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Pregnancy and Miscarriages

Dr. John Larsen
Maternal-Fetal Specialist, George Washington University Medical Center
Tuesday, March 1, 2005; 1:00 PM

Medical textbooks, U.S. government statistics and many obstetrician/gynecologists state that about 15 percent of pregnant women will miscarry. But this number refers only to "clinical" pregnancies -- those confirmed by a pregnancy test at a doctor's office.

An authoritative study published more than 15 years ago in the New England Journal of Medicine found that more than twice as many pregnancies, 31 percent, result in miscarriage.


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Read today's story:Beyond Miscarriage: After His Wife Lost Four Pregnancies, the Author Set Out to Look for the Facts. Among the Surprises: Two Very Happy Ones. (Post, March 1)

Dr. John Larsen, a specialist in maternal-fetal (high-risk) pregnancy at George Washington University Medical Center, was online Tuesday, March 1, at 1 p.m. ET to discuss pregnancy and miscarriage.

A transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

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John Larsen: The findings in today's Post story are correct. The unfortunate part was the original misinformation and that's perplexing to me. It is possible that in the emotional context of miscarriage the original numbers may have gotten inverted. The three percent number is very close to the likelihood of having a chromosome problem. In the stress of counseling, it is common to have the information scrambled between the lip of the speaker and the full perception of the listener.

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Arlington, Va.: As a 35-year-old woman who had a miscarriage last fall and is currently five weeks pregnant, if I lose this one, which tests should I try to get done? And are there any miscarriage clinics near the metro D.C. area?

John Larsen: There are not specific miscarriage clinics but there are doctors who deal with reproductive loss at George Washington and Georgetown and the suburbs.

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John Larsen: You should have the tissue from the miscarriage analyzed the way it was suggested in the article.

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washingtonpost.com: Dr. Larsen is at the airport checking in. He will resume this discussion momentarily. Please stay with us.

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washingtonpost.com: We're still waiting for Dr. Larsen to rejoin us. Please stay with us.

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Gaithersburg, Md.: How much does a genetic link play in trying to guess a woman's risk for miscarriage? For example, if one's mother had two miscarriages out of five pregnancies, what would be any relevance to her daughter?

John Larsen: No. Miscarriages are extremely common in all generations and all ethnic groups.

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Arlington, Va.: Can I (my ovaries) be tested to learn how many eggs remain so that I might determine how close to menopause I am and consequently how many years I might be fertile? I am 36 years old.

John Larsen:
The ovaries can't be tested directly but the people at the reproductive endocrine/IVF centers do this indirectly by measuring the output of the pituitary gland to see how hard the gland is working to stimulate the ovaries.

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Arcata, Calif.: My ob-gyn prescribed a round of antibiotics for my husband and me after three miscarriages, telling us we shared a mycoplasma infection. We subsequently had a normal pregnancy. He told me that up to one third of miscarriages are caused by undiagnosed mycoplasma infections. Any truth to this?

John Larsen: Some truth but the question is what the size of the number is. Mycoplasmas are very common and they do not reliably cause miscarriage but the antibiotics seem to help in some cases.

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Washington, D.C.: How soon can you try after miscarriage?

John Larsen: As long as there has not been dramatic surgery or tremendous blood loss, you can start right away. The idea of waiting a few months is an old wives' tale based on cases in which there were relatively late miscarriages which had complications.

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Potomac, Md.: On average -- average being the key word -- what is the latest age now at which a woman in the U.S. can safely conceive and have a baby? Various people are throwing around 45, 44, 42, 47, 40. As more and more women are delaying the age at which they have children, due to various factors, this becomes a question that needs to have a hard, solid, fact-based answer. Thank you.

John Larsen: Good question and I sense your desire for a bright line answer but that's not reality. In reality, the fertility decreases bit by bit from age 38. The health of the woman deteriorates slowly from the mid-20s. You're at the prime of your life at age 23. After that, it's a gradual downhill process. So it depends on the health of the mother and it has to be individually answered for each woman.

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Greenbelt, Md.: Dr. Larsen --

Has your research found any causal relationship between maternal weight and pregnancy loss?

Thanks for shedding some well-needed light on this subject.

John Larsen: No, in general. At the very extreme individuals can be ill from their thinness or their heaviness but in the broadest range there is no change in miscarriage rates with age. So from 100 to 300 pounds, for instance, the miscarriage rate would vary such that very thin women might not be able to provide enough nutrients for a baby to grow to full-size and an extremely heavy woman has risk if she needs surgery or anesthesia related to child birth.

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Washington, D.C.: Dr. Larsen,
I just wanted to know what steps does a woman take when going through depression and constant anxiety do to have a healthy and lasting pregnancy?

John Larsen: If a woman is depressed and anxious there is a certain point where medical treatment including psychotherapy and antidepressants are advised. Nonetheless for the vast majority of milder cases, drugs are not advised when trying to get pregnant. An experienced psychotherapist can support the woman who is intensely struggling to get pregnant and is anxious about every event.

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Washington, D.C.: I am five months pregnant with my second child. My problem is that I have an excessive saliva issue; I have to be spitting constantly. I had the same problem with my first pregnancy and it continued until I gave birth. My doctors have recommended several medications but nothing works. Do you are anyone out there had any success with this problem? It is driving me crazy. Thanks for any suggestions.

John Larsen: No success. The regimen is to carry a cup and spit discreetly. You have my condolences but it would be wrong of me to mislead you.

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Washington, D.C.: The statistics given for miscarriage as a result of amniocentesis are really vague. I've read there's a 1 in 200 chance, but there always seems to be a disclaimer that that number comes from studies done before the use to ultrasound to guide the needle. Why aren't there up-to-date statistics on miscarriage from amnio -- and if there are -- what are they?

John Larsen: The up-to-date number seems to be if the ultrasound is done and the findings are normal ... if you just count those cases ... risk is about 1 in 1,200. That is published and is recent. The idea is the old number of 1 in 200 came from a relatively unselected group of pregnancies in which there were also individuals who had abnormal findings and were more likely to miscarry because of those findings.

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Arlington, Va.: I will be 36 soon and am not ready to begin a family. Is it safe and/or advisable to extract and freeze eggs for future use?

John Larsen: No. Sperm can be frozen but freezing of eggs is not practical.

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Palm Beach, Fla.: Do you feel it is reasonable to treat a women empirically with antibiotics, baby aspirin and progesterone after she has had multiple miscarriages with no known cause?

John Larsen: I thin that the antibiotics and the aspirin are fine. I don't see using progesterone for the miscarriages unless there is a proven deficiency in luteal-phased effect. Luteal-phased effect means that there is a low progesterone production by the body. Progesterone may be effective in prolonging pregnancy in women who tend to deliver living babies prematurely.

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Alexandria, Va.: In general, what is the risk of miscarriage in a 34-year-old woman? Is this increased when there is a history of infertility related to endometriosis? Thank you.

John Larsen: The numbers is today's story are correct. The question is whether endometriosis increases the miscarriage rate and there is still question about this. Endometriosis primarily leads to infertility rather than miscarriage.

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Katy, Tex.: I am 35 years old. I had a miscarriage at 6 weeks. It was the result of a failed tubal ligation I had 8 years ago. If I get pregnant again will I keep having miscarriage because of the tubal ligation?

John Larsen: No. The issue with the tubal ligation is that you might be at increased risk by one of the pregnancies sticking in the fallopian tube and causing an ectopic pregnancy. This can be fatal to the woman so anytime you think you're pregnant report to your doctor promptly so that you can be monitored in early pregnancy.

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Centreville, Va.: Dr. Larsen,

Are you more likely to miscarry if you've had an abortion?

John Larsen: Only by a little bit and the issue there is has the abortion caused an injury to the cervix. If there has been no injury. If there has been no injury, then there is no increase in the miscarriage rate.

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Rockville, Md.: About the pill: Do you think that since the pill stops me from releasing an egg each month, that this will help decrease my chances of miscarriage when I do try to get pregnant since that would mean I have more eggs left?

John Larsen: The answer is no. The eggs seem to proceed to degenerate anyway.

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Arlington, Va.: Can excessive exercise play a role in miscarriage?

John Larsen: No. The only thing that could possibly cause a miscarriage would be full contact violence and it would have to be very impressive.

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Washington, D.C.: I'm 35 years old and have been trying to get pregnant since August last year. I only have one ovary. Ovulation kits show I'm ovulating, but I have yet to get pregnant. What are my chances of conceiving at this age with 1 ovary?

John Larsen: The details are insufficient. One ovary is fine but the question is how did the other ovary happen to be gone and that implies that surgery was done and that implies adhesions could be present, blocking the function of the remaining tube or tubes.

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Fairfax, Va.: Dr. Larsen: Is it true that a woman can test normal for clotting disorders and immune disorders after a miscarriage but could actually have clotting or other disorders in a subsequent pregnancy?

I'm paranoid even though my tests came back normal, that I'll "develop" something if I manage to get pregnant again.

thank you.

John Larsen: I'm sorry that you feel anxious about this. It is always possible to develop an abnormality and yet I would urge you to be of good cheer and give it a try if you really want to be pregnant. The sooner the better.

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Springfield, Va.: My wife has had a full term and health pregnancy, and then suffered a three consecutive miscarriage ,all of them during the first 12 weeks.
How is it possible to have one full term and healthy pregnancy and then suffer three repeating miscarriages? My wife is a fairly young woman. She is only 22 years old and healthy.

John Larsen: Because the risk of miscarriage is so high as with any frequently recurring event, if you reset the probability at 50 percent, it's easy with it that common to have three in a row. It would be the same thing if you were flipping a coin: you could get three in a row without much work.



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Arlington, Va.: Dr. Larsen,

Is your mother's age at menopause a predictor of when you will hit menopause? Thanks!

John Larsen: To slight extent and I cannot give an exact number on that.

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Rockville, Md.: I had a D and C last fall. Does that affect my chances of having a successful pregnancy?

John Larsen: It depends on the details. The D and C had to have been done for some reason so the answer would be related to the basic disorder, like with the earlier abortion question, if the D and C caused an injury, it would affect the ability of the uterus to hold the pregnancy.

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Washington, D.C.: Sorry for the insufficient details. Yes I had surgery to remove the one ovary due to growth on it. However, I have had a child since that operation was done.

John Larsen: Then I would assume that you have a normal chance of getting pregnant related to your age since you had the one child. You might go nonetheless and have an evaluation for possible tubal blockage. Sometimes just mucous can be thick blocking the tube.

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