in this issue
Sonja Kristiansen, MD
Medical Director & co-founder
of
the
Infertility Center
of Houston, Dr. Kristiansen is double board certified in
Reproductive
Endocrinology and Obstetrics & Gynecology and
specializes in surgical and IVF procedures.
She has
advanced training in hysteroscopy, laparoscopy, and
microtubal reconstruction. She also works with
female endocrine abnormalities relating to
menstrual and reproductive development.
Quick Links...
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When people hear the word "infertility," they usually
think only of the inability to conceive. Many do not
know that miscarriage and infertility are often related.
Some of the causes of conception difficulties may also
lead to miscarriage. In fact, in the case of recurrent
miscarriage (more than two losses), an infertility
specialist may be the best medical practitioner to see.
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Meant to Be?
When my patients get pregnant, their joy is
understandably overwhelming. It only makes sense that
those who lose their pregnancy are devastated. My job
then is to offer new hope.
Miscarriage doesn't "just happen" -- there are reasons
why a pregnancy ends too early. Importantly, some of
the causes are preventable or treatable.
The most common causes are chromosomal
abnormalities that prevent the embryo from developing
normally. These situations cannot be corrected at the
time of loss. Once a first or second trimester pregnancy
with chromosomal problems begins to fail, management
of the loss becomes our priority. We make sure that
the mother remains healthy during the miscarriage
process. That is not to say that she has no hope for
the future! Chromosomal testing can be performed for
both mother and father that may reveal answers and
indicate how best to proceed toward future successful
pregnancies.
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How Many DO I Have to Lose?
While some OB/Gyns may insist that their patients wait
until they've had three or more miscarriages before
seeking specialty care, I encourage couples to start
exploring for causes and possible treatments after only
two losses. Especially for people who've already spent
more time than average just trying to conceive,
spending more time just to "wait and see" if yet
another precious pregnancy ends can only increase
your misery.
In additional to chromosomal abnormalities, miscarriage
can be caused by:
- Structural issues, such as uterine malformations,
interior uterine growths or scar tissue, severe
endometriosis, and incompetent cervix.
- Hormonal issues like untreated thyroid disease,
diabetes
mellitus, hyperprolactinemia.
- Immune problems such as lupus or the presence of
certain maternal antibodies.
- Environmental factors like exposure to certain toxins
and malnutrition.
A woman's age has an impact, too. In general, older
mothers are more likely to miscarry, for many reasons.
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What Can We Do?
Proper physical examination, along with a detailed
medical history, can help us determine if structural,
hormonal, or environmental reasons for miscarriage are
present. In some of those cases, corrective surgery or
other pre-conception treatments may be possible.
Some conditions can be managed during subsequent
pregnancy via either medication or lifestyle
management.
In addition to testing both parents for unseen genetic
issues that can increase the chances of a
chromosomally-based loss, we can also sometimes test
any available tissue of the fetus. If either of the
parents is found to have certain incorrectable genetic
conditions, they may consider the use of donor sperm
or egg for future pregnancies. Also, the use of in vitro
fertilization (IVF) with preimplantation genetic diagnosis
(PGD) is an efficient way to select a normal embryo for
transfer, especially in cases where both parents are
found to have normal chromosome karyotypes.
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In Summary
Because a large percentage of women who struggle
with infertility are also statistically more susceptible to
having a miscarriage, I and other reproductive
endocrinologists have become well-versed in the
diagnosis and possible treatment of first trimester
pregnancy loss. After I've worked with patients to help
them conceive, my next job is to hopefully lead them
through that first 12 weeks and on to their preferred
obstetrician to continue a successful pregnancy and
deliver a healthy baby. The important thing for patients
to know is that answers are available.
As always, I'm here to respond to your concerns about
getting and staying pregnant. Your goal and mine are
the same -- to bring a new child into the world.
Sincerely,
Sonja B. Kristiansen, MD
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