Up until last year, I considered myself one of the lucky ones. Despite going through several failed IUIs and a round of IVF to conceive my twins, I had never experienced pregnancy loss — until recently.
I have had two failed embryo transfers and two miscarriages in the past year. My first loss was, technically speaking, a chemical pregnancy — my hCG levels came back low nine days post-embryo transfer, and blood work a few days later confirmed the pregnancy was not viable. Despite it being so “early on” in my pregnancy, it was emotionally devastating.
After getting a positive pregnancy test at home, the excitement was palpable. We started calculating our due date and thinking of baby names! Then, suddenly, it was over before it had even begun.
My more recent miscarriage was different. We had transferred an embryo rated as “normal” with preimplantation genetic testing for aneuploidy (PGT-A). My beta hCG levels were doubling appropriately. We saw a gestational sac during our 5-week ultrasound. Then, at six weeks, we saw nothing. No yolk sac, no fetal pole — just an empty sac. A ‘blighted ovum.’ We were (and still are) heartbroken.
Questions to Ask After a Miscarriage
When you experience a pregnancy loss, the moments after the doctor says, “I’m sorry, but there’s no heartbeat,” are a blur. Even if you did all of your research before that point, it’s almost impossible to remember what questions to ask while your heart is breaking in two.
But there are things you should consider asking your healthcare provider once you have a chance to regroup. Here are some common questions you might want to ask after suffering a miscarriage:
1. What might have caused my miscarriage?
1 in 4 known pregnancies ends in miscarriage, but just because pregnancy loss is common, that doesn’t make it any less heartbreaking for anyone who experiences it. In the aftermath of a pregnancy loss, it’s normal to wonder what you could have done differently; but the truth is, the answer is nothing. You didn’t cause your miscarriage, nor could you have prevented it.
50-60% of miscarriages in the first trimester are due to chromosomal abnormalities in the embryo, which are random and become increasingly more likely as women age and egg quality declines. Other common causes include things like blood clotting disorders, uterine structural anomalies, inherited genetic abnormalities, infection, or underlying medical conditions like thyroid disease or diabetes.
So, while it’s no less devastating, please know that your miscarriage was unequivocally not your fault.
2. What can I expect during a miscarriage?
While mild menstrual-like cramping and spotting are normal in early pregnancy, increased bleeding and pain is not. According to Double Board Certified Reproductive Endocrinologist & Infertility Specialist Dr. Roohi Jeelani of Kindbody, “usually miscarriages feel like strong cramps accompanied with heavy bleeding.” If that describes what you are experiencing, be sure to consult with your healthcare provider immediately.
If you get the devastating news that you’re miscarrying, there are a few different management options. The first is “expectant” management, which means waiting for your body to recognize the pregnancy as unviable and pass the tissue on its own. The second is “medical” management, where a medication like misoprostol can assist your body in expelling the pregnancy. The third is “surgical” removal of the pregnancy through dilation and curettage (D&C).
While none of these options are easy (physically or emotionally), there are pros and cons to each. Talk with your doctor about the risks and benefits before ultimately deciding which one feels right for you. Don’t forget to take care of yourself during this time.
3. What are my chances of having another miscarriage?
Because miscarriage is so common, many people will experience one. The good news is that 95% of those people will not have a second consecutive loss. Trying to conceive after a miscarriage can be scary, but statistically speaking, the chances are good that if you’ve had one miscarriage, history will most likely not repeat itself.
However, Dr. Jeelani explains, “The risk of miscarriage goes up when you have had two or more consecutive losses. Increased odds of miscarriage also go hand in hand with age; the older a woman is, the higher the risk of the chromosomal abnormalities that can lead to pregnancy loss.” If you’ve had more than one loss, your healthcare provider may recommend additional testing to learn if there is an underlying issue.
4. What testing do you recommend after pregnancy loss?
After experiencing a miscarriage, you may feel that more answers are needed to give you peace of mind before trying again. If you are in the 5% of people that have had two or more losses, advanced testing is definitely warranted.
Dr. Jeelani says, “I usually offer chromosomal testing to my patients on the miscarriage [products of conception], using kits such as Anora™.” By examining the tissue from the pregnancy loss, the Anora™ miscarriage test looks for chromosomal abnormalities and can help determine why a miscarriage occurred. Results are typically returned to your doctor within one week.
In addition to Anora™, for patients with Recurrent Pregnancy Loss – defined as two or more miscarriages – Dr. Jeelani says she offers further testing “to look for autoimmune conditions, endocrine hormones like thyroid, and structural causes like a uterine septum.”
5. How long should we wait before trying again?
While well-meaning friends and family members might tell you, “You can always try again,” it’s important to wait until you’re emotionally ready to do so. Everyone grieves differently, and it is an extremely personal decision whether to jump right back in or give yourself time to heal before pushing forward.
If you’re the type of person who doesn’t want to skip a beat, Dr. Jeelani emphasizes, “There is usually no need to wait to begin trying again after a miscarriage. Physically, you can begin trying the following cycle.”
Miscarriage: You Are Not Alone
Historically, there has been a lot of shame and embarrassment associated with pregnancy loss. Miscarriage is the club that no one wants to be a part of, but once you start talking about it, you quickly realize that you are far from alone. Getting answers can help you find peace during this time, but ultimately you are the only one who can decide when is the “right” time to begin trying again. Take all of the time you need to grieve; and in the meantime, the Rescripted community is here to support you every step of the way.
Natera offers Anora™ Miscarriage Test (POC), a highly comprehensive test that helps determine the cause of a miscarriage. To learn more about Anora and request a kit, visit www.natera.com/request-anora-kit/.