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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
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.
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