Miscarriage

Losing weight before conception

Weight loss before baby: Princeton IVF blog
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This time of year is a time when many couples who are having trouble conceiving decide it’s time to start seeking help. That help could come from the OBGYN, a midwife or a fertility specialist. It’s also a time in the year, after indulging during the holidays, when many of us have a few extra pounds to shed.

For those who are overweight, part of that advice will be to lose weight before conception.

While this may not be easy, there are multiple reasons why weight loss before pregnancy is good advice.

  • Being overweight will reduce the chances of you getting pregnant on your own

  • Being overweight will increase the chances that if you do get pregnant, you will miscarry

  • Being overweight will increase the chances of medical complications during pregnancy such as diabetes and high blood pressure.

  • While diet and exercise during pregnancy can help limit weight gain during pregnancy, it is not likely to reduce the likelihood of pregnancy-related complications such as diabetes and hypertension.

Delaying pregnancy and excess weight are both bad for fertility, so delaying pregnancy for weight loss is balancing two risks.

At what point do the risks of delaying pregnancy offset the benefits of weight loss?

  • According to a recent study presented at the American Society for Reproductive Medicine, women in their late 30’s or those have poor ovarian reserve may be best off not delaying childbearing despite the obvious benefits.

Pain medicine and miscarriage

NSAIDS and miscarriage risk: Princeton IVF blog

Opioid pain medications are making all the headlines, but are over the counter pain medications really safe?


New research suggests that taking over the counter pain meds could increase the risk of miscarriage.

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California researchers tried to determine whether using over the counter pain medications such as acetominophen (Tylenol) and non steroidal anti-inflammatories ( such as ibuprofen, Motrin or Advil) might affect the risk of miscarriage. They studied almost 1100 pregnant women, comparing those women who took no pain medications to those who took acetaminophen, those who took non-steroidal and those who took both.

What they found was interesting…

  • Women who took tylenol or NSAIDs such as ibuprofen were more likely to miscarry that those who did not

  • Taking this medications around ovulation appeared to be the riskiest

  • Women who used these drugs for longer periods of time were at the greatest risk

  • Thin women were more at risk than overweight women

So, what does this all mean…

  • It does not mean that over the counter pain medications actually cause miscarriages, just that women who take them for whatever reason are more likely to miscarry.

  • It is a good idea to avoid Tylenol, Motrin, Alleve and other over the counter pain medications around the time of ovulation is you are trying to have a baby

Can having a miscarriage increase your chances of having a baby?

Miscarriage after IVF may mean a better chance for future baby

An unsuccessful IVF cycle can be downright devastating to couples going through fertility treatments, particularly when the cycle results in a miscarriage. Between the guilt, the disappointment and the "if I only had's," many couples leave the experience totally devastated.  But are those concerns really warranted?

Probably not.

Fertility specialists have known for years that women who miscarry, are actually more likely to have a baby, even though most patients are a understandably somewhat skeptical about this.

To look further into this fertility specialists at the University of Aberdeen in Scotland looked at well over 100,000 IVF treatment cycles performed between 1999 and 2008. They were particularly interested in women who had a first cycle at that was unsuccessful, whether that was there was a miscarriage or no pregnancy at all. What they found was not surprising considering what we already know.

Women who had miscarried had a higher 49% chance of livebirth in the subsequent IVF cycle as compared to only a 30.1% chance had the first cycle not resulted in a pregnancy.

So, what does this all mean? 

  • Don't be in a rush to give up. Lots of women conceive on subsequent cycles.
  • Having a miscarriage from IVF, and likely from other treatments, means you are more likely to have a baby, not less likely.

Caffeine, vitamins and miscarriage

Can caffeine affect your miscarriage risk: Princeton IVF blog
Caffeinated beverages and risk of miscarriage

It may be time to cut back on coffee before pregnancy...

An new study from the National Institutes of Health suggests that the morning pilgrimage to Starbucks, Dunkin Donuts or your favorite coffee may not be such a good idea, at least if you or your partner are trying to get pregnant.  In the past, it was thought that small amounts of caffeine intake were not an issue, but researchers have now found that the as little as 2 drinks a day may almost double the risk of a pregnancy ending in miscarriage. Furthermore, this risk was present not just during pregnancy but when a woman drinks caffeinated beverages even several months before conception, and was even true when the male partner consumes caffeinated drinks. The risk of miscarriage was just as high when the male partner used caffeine.

So, does that mean caffeine causes miscarriages?

Not necessarily. The study was small so this could just be a statistical fluke and it is quite possible that people who drink more coffee have other unrelated issues that make them more prone to miscarriage.  Still, prudence would suggest  avoiding caffeinated beverages such as coffee, tea and soda are a good idea when planning pregnancy.

But, there is a bright side to the study...Vitamins.

It turns out that women who took multivitamins actually had a lower miscarriage risk, by about 50 %.

Endometriosis and pregnancy outcomes

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Can endometriosis affect the chances for a successful pregnancy?

A new study from Scotland suggests that it may. It has been known for years that endometriosis can cause infertility, but it was less clear was whether it might affect the outcomes of those who do successfully conceive.

For those who are unfamiliar, endometriosis is a condition in which tissue resembling the endometrium (the lining of the uterus) grows in places where it does not normally belong such as as on the ovary, near the fallopian tubes or in other parts in the peritoneal membrane that lines the pelvis. Besides affecting fertility, endometriosis can result in painful menses (dysmenorrhea) and painful intercourse (dyspareunia). The symptoms of endometriosis are often cyclic, fluctuating along with a woman's reproductive hormones.

In a large study presented at the ESHRE meeting in Lisbon, the group from Edinburgh in the UK, reported that women who with known endometriosis were more likely to have miscarriages and ectopic pregnancies that those who did not. While this does not prove that endometriosis causes poor pregnancy outcomes, it does suggest that women with endometriosis are more likely to experience an early pregnancy loss or ectopic pregnancy.

Miscarriages and misperceptions

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A recent survey published in Obstetrics and Gynecology suggests most of the public is poorly informed about how common miscarriage is and what causes early pregnancy losses.

First the good news. Most folks' perception is actually worse than reality, and most respondents identified genetic abnormalities as the most common cause for miscarriage.  As a reproductive medicine specialist, these misunderstandings come as no surprise. Here are some of the misperceptions the surveyors found...

10-15% of pregnancies end in miscarriage, but ...

  • Most respondents believe miscarriages are rare (< 6%)

Stressful life events, lifting heavy objects and prior IUD or birth control pill use do not miscarriages but..

  • 76 % believed that stress causes miscarriages
  • 64 % believed that lifting heavy object can cause miscarriages
  • 28 % believed that prior IUD use (Mirena, Paraguard) can cause miscarriages
  • 22 % believed that prior birth control pills can cause miscarriages

The take home message from the study is that many couples attribute their pregnancy losses to factors within their control even though this is rarely the case, and counseling is the solution.