Miscarriage

Is the traffic outside affecting your chances of having a baby?

Living near a highway and IVF pregnancy rates: Princeton IVF blog
Women who live in high traffic areas are more likely to miscarry

Living in a high traffic area may hurt your chances for success with IVF

Research from Harvard presented at the annual meeting of the American Society for Reproductive Medicine suggests that women with a higher exposure to automotive traffic have lower IVF success rates than other women.

The researchers looked at 660 IVF cycles done over a 14 year period and compared their success rates to  how far they lived from a class A roadway. A class A roadway means an interstate, state or US highway. 

Women who lived more than a kilometer (0.6 miles) from a major roadway were 70% more likely to have a baby than those who lived within 200 meters (about 2 football fields) of a major roadway.

Interestingly, both groups of patients had similar pregnancy rates, but the those who live closed to the highway were more likely to miscarry.

Does this mean moving to a low traffic area will improve your chances  of having a baby?

Not necessarily. It does show what we already know, that the environment we live in and the air we breathe plays a role in reproduction, as it does in other aspects of health.

 

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.

Is it possible to stop the biological clock?

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Today, age is the most important determinant of woman's ability to conceive both naturally and with treatments such as IVF, but might it be possible to overcome the "biologic clock"? 

It is has been understood for many years that a woman is born with all the eggs she will ever produce and that she begins to lose eggs even before she is born. The eggs seem to work reasonably well into the early 30's but in the late 30's  and particularly in the 40's the number and quality of those eggs diminish considerably. We know that most if not all of that drop is the result of abnormal chromosomes in the eggs and when genetically abnormal eggs fertilize they produce genetically abnormal embryos. Most genetically abnormal embryos will not implant in the womb, and if they do, they usually miscarry.

These abnormal eggs result from errors in a process call meiosis. If this sounds familiar from high school biology, it is. Meiosis is the process by which reproductive stem cells produce eggs and sperm for reproduction. Most scientists nowadays believe that these errors result, at least in part, from a lack of the energy needed to divide the chromosomes properly, and that energy comes from cell's natural batteries, the mitochondria.

Now, a biotech company has come up with a technique to transfer fresh young, energy-rich mitochondria into a woman's eggs, and has even achieved a live birth with it. Sounds like a miracle cure? Maybe, maybe not.  If proven successful and safe, it has the potential to revolutionize IVF treatment for women over 35 and extend the age at which non-donor IVF may be successful. Still, don't expect to see it an IVF clinic near you any time soon. First, we do not know how effective this technique really is and most importantly whether it results in healthy children. The technology involves cloning technology and "3-parent IVF," and it is unlikely that will get past regulatory agencies here in the US anytime soon.

 

Endometriosis and pregnancy complications

endometriosis-miscarriage-ectopic-preterm.jpg

It is well known that women who suffer from infertility and become pregnant are more like to have a difficult pregnancy. The rates of a number of pregnancy complications are increased in these women even if the pregnancy was not the result of treatment such as fertility drugs, IVF or IUI.  It is also widely known that endometriosis may cause infertility.  What is less clear is whether is there is a relationship between endometriosis and pregnancy complications.

Now a group from the UK has studied the link  between the two and found that women with endometriosis in fact do have higher rates of pregnancy complications than other women. Their findings were presented at  The European Society of Human Reproduction and Embryology . They found that that pregnant Endometriosis patients were more likely to experience:

  • Ectopic pregnancy 
  • Miscarriage 
  • Placenta previa 
  • Preterm birth  
  • Heavy bleeding before or after birth  

While the study may be small and limited, it does suggest that like infertility, endometriosis in itself may be a risk factor for a complicated pregnancy.