Reproductive Health Information - Miscarriage
There are many possible contributing factors to recurrent pregnancy loss; poor blood flow to the developing embryo due to autoimmune conditions, pelvic region inflammation, *poor semen parameters, genetic issues, uterine abnormalities or myomas, emotional stress, diet, and living an unhealthy life that is not conducive to natural conception and carrying to term.
Although to date, modern medical science has done very little to advance the treatments associated with miscarriage, there much a woman can do to prevent recurrent pregnancy loss.
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Treatment & prevention of miscarriage & recurrent early pregnancy loss (before and after).
Evidence from both animal and human studies suggests that Intralipid, administered intravenously, may enhance implantation and maintenance of pregnancy when the patient has had an abnormal NK cell level or Function Intralipid is a 20% intravenous fat emulsion which is usually used as a source of fat and calories for patients requiring parenteral nutrition. Intralipid consists of soybean oil as well as egg yolk phospholipids, glycerine and water.
In vitro investigations have revealed the ability of Intralipid to suppress the natural killer (NK) cytotoxicity. Fifty patients with abnormal natural killer levels received Intralipid infusions and 78% showed suppression of the natural killer activity to the normal range one week after infusion, 22% showed suppression but not yet into the normal range in these patients received a second infusion 2 to 3 weeks after the first and all but one of these 11 patients have normal natural killer levels the following week. Four patients required a third infusion and after the first, all showed normal natural killer activity. Forty seven of these 50 patients continue to have normalization of their NK levels for between six and nine weeks, two patients remained normal lives five weeks and in one patient the effect lasted for four weeks.
Conclusion of the study was that Intralipid was effective in suppressing in vivo abnormal NK cell function, suggesting that Intralipid can be used successfully as a therapeutic option to modulate abnormal NK activity in women with reproductive failure. Intralipid has also been shown to be effective in enhancing live birth rates among women with elevated NK cell cytotoxicity and a history of recurrent implantation failure and pregnancy loss. Of 60 for women under age 40 who were experiencing recurrent implantation failure with elevated NK cell activity, the pregnancy rate for IVF cycle was 42%. Ten of 11 women experiencing recurrent pregnancy loss and a successful pregnancy. The advantages of Intralipid include the fact that it has been used for intravenous feeding for more than 30 years with very few side effects, and infusion costs between $500 - $600 and it is not a blood product.
Based on this in vitro as well as in vivo confirmation of the effective normalization of natural killer activity by Intralipid and also based on the signifIcant cost saving, Intralipid is a good alternative to IVIG.
Intravenous Immunoglobulin (IVIG) is a sterile protein preparation derived from human blood. According to the suppliers, every effort has been made to ensure that IVIG is free of bacterial and viral contamination. IVIG consists of 98% immunoglobulin (Ig), with trace amounts of IgA and IgM. The benefit of IVIG infusion lies in its ability to provide a broad spectrum of antibodies that may be therapeutic in a variety of conditions such as immunodeficiencies and situations where regulation of the immune system is beneficial.
There are basically two ways in which IVIG can help promote and sustain implantation. The first is by supplying a variety of blocking antibodies which will protect the pregnancy from rejection. Secondly, IVIG may act as a sponge, absorbing and neutralizing antibodies as well as certain Natural Killer Cells which may attack the implanting placenta and destroy its root system.
In summary, then the therapeutic benefits of IVIG include the replacement of certain "friendly" blocking antibodies and regulation of the immune system by damping down and neutralizing certain factors that are hostile to the implanting embryo. IVIG is an intravenous infusion and will take one to three hours to administer. It is performed a few days prior to the embryo transfer and should you conceive, it may be necessary for treatment to be administered every 3 to 4 weeks for a period of time, usually until 12 weeks of pregnancy, but occasionally longer, depending upon the indication for treatment and the severity of the immunologic disorder.
The side effects associated with IVIG therapy are usually relatively mild and transient in nature and subside spontaneously without having to discontinue the infusion. The following are some of the symptoms which may occur: dizziness, headaches, nausea, muscle and joint pains, allergic skin reactions, chills, flushing, a temporary rise in body temperature, itching, backache, local reactions at the site of the infusion, a rise in heart rate and alterations in blood pressure. Isolated cases of a severe and dangerous generalized allergic response have been reported. However, this is virtually confined to women with low blood immunoglobulin A (IgA) levels which we routinely test for prior to commencing treatment. Because of the above, IVIG infusions should be confined to settings where competent medical supervision is available at all times.
The potential risks of using a blood product such as IVIG which comes from multiple blood donors, is of course the transmission of undesirable infectious agents such as viruses and prions. (Prions are infectious proteins that cause illnesses such as Mad Cow Disease) The manufacturers of these products assure us that they are safe and that the risk of transmitting an infectious agent is extremely small. However - there is a potential risk and it is ultimately a decision to be made by you the patient.
Antiphospholipid antibodies increase the tendency for blood to clot in the vessels surrounding the root system of the placenta. Aspirin inhibits this effect. Children's aspirin contains 81mg of aspirin per tablet. This is less than one-fourth the dosage of a regular adult aspirin tablet. Aspirin may cause gastrointestinal upset, heartburn, nausea, etc., and should not be taken by individuals with known gastrointestinal ulceration or by individuals who have a bleeding tendency. There is no evidence that the ingestion of aspirin during pregnancy causes fetal abnormalities. One of the side-effects of aspirin therapy that is of significant benefit to us, is that it causes platelets to be less able to form blood clots.
It is believed that Heparin inhibits the binding of antiphospholipid antibodies with the phospholipids of the placental root system thereby preventing damage. As such, Heparin therapy will not necessarily lower the concentration of antiphospholipid antibodies in the blood. In fact, because Heparin prevents the binding of the antibodies to phospholipids, the antiphospholipid antibody concentration might even rise.
When administered in large doses, heparin is an anticoagulant, and is commonly administered to people who have developed, or are at risk of developing thrombosis (blood clot formation in blood vessels). In very low doses prescribed for the treatment of ANA and APA, heparin with very rare exception, does not significantly effect blood coagulation (clotting). Moreover, heparin does not cross the placenta and enter the circulation of the fetus. Very rare complications to the patient include bleeding due to a decrease in the concentration of blood platelets, osteoporosis, gastrointestinal symptoms, and allergic-type reactions. These side effects are rarely encountered in the low dose regimen recommended above. Moreover, the fact that we discontinue heparin therapy the night prior to the egg retrieval virtually eliminates the risk of bleeding during this procedure. By the time the egg retrieval is performed, there is no longer any heparin in your system. It is also safe to recommence heparin therapy immediately after the egg retrieval.
You will receive directions on how to self-administer low dose, subcutaneous heparin. A favorable site is the abdomen, around the belly-button (after numbing the area with ice). If you imagine the belly-button as being the center of a clock, then the daily injections can be given in each hour position, going around the face of the clock, approximately one to two inches from it's center point. Local irritation, redness, mild pain, bruising or ulceration rarely follows deep, subcutaneous injections.
Heparin must be used with caution in individuals with stomach ulcers, liver disease, impaired hemostasis (clotting), as well as in individuals using platelet inhibitors such as a high dose aspirin, Motrin, Advil, and other non-steroidal anti-inflammatory drugs. Significant elevation of two liver enzyme (SGOT and SGPT) levels have occurred in a small percentage of health patients. Signs of heparin overdose are nosebleeds, blood in the urine, tarry stools, and easy bruising (except at the injection site). A baseline CBC with platelet count will be performed and as long as the baseline lab values are within normal limits, the CBC with platelets will be repeated every few weeks. If these values remain stable after several weeks, then limited monitoring is necessary.
The implanting conceptus (the embryo, the placenta, and the fetus) is immunologically foreign to the mother and it is indeed surprising that all pregnancies are not summarily rejected. In fact, the ability of the mother to successfully host a pregnancy is entirely dependent upon a complex interaction of sophisticated immunologic adjustments that are designed to prevent immunologic rejection of the conceptus.
The placenta and the fetus carry imprints of the father's immunologic make-up, which differ substantially from that of the mother. These imprints are referred to as HLA antigens. This immunologic difference between the conceptus and the mother causes the mother to produce blocking antibodies against the HLA antigens. The blocking antibodies produce a protective barrier around the fetus which is designed to quarantine the baby from rejection by the mother's immune system, thereby transforming the uterus into a "privileged site" for implantation. The production of such blocking antibodies is referred to as an allo-immune response. In some cases, where the father and mother share some of the same HLA antigens, blocking antibodies fail to develop and the required allo-immune response does not take place, thereby exposing the conceptus to a rejection process. Many repeated miscarriages and/or late pregnancy losses are believed to occur in such circumstances. Damage caused to the placenta as a result of such immunologic rejection, often causes the body to produce antibodies to phospholipids (a component of its own cells). The production of these so-called auto-antibodies or more specifically, antiphospholipid antibodies, are part of a process referred to as an autoimmune response. The antiphospholipid antibodies combine with phospholipids and severely damage placental cells, often resulting in early miscarriages or later pregnancy losses. A similar auto immune response is also known to occur in association with a variety of disease states where antibodies are formed to the body's own tissues. Examples include conditions such as Rheumatoid Arthritis, Hashimoto' s Thyroiditis, Lupus Erythematosus, Myasthenia Gravis, etc. Not surprisingly, these are all diseases associated with a high incidence of repeated miscarriages or late pregnancy losses.
It has been recently demonstrated that many women with organic pelvic disease (e.g., chronic pelvic inflammatory disease, endometriosis, and pelvic adhesions) also produce antiphospholipid antibodies and that such women find great difficulty in achieving pregnancy. In such cases, these antiphospholipid antibodies often destroy the root system of the very early placenta even before there is any indication that implantation has occurred. Such women are often erroneously labeled as being infertile when in fact they are simply rejecting their pregnancies so early (through an auto immune process) even before it can be diagnosed. In other words, reproductive failure associated with a failed alIo-immunity as well as auto immunity are ultimately most commonly a result of placental damage due to the influence of antiphospholipid antibodies.
In the past, the traditional approach to treating failed allo-immunity resulting in recurrent pregnancy loss, was to induce production of blocking antibodies by the immunization of the woman with her husband's (or donor's) white blood cells. As mentioned above, these blocking antibodies would quarantine the baby from the mother's immune system and thereby prevent the production of antiphospholipid antibodies. This treatment was often unsuccessful in spite of best efforts.
Administration of mini-dose Heparin with aspirin (HIA), prior to initiating pregnancy through in vitro fertilization and embryo transfer may counteract the effects of antiphospholipid antibodies in most patients with autoimmune problems, resulting in a much higher success rate than that which could be achieved in the absence of such treatment. However, there are a number of situations where in spite of HIA treatment, a successful pregnancy does not occur. Accordingly, while HIA treatment in such auto immune states is a treatment of choice, it is not a panacea. Patients with positive Anti Phospholipid Antibodies (phosphoethanolamine and phosphoserine) and patients with positive thyroid antibodies, may have elevated levels of Natural Killer cells which may harm a developing pregnancy
Although to date, modern medical science has done very little to advance the treatments associated with miscarriage, there much a woman can do to prevent recurrent pregnancy loss.
There are many possible contributing factors to recurrent pregnancy loss; poor blood flow to the developing embryo due to autoimmune conditions, pelvic region inflammation, *poor semen parameters, genetic issues, uterine abnormalities or myomas, emotional stress, diet, and living an unhealthy life that is not conducive to natural conception and carrying to term (see article 'What causes disease?').
Biomedical science will most often either recommend baby aspirin, or prescribe low molecular weight heparin injections before and throughout pregnancy. I have seen this help, particularly when a blood clotting (thrombolitic) condition has been identified which is reducing blood flow to the developing embryo.
Alternatively, showing great effectiveness clinically, is the regular employment of counseling, acupuncture, and Chinese herbal medicine. Acupuncture and herbal medicine throughout the first trimester not only helps prevent miscarriage, but reduces high stress levels that are so often associated with advanced age pregnancies and women that are pregnant and have miscarried before.
Acupuncture has been proven effective for increasing blood supply to both the ovaries and uterus (see IVF acupuncture research section), which in large part is paramount for its great success with treating both infertility and preventing miscarriage. It does so through reduction of inflammation, enhancing local circulation, balancing hormone levels, regulating the immune system, smoothing the impact of emotions and stress, and being a good step toward a life more conducive to building healthy families.
Chinese herbal medicine has also been used for centuries to prevent miscarriage and promote healthy pregnancy. Evidence shows the strong anti-inflammatory, anti-coagulant, and immuno-regulatory properties of many Chinese herbs. These pharmacokinetic properties are the foundation of the western medical treatments available in the prevention of miscarriage. The advantage to utilizing herbal medicine in pregnancy is safety. When prescribed by a knowledgeable doctor, Chinese herbs are safe, can help prevent miscarriage, AND promote a healthy pregnancy (see 'pregnancy treatment').
It is an important note that miscarriage and sperm quality are very intimately linked. For those who are unaware of this fact or are skeptical, a simple google scholar search will be enlightening (click here). Contrary to most physicians beliefs or knowledge, there is a lot a man can do to optimize his sperm and do his part to help reduce the chances of recurrent pregnancy loss. Making healthier lifestyle choices, taking certain supplements, and employment of acupuncture and herbal medicine are a good start.
'Tend and befriend'. Research shows, another important concept in the management of the stress associated with infertility and miscarriage, is women spending time with other women and children. Women naturally gravitate toward other women and children in times that are difficult. Science has shown that this is due to the release of certain hormones that relax the body and mind when spending time with girlfriends and babies. Time to re-introduce some social activity.
Installing habits and treatments that effectively reduce stress levels and increase well-being in pregnant women physiologically help increase the amount of blood flow to the uterus which is ultimately necessary for the development of the baby. Yoga, nature, mindful walks, deep breathing, singing, journalling, meditation, & acupuncture are just a few.
Lastly, eating a diet of foods that are right for you (check with a holistic nutritionist and doctor of traditional Chinese medicine) allow the body to more easily digest and produce vital substances (such as blood) for the mother and growing embryo.
General information on miscarriage & recurrent early pregnancy loss (symptoms, after)
The end of a pregnancy where the embryo or fetus can no longer survive independently. A miscarriage before 6 weeks gestation, calculated from last menstrual period (LMP), is commonly referred to as 'early pregnancy loss', or 'chemical pregnancy'. Miscarriage is the most common complication of pregnancy.
A blighted ovum is characterized by a normal-appearing gestational sac, but the absence of an embryo. This scenario often results in miscarriage. It is a condition where the gestational sac develops normally, but the embryonic part of the pregnancy is either absent or stops growing very early. In other words, the sac that normally surrounds the embryo is present, but there is no developing embryo inside. This can usually be detected by approx. 6 weeks gestation (6 weeks after last menstrual period) via transvaginal ultrasound.
Habitual abortion, recurrent miscarriage or recurrent pregnancy loss (RPL) is the occurrence of three or more pregnancies that end in miscarriage of the fetus, usually before 20 weeks of gestation. RPL affects about 0.34% of women who conceive. The majority (85%) of women who have had two miscarriages will conceive and carry normally afterwards, so statistically the occurrence of three abortions at 0.34% is regarded as "habitual". (wikipedia)
Information on the causes of miscarriage and recurrent pregnancy loss
Anatomical: uterine abnormalities i.e. uterine septum, cervical incompetence. Chromosomal: balanced translocation or Robertsonian translocation, Aneuploidy (abnormal number of chromosomes). Endocrine: hypothyroid, diabetes, PCOS (polycystic ovary syndrome), low progesterone levels. Thrombophilia (propensity for blood clots): factor V Leiden and prothrombin G20210A mutation. Thrombophilia may explain up to 15% of recurrent miscarriages (wikipedia). Immune Factors: Antiphospholipid syndrome, increased natural killer cells in the uterus (It is poorly understood whether these cells actually inhibit the formation of a placenta, and it has been noted that they might be essential for this process). Ovarian Factors: diminished ovarian reserve (egg count and quality reduce with age), Luteal phase defect (low endometrial progesterone) is a condition that has differing evidence to its impact of miscarriage. Lifestyle Factors: smoking, drinking, drugs, poor diet, stress. Infections: listeriosis, toxoplasmosis, rubella, herpes simplex, measles, cytomegalo virus, coxsackie virus, Malaria, syphilis and brucellosis can all lead to miscarriage.
Weight is a risk factor of infertility and a cause of increased incidence of miscarriage. Obesity is an epidemic that can be avoided or reversed with proper support, sensible diet and nutrition, sustainable healthier lifestyle choices, deep commitments to change, and shining lights on the aspects of yourself that will sabotage your success.
Consider getting help from a holistic nutritionist as well as a doctor of traditional Chinese medicine to find what foods and diet are right for YOU.
Consider getting help from a good life coach. They will help you uncover the reasons you continue to not achieve a healthy weight, and help you cultivate a plan as to how to step into a new story and future, one that manifests a healthy fertile you. I highly recommend a coach by the name of Thomas Kevin Dolan. If he has time to take you on as a client you are very lucky.
Educate yourself deeply on the plethora of other health conditions that may be caused by obesity as a way to catapult yourself into sustainable long-term change.
Bottom line here is that you do not just want to get pregnant, nor do you just want to have a baby. Ask yourself to get clear on your true goals and vision. Is it to have a healthy baby and be healthy parents? Healthy families contribute to a healthy community and a healthier more fertile world.
Dietary suggestion for prevention of miscarriage and recurrent early pregnancy loss
At one time or another, women trying to conceive will understand the importance of optimal blood flow to the uterus and ovaries. Blood brings food and oxygen to your eggs, uterine lining, and developing embryo.
Stress, lack of exercise, not enough rest, lack of joy, and certain foods all can inhibit blood flow to the uterus and ovaries. This will ultimately lead to periods with clotted blood. Clotted menstrual blood is nothing more than uterine lining that is necrotic, or dead, due to lack of food and oxygen supply. If a new embryo tries to implant into uterine lining that is not living, the chances of its survival are drastically reduced. So treatment to reduce and eliminate clots in menstrual blood is a very common approach to improving fertility and reducing chances of miscarriage.
Here are a few Dietary principles you can implement when you are bleeding to help eliminate menstrual blood clots, increase your fertility, and reduce the chances of miscarriage;
1. avoid sour food when bleeding (yogurt, vinegar, pickles, grapefruit, currants, and green apples.
2. eat more blood nourishing foods when bleeding such as eggs, carrots, spinach, dates, & goji berries.
3. consume more blood invigorating foods when bleeding such as fish, ginger, cinnamon, and turmeric.