Understanding Miscarriage: A Holistic and Integrative Approach to Recurrent Pregnancy Loss
When you are faced with living through a miscarriage, it can be a lonely and grief filled time. And then your second miscarriage happens. And then your third. That grief moves from sadness and emptiness to hopelessness. Often at this point, women and their partners are offered testing to rule out genetic causes, and you may have had testing to determine if there were chromosomal abnormalities of your baby. That may be the extend of similarities women experience throughout this journey, however. Every woman I talk with had different tests run, was told different information, and some, unfortunately, were given no guidance or offered any testing. Integrative and functional medicine, however, embark on a more comprehensive, holistic journey towards understanding and resolving the mysteries of recurrent miscarriages. This fertility-focused approach delves deeper, exploring a broader spectrum of causes and treatments beyond generic genetic tests. It encourages a supportive dialogue, aiming to equip women with meaningful insights and options in their pursuit of motherhood.
Maybe you heard what I did, “We don’t start testing until you’ve lost three or more pregnancies.” “These things just happen. I’m sorry.” “Just make sure you’re taking your prenatal.”
If you want additional information and the provider you are asking for help from tells you anything like that, find someone else.
There is a lot to say about root cause investigations for recurrent pregnancy loss. Today, I want to focus on patterns you may be seeing about when your pregnancy loss is occurring. This is not an exhaustive list, but the most common causes of “unexplained" miscarriage by week. I am leaving out chromosomal and genetic causes, but know that those do contribute to early pregnancy loss through usually the 8th or 9th week.
Miscarriage by Week
Weeks 4-6
The Early Foundations ~ During these initial weeks, an egg has to go from fertilization to implantation. Chromosomal and genetic factors are primary causes of single miscarriages, but when dealing with recurrence, it’s time to look under the surface:
Hormonal Imbalances: Progesterone and estrogen set the stage. Any imbalance can disrupt the delicate process unfolding within.
Endometrial Lining Issues: A supportive environment is crucial. Inflammation or a thin lining can hamper the embryo's ability to thrive.
Luteal Phase Defects and Uterine Abnormalities: These can interfere with the essential early stages, hindering the pregnancy’s progression.
Deep Dive: At this stage, the fertilized egg completing implantation and the initiation of vital organ formation, with the heart beginning its first beats. The corpus luteum stands as a guardian, producing hormones necessary for the pregnancy to continue.
Weeks 7-8
A Time of Continuation and Growth ~ These weeks are marked by the embryo's continued growth and the vital process of organ development.
Autoimmunity: Conditions like anti phospholipid syndrome (APS) and thyroiditis can cast shadows on this phase, introducing elements of risk and uncertainty.
Infections and Toxin Exposures: The vulnerability during these weeks is heightened by external factors, which can jeopardize the pregnancy’s wellbeing.
Deep Dive: The corpus luteum continues its role, releasing progesterone to nourish the ongoing journey of pregnancy. Corpus luteum defects remain a concern now. If autoimmunity is suspected, you need to reach out for additional testing.
Weeks 9-10 and Beyond
The Placental Passage ~ This period witnesses a significant transition, with the placenta assuming a central role. Some examples are:
Endometrial Inflammation and Structural Abnormalities: These aspects can pose challenges, affecting the environment in which the pregnancy is unfolding.
Autoimmunity and Blood Clotting Disorders: Carried from weeks 7and 8, such conditions can impact the essential life-sustaining blood flow to the pregnancy.
Deep Dive: With the placenta taking over around 8-10 weeks, investigating any factors that could affect its functioning and the overall progression is crucial. Again, if autoimmunity or blood clotting disorder is suspected, please seek a specialists help in further evaluation.
When Faced with Unexplained Recurrent Pregnancy Loss
Unexplained infertility factors can directly impact egg quality and the likelihood of miscarriage, too. Key contributors include metabolic dysfunction, which hampers the body’s normal processes, and autoimmunity or immune dysfunction, which creates internal conflicts that can hinder pregnancy. Additionally, energy and mitochondrial dysfunction can lead to cellular fatigue, affecting the egg's vitality. Inflammation, too, acts as a subtle adversary, potentially disrupting the environment necessary for a healthy pregnancy. Recognizing and addressing these factors is crucial in improving the chances of a successful pregnancy.
Wrapping Up
Some of these reasons are out of our hands, such as chromosomal abnormalities. And often, we can never pinpoint the exact cause. When dealing with recurrent pregnancy loss, if you can identify a pattern of when they are happening, it might give you a clue as to what the next best step will be on your road to healing and a healthy conception. Depending on the weeks of recurring loss, you may benefit from seeing a reproductive immunologist or hematologist for additional testing, as I listed above.
Remember, answers don’t all come packaged in a box with a bow. Integrative medicine can help us remember that you are at the center of your condition, and that you are MORE than what you’re experiencing. The investigative process can be messy, and HARD, but having someone on your team who understands that and can support and guide you will be key to feeling empowered. This is not to say that your miscarriage could have been prevented. You cannot go down the “What If” road here. I am speaking directly to the woman who is searching for answers to prevent her next pregnancy from ending in miscarriage. I am here for you. I understand. Because I am you.