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Miscarriage/Unexplained Recurrent Pregnancy Loss

In most first trimester miscarriages, the vast majority of lost fetuses have chromosomal abnormalities, reports Reproductive Endocrinologist Serena Chen, M.D., Director of egg donation at the Institute. Approximately four percent of the population will experience unexplained recurrent miscarriages, defined as three or more pregnancy losses. In women 35 and older, approximately 35 percent of pregnancies are miscarried.

After two or three miscarriages, couples often have no explanation for the continued loss, especially when both partners have had their chromosomes analyzed and no abnormalities were found. Even when both partners have normal chromosomal alignment, says Dr. Chen, a fetus can be produced with abnormal numbers of chromosomes, a condition called aneuploidy. In the body’s relatively complicated process of making eggs, sometimes mistakes are made; and the bodies of some individuals may make these same mistakes on a regular basis. If an error occurs that leads to the egg or sperm having an extra or missing chromosome, the resulting embryo will also carry the error.

Institute Pioneers Revolutionary Treatment for Unexplained Recurrent Pregnancy Loss

Livingston, N.J.—A couple experiences the joy of pregnancy, only to suffer a devastating loss five weeks later when a miscarriage occurs. Still grieving, they become pregnant six months later. Their excitement is tempered by fear of another loss, and tragically, another miscarriage happens at the four-week point. When yet another unexplained miscarriage occurs months later, the couple is grief stricken and unsure if they are emotionally equipped to handle any further pregnancy losses.

Now, a procedure called preimplantation genetic diagnosis (pgd) offers hope of normal pregnancy to women who have experienced the anguish of unexplained recurrent miscarriage in the first trimester. At the Institute for Reproductive Medicine and Science at Saint Barnabas Medical Center, the rate of future miscarriage in women who have experienced repeated miscarriage was reduced significantly after pgd, from 23 percent to 9 percent.

The Institute is one of the major centers for PGD in the world. Director of Implantation and Genetics, Santiago Munne, Ph.D., who performed the procedure more than 400 times last year, is one of the leading pioneers of PGD in the world.

PGD is performed after a couple has created embryos through in vitro fertilization. Before implanting the embryos, physicians at the Institute test a single cell from each embryo for a variety of conditions. They then implant in the woman’s womb only those embryos which appear to be chromosomally normal.

Repeated Loss, Repeated Pain

For women who suffer unexplained recurrent miscarriages, the mystery of the situation is often compounded by both misinformation and a sense of helplessness.

“Most patients are told to just keep trying, but often this is a painful situation fraught with grief over the losses,” says Dr. Chen. “Couples may become frustrated or be offered treatments with no legitimate scientific basis. With PGD, we can provide a potential solution based on scientific evidence.”

Diane Rinaldi of Tinton Falls, N.J., suffered four miscarriages in the first trimester and describes the experiences as “still very upsetting.” After spontaneously miscarrying the first three times, Ms. Rinaldi and her husband became pregnant through in vitro fertilization for their fourth attempt.

“We thought that would fix it, “ she recalls. “But I had another miscarriage. It became clear that our problem was not becoming pregnant, it was staying pregnant. It seemed like we should give up at that point, but we just could not.”

She learned of the PGD procedure and decided to come to the Institute to see if there was anything to be gained by having physicians examine the health of the embryos before implantation. Of eight embryos that were produced by the Rinaldis, only three proved to be viable for implantation.

The Rinaldis became pregnant after the in vitro fertilization with PGD and delivered a healthy 7 and a half-pound boy, Joseph, on March 5, 2002.

“It was truly amazing,” says Ms. Rinaldi. “I know for certain that this is the only way that we could have had a baby. If it were not for PGD and the Institute, we would have given up. Thanks goodness this is something that is available right here in New Jersey.”

New Hope for a Variety of Patients

While this technique offers new hope to couples with unexplained recurrent first trimester pregnancy loss, PGD is also an increasingly important technique for women over 35 who wish to become pregnant but who are concerned about the increased risk of recurrent miscarriage or birth defects. Although not as accurate as amniocentesis or chorionic villus sampling, PGD has the advantage of being performed before pregnancy occurs.

“The average rate of genetic abnormality in patients with recurrent miscarriage is 50 to 60 percent, but this figure rises greatly with increased maternal age,” says Dr. Munne.

Of note, the Institute performs PGD for gender selection only when there is a risk of sex related diseases.

Preimplantation Genetic Diagnosis (PGD) may significantly improve the risk of miscarriage in patients who have had 2 or more first trimester pregnancy losses or have lost a pregnancy due to a chromosomal abnormality. PGD can also decrease the increased risk of miscarriage due to maternal age over 37. Saint Barnabas is a world leader in the PGD technique and research and has a proven success rate.

For More Information

* Read more about first trimester miscarriage and PGD.
* Go to the preimplantation genetic diagnosis PGD page.

PGD fees are in addition to the cost of in vitro fertilization and embryo transfer, the latter two of which may be covered by individual insurance through the New Jersey Family Building Act. For further information about PGD, please contact the Institute for Reproductive Medicine and Science at (973) 322-8286.