive, or if she can, she cannot carry the baby to term, resulting in miscarriage,” says Dr. Rachel A. McConnell, an OB/GYN with ColumbiaDoctors, the faculty practice of Columbia University Medical Center, who sees patients in the Scarsdale office of NewYork-Presbyterian Medical Group Westchester.  “When a woman cannot bear children, it can tremendously affect her identity. Conditions such as infertility or multiple miscarriages can result in everything from depression to anxiety to tensions in her romantic relationship.

Infertility: A closer look

Age remains the primary risk factor for infertility. Women who are older (age 35 and up) will have difficulty getting pregnant due to decreased egg count and quality.  Yet there are other common reasons for infertility, notes Dr. McConnell, who specializes in Reproductive Endocrinology and Infertility, “including blockage of the fallopian tube, where the egg is not able to travel to the uterus; damage to the uterine cavity such that implantation of the embryo cannot occur, and hormones. Problems of the thyroid, pituitary and hypothalamus can result in hormonal imbalances manifesting in irregular periods that can interfere with ovulation. But the fact remains that there are many conditions that can cause infertility — sometimes related to the woman, sometimes the man, and sometimes both, which is why it’s important for both partners to have a full medical workup.”

Infertility may be temporary, especially in cases of hormonal imbalance. When medically treated, future pregnancies can occur naturally, or sometimes can be treated with surgical repair of reproductive organs.

“Another option is in-vitro fertilization or IVF, where the woman's eggs are surgically removed from the ovaries, mixed with sperm outside the body, and allowed to fertilize before the embryo is transferred back into the uterus. The chances of pregnancy are greatly increased using IVF,” says Dr. McConnell. “Donor eggs are another option, as is egg freezing for women who want or need to delay childbearing due to education goals, careers and other personal matters.” She advises that women who are in their prime reproductive years (20s and early 30s) should have discussions with their gynecologist about tests that can help them assess their ovarian reserve and discuss options if or when they should consider egg freezing.

Recurrent pregnancy loss: A closer look

Recurrent pregnancy loss is defined as having two or more miscarriages. Like infertility, this too can be due to a number of factors. However, in about 40-50 percent of cases, the cause of recurrent pregnancy losses is unknown.  Many early miscarriages are due to genetic abnormalities of the fetus as a result of advanced maternal age. In addition, explains Dr. McConnell, “Some women might be born with an irregularly shaped uterus, and some women may develop abnormalities such as uterine fibroids that can cause a miscarriage. Also at increased risk are women who have untreated diabetes, thyroid disease, and abnormalities of the immune and/or vascular system (clotting system).”

If a woman has experienced more than two miscarriages, she should consult with her OB/GYN or get a referral to a fertility specialist to help narrow down possible causes and determine what can be done to hopefully prevent future losses.  In some cases, testing can help doctors identify the underlying cause, so that appropriate treatment can be administered to rectify the problem.

“The good news is that there are some treatment options for women suffering from infertility and recurrent pregnancy loss. Even if a woman has endured three pregnancy losses, she may still be able to conceive and have a child.  By working closely with her doctor, and with the right support, she will be able to experience what many other women successfully do — conceive, carry a pregnancy and ultimately, deliver a healthy baby.”

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