Sunday, 26 October 2014

Miscarriages - blessing or curse ??


 

Being an Infertility specialist and gynecologist for more than a decade, I have been lucky to witness the joy of a mother when she held her baby for the first time, but I also had to shed tears with heartbroken women when they lost their baby prematurely due to miscarriage.



The excitement and joy experienced by a couple, when they see a second line on UPT kit is no less than winning a marathon. But sometimes this joy is short lived and all their hopes are shattered by miscarriage or a scan report which indicates lack of growth of the  baby. As doctors, one of the toughest part of our job is to explain this to the patients, especially when it happens repeatedly. The sad and devastating look on the face of the aspiring mother  and the aggressive attitude of the spouse are both difficult to deal with.

It is shocking that miscarriage occurs in one out of every three pregnancies and many a times it happens before the detection of pregnancy and goes unnoticed. It is more common in sub fertile couple and women with PCOS, so infertility specialists have to deal with it frequently. I am  sharing some facts regarding the common  causes for miscarriages. 



In most cases, the baby stops growing because the foetus  is not normal enough to continue to grow.   (none of the foetus are perfect, but most of them are viable).The mother nature is actually blessing us by stopping such pregnancy to grow, as it may  have ended up in either physically or mentally abnormal child  who might have later died in an advanced pregnancy stage  or in  early childhood. Our  body is selective and often recognise that the embryo is genetically abnormal, so the uterus does not allow it to grow.  (uterus is apparently a huge lab where genetics is recognised ). Thus 60 % or more miscarriages happens due to genetic problems  with the embryo, due to the  abnormal eggs/ sperms or both.

In some cases, there can be  problems in blood circulation, like clot formation, which can cause blocks in the normal circulation of the tiny embryo resulting  in cessation of foetal heart beat. This condition can be screened in labs by doing certain blood tests during non pregnant stage and are called APLA screening (anti phospholipid screening) . Women who are found   positive are treated with blood thinning agents like aspirin and heparin injections ( low molecular weight heparin ) which gives successful results.

Autoimmune disorders like thyroiditis and many undiagnosed disorders can result in repeated miscarriages and medical treatment with steroid may have benefit in confirmed cases. Steroids should not be given without proper indication as they have lot of side effects.

Some acute viral infections can trigger a miscarriage, but  not a very common cause. The child might become abnormal because of foetal infection.

Hormonal problems, as in PCOS  charecterised by high circulating estrogen or lack of luteal support because of low progesterone is also a reason for  miscarriages in a very small percentage of women . Pumping  women with hormones is not needed to treat this. Best treatment for PCOS is diet and exercise and change in life style.http://bangaloreivf.blogspot.ae/2014/09/low-glycemic-food-chart-for-pcos.html http://bangaloreivf.blogspot.ae/2014/08/dr.html


 

There are abnormalities of reproductive organs, like uterus or cervix, which causes miscarriages in some women, which is again only a negligible percentage and screening in the form of scanning is sufficient to diagnose  in most of the cases. Surrogacy can be a good option for in-correctable cases.

It can be inferred that, the common determinant  for the mishap is invariably genetic abnormality. So if we look at it positively, these miscarriages are  a blessing rather than a curse.  Proper tests must be done by checking chromosomal analysis of husband and wife and the dead foetus to diagnose the cause correctly. If genetic abnormalities are there in one parent or both the parents, it is better to opt for Donor egg or sperm or both and you will be blessed with a  healthy baby.



Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com

Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.

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