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