Fertility Q&A: What Should You Do If You’ve Had Multiple Miscarriages?

It took Amy Klein three years, four miscarriages, and 10 doctors in three countries to finally get pregnant and have a baby. During that lonely and isolating time, she went through nearly every treatment available and chronicled the experience in The New York Times' Motherlode blog. Hundreds of people have written to her with questions about conceiving, IVF, surrogacy, egg donation, adoption, and everything related to baby-making. She’ll be answering some of those questions for Refinery29 — and welcomes yours as well. (Send emails to dearfertilelady@gmail.com) Q: I’ve had three miscarriages and am at the end of my rope. Doctors tell me to “keep trying,” but I can’t handle another pregnancy gone wrong. What should I do?

A. Oh, do I hear you.

I got pregnant twice, naturally, and after my second miscarriage, I knew there was something wrong with me. We’d already heard the baby’s heartbeat, and on a routine checkup at nine weeks, they discovered it had just stopped. It was the most awful moment of my life.

After that, I went to an IVF clinic, and the doctor started me on the road to fertility treatment.

But IVF was the wrong road for me. Another two years of treatment, another two miscarriages — one with a donor egg! — told me what I suspected from the start: It wasn’t my eggs; it was me.

Shortly after I had the D&C to remove my fourth miscarriage, a doc at the fertility clinic sneered, “Are you going to go to a ‘reproductive immunologist’ now?” He actually used his fingers to make the quotation marks, underscoring his disdain for this emerging new field of doctors who treat women with recurrent pregnancy loss (RPL).

His advice? “Keep trying.” He was lucky we were out of surgery, because I would have taken the forceps and done something drastic. I couldn’t help being angry about how many of these male doctors seemed to have no clue what it feels like, physically, to lose a baby. (Not even my husband, who was devastated by all our losses, could feel the abysmally low hormonal drops, the five-pound weight gain each time, and the pulsating scars inside where the babies had been.)

I came away from that experience mad enough to research reproductive immunologists, who believe that the body can reject pregnancies the way that it does organ donations, and who work to suppress your immune system to tolerate the “foreign” embryo.

Miscarriages are more common than people realize. Statistics vary, but between 10 and 25% of all pregnancies result in loss, according to the American Pregnancy Association, primarily in the first trimester, most often due to chromosomal abnormalities. Women under 35 have about a 15% chance, whereas women ages 35 to 45 have a 20-35% chance. The American Pregnancy Association says that “a woman who has had a previous miscarriage has a 25% chance of having another (only a slightly more elevated risk than someone who has not had a previous miscarriage).”

That’s why doctors are quick to say, “Keep trying.”

But if you’ve had two clinical losses (a pregnancy after five to six weeks, confirmed by ultrasound), it’s considered RPL according to The American Society of Reproductive Medicine. And according to the Mayo Clinic, the risk of miscarriage increases if you’ve had multiple miscarriages.

That said, there’s a “catastrophic misunderstanding” of miscarriage statistics, says Jeffrey Braverman, MD of Braverman Reproductive Immunology, because they’re all lumped together. “Euploid losses [miscarriages that were chromosomally normal] and certain recurring aneuploid losses [miscarriages that were chromosomally abnormal due to bad eggs] have totally different mechanisms for loss,” he explained. Translation: Miscarriage is more complicated than it seems.

So when is it time to consider looking for a doctor who specialises in repeat miscarriage?

“If you’ve had more than two miscarriages before a fetal heartbeat was detected that do not appear to be age-dependent, you should contact [a specialist],” Dr. Braverman says. It’s also worth seeking treatment “if you’re over 41 years old and the loss was genetically normal, or any miscarriage where there was already a heartbeat,” he said. Anyone with a history of autoimmune disease, endometriosis, or preeclampsia who has suffered a miscarriage might also need treatment. Dr. Braverman also suggests you test every miscarriage to know if the embryo was chromosomally normal.

Listen, I know the last thing you want to do at this point is go to another doctor and run a whole new battery of tests (expensive tests and treatment, I might add), but you want someone who understands your situation to be monitoring your next pregnancy with the expertise and sensitivity that recurrent miscarriages require.

“Many safe therapies are available to treat the immune issues related to these complications,” Dr. Braverman said. “It’s better than the ‘keep trying’ method.”

And if you want to stop trying, just be completely done with the baby-making process, I understand that feeling, too. I was there a zillion times, wanting it to be over, one way or another, baby or no baby: no more pills down the hatch, needles in my thighs, ultrasounds up my vagina. Just finito. That’s a road that plenty of couples take — a road on which they end up finding happiness, too.

I had to give it one last shot, though, with the immune suppression treatment. The result is my nine-month-old daughter. She was my fifth pregnancy.