Five Steps to Take After a Miscarriage
Today’s post is all about the five steps to take after you’ve had a miscarriage. I want to start a miscarriage revolution. I want to change how we approach care of women who have had a pregnancy miscarry and here’s why.
There’s one thing you might not know about me, and that’s why I went into fertility medicine. I went into fertility medicine to help people with miscarriages because of the experiences my mother had when I was a young girl. I used to literally be in bed listening to her cry in the middle of the night. I said to myself, “I’m going to dedicate my life to helping people who are going through what she’s going through right now.” That’s why I became an IVF doctor, a fertility specialist, a reproductive endocrinologist, and a miscarriage expert. That’s what all fertility doctors are.
We’re just not doing enough as physicians in the United States and across the globe to let people know what tests they can do after a miscarriage, and even at the time that a pregnancy is diagnosed as abnormal, so that you can take the lessons from the miscarriage, your precious pregnancy, to teach you what you should be doing and thinking about next. These pregnancies, you’ve probably heard of them called angel pregnancies or angel babies.
It’s just fitting that I call this the ANGEL workup. This is part of my miscarriage revolution.
I’m going to break it down for you. This should not be considered confusing or complicated. Obviously, going through a pregnancy loss is devastating. But I get fired up, this is a chance to learn, this is a chance to figure out what we need to do next so we can move forward with our eyes wide open, understanding what all our options are.
The A stands for Age, Autoimmune, and Anatomy
Why is age important? It’s simple. As we get older, especially as women, but men too, the viability of our eggs down. There are simple tests that you can do. The AMH, antral follicle count, FSH, and estradiol. AMH can be done any day in your cycle, and we know that if the level is low, especially less than 0.6, you might have a higher chance of miscarriage because of genetic abnormalities in the embryo due to egg quality. The FSH and estradiol are done cycle day three, these are diagnostic tests that also tell us about egg quality.
You can also do a special ultrasound looking at the ovaries called an antral follicle count. The AFC is also a guide as far as what’s going on with our egg quality. Every embryo takes an egg and a sperm cell, and we know that if the egg quality is low, we might have a higher chance of miscarriage. Rather than going through another miscarriage without this special test, you can get these tests done by asking your doctor for them if they’re not bringing them up.
It’s very important for you guys to get a piece of paper and a pen out. I’m just kidding. You don’t have to, because I’m giving you all this information right now and you’ll have a blog article that goes along with this show so that you can print it out, talk to your doctor about these tests, and make sure you’re getting all of the information you possibly can about yourselves.
Next is autoimmune diseases. I do an autoimmune workup looking at things like Hashimoto’s thyroiditis and Lupus, to see if a patient has that. The other thing is antiphospholipid antibody syndrome. We also know that Celiac Disease, for example, can cause issues and be the culprit for people who have had recurrent pregnancy loss.
The last A is anatomy. You can have a uterine anomaly, like a uterine septum, a unicornuate uterus, a bicornate uterus. These are uterine anomalies that have been associated with a higher risk of miscarriage. Understanding what’s going on with your uterus and potentially fixing it — for example, if you have a septum — can be extremely helpful and may prevent miscarriage in your next pregnancy.
Now I want to go to the N. That’s Nutrition.
You hear me say this all the time and I know you’re rolling your eyes like, “stop saying it.” But it is so true for you to be the best version of yourself every single day. You deserve to be pregnant again. You deserve to have a healthy pregnancy. You deserve to take really good care of yourself.
Please follow a plant based Mediterranean diet if you can. Talk to a nutritionist. Check out Food Fuels for recipe tips. We know that healthy nutrition also promotes a healthy ovulation. Especially if you have PCOS, we know how important a healthy diet is for women who have PCOS. I have the HOPE approach, and part of the HOPE approach is the E for eating for women with PCOS. If you haven’t watched that show, please watch it to learn more about PCOS.
I mentioned already about Celiac Disease. People who have Celiac have a much higher chance of having a miscarriage, so be sure to get tested if indicated, follow a gluten free diet, and see how your fertility can be restored. You might have a lower chance of miscarriage by doing that. Same thing in men. Men can have Celiac Disease as well, and this can result in sperm abnormalities, such as abnormal shape, low motility, low testosterone. Following a gluten free diet if you have Celiac Disease — I’m not recommending this for everybody — could potentially help.
Now I want to get to the G, Genetics.
Your DNA is so important and it can play a role. That’s why screening both the male and female partners is super important, because of how important a role genetics can play. At the end of the day, there are tests that you can do, simple blood tests. Gene screening and chromosome analysis on both partners, sperm DNA fragmentation tests (not done on women, obviously), and then you can also test the pregnancy tissue.
If someone reaches out to me and says, “Aimee, I’m dealing with a pregnancy that has miscarried,” I just want to run over to their house with a kit, because I want to study what’s going on with that miscarriage. I can tell you if the pregnancy has normal chromosomes, that tells me to go one direction with testing. If the pregnancy has abnormal chromosomes, that tells me to go a different direction as far as testing. If I have a pregnancy that has miscarried and I don’t have the answer to why from a genetic standpoint, then I’m going to go through both lists of tests that I would do because I don’t know.
That’s why if you have a pregnancy that has miscarried and you are currently pregnant, ask your doctor to do whatever they can to test that pregnancy. The test kit that I use is called the Anora Test. It’s a very simple test with a kit and you can take the tissue and put it in there. I have my way of telling my patients how to take it. I don’t want this to be triggering for people.
If you’re currently pregnant and you’re dealing with a miscarriage, what I suggest is you get a sieve or a strainer and put it in the toilet for when you’re home about to miscarry, if this happens before a D&C procedure. And certainly, if you want a D&C, your doctor can do this for you. Once the tissue has come out, don’t worry about anything like touching it with your hand. You can just take a plastic bag, lift up the strainer, grab the tissue, and pull it through.
Then you can take it in to your doctor. There’s no emergency to do so, it’s not time sensitive. Don’t freeze the tissue. Don’t wrap it in paper towels or anything like that. You can just close it up, put it in the garage or put it in the refrigerator until you’re ready to bring it in. Just don’t freeze it or wrap it in any paper towels or paper anything.
We’ll get results about a week later and we’ll do a post-miscarriage consult to review the results and find out more as to why the pregnancy miscarried. About 10% of the time, you may not get results at all, but you’ll never be mad that someone didn’t tell you that you could actually find out. It’s one thing to be told that your pregnancy miscarried because of a genetic abnormality and it’s so common, don’t worry about it. But at the end of the day, we are going to worry about it, because we’re human beings, we think about these things, and we want answers.
It’s something that you’ll always have in your heart and in your mind as far as why did my pregnancy miscarry. It’s so routine that as women we blame ourselves. I’ve heard people say things like, “It’s because I lifted up my laundry basket,” or, “It’s because I got in a fight with my husband because he didn’t pick up the laundry basket.” I’m trying to make a joke for something that’s really not funny. The serious side of it is that people actually tell me that’s why they think they miscarried. That’s why I want them to have a piece of paper that tells them why, so they don’t wonder in this way that may seem rational but is slightly irrational, because it’s not possibly to miscarry because of that.
Now I want to move on to the E of the ANGEL workup, and that’s endocrinology.
Your endocrine system can have some abnormalities. What do I mean? I mean things like a thyroid disorder, high prolactin, diabetes. Simple tests, once again. These are simple tests that are part of a preconception panel for my patients, but when someone has had a miscarriage, I’m going to dive a little bit deeper. I’m going to look at a full thyroid panel, including antithyroid antibodies. If I’ve done the prolactin before, if it hasn’t been done in the last year, I’m going to do it again.
L is for Lifestyle
Your lifestyle can play a role. Women who are curvier might have a higher risk of miscarriage. I want you to be in the best shape of your life. Consider, again, a plant based diet. Avoid alcohol, or at least minimally drink alcohol. Avoid completely pot smoking and cigarette smoking, for both females and males. Maintain a target BMI. Ask your doctor what that BMI should be, because it isn’t a one size fits all sort of approach when it comes to BMI and miscarriage. Talk to your doctor and have a really honest conversation to say, “What do you think my BMI should be, given everything you know about me, to give myself the best chance of having a healthy pregnancy?”
At the end of the day, you want to put the sperm through a sperm bootcamp, toss the champagne out the door, and start swimming those laps. I’m serious, but not serious, but kind of serious. The reason why I’m serious is because we know that sperm health is really important, and we have more and more mounting evidence to suggest that. That’s why having healthy sperm is also important, because it’s not just about the female partner. We shouldn’t blame ourselves for miscarriages. We know that it’s always out of our control.
Doing these tests as part of the ANGEL workup, part of my miscarriage revolution, will hopefully make us learn from the experience we had, feel more knowledgeable about the things that we can change that are in our control, so that when we’re pregnant again we’re not as nervous or anxious. You’re still going to be, because that’s normal, but if you know that you’ve tested everything ahead of time, you’re never going to look back and say, “Why didn’t someone tell me what my options were? Why didn’t someone tell me that I could do genetic testing of my embryos before I got pregnant again to minimize miscarriage?”
I hope this helped you guys. I hope to see you in class. Join me at EggWhispererSchool.com for my next class to learn more about my strategies to improve fertility and prevent miscarriage.
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