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Beyond Miscarriage

After His Wife Lost Four Pregnancies, the Author Set Out to Look for the Facts. Among the Surprises: Two Very Happy Ones.

By Jon Cohen
Special to The Washington Post
Tuesday, March 1, 2005; Page HE01

After my wife, Shannon, had her third miscarriage, the best specialist we could find told us that she had a 3 percent chance of ever carrying a baby to term.

Shannon was 39 at the time, and the doctor explained that first-trimester miscarriages become more common after women pass age 35 and enter what medical science indelicately refers to as "advanced maternal age." Exhausted from the emotional roller coaster of repeated losses and satisfied that we had had one child, who then was 8, we decided to quit what had become an aggressive program of trying to get pregnant.

_____Live Discussion_____
Transcript: Dr. John Larsen, a specialist at George Washington University Medical Center, answered questions about high-risk pregnancies.
_____Special Family Issue_____
Pregnant Question (The Washington Post, Mar 1, 2005)
Making Girls Fit (The Washington Post, Mar 1, 2005)
To Eat Better, Eat Together (The Washington Post, Mar 1, 2005)

When Shannon became pregnant again at 41 and quickly lost that embryo, it seemed to seal our fate. But then a few months later, she became pregnant yet again -- and this one went to term without a hitch. Our son, Ryan, was born on Aug. 6, 2000.

Ryan's birth made me realize that I had committed an offense analogous to those of physicians who foolishly delay seeking medical help for their own ailments. Although I am a veteran biomedical journalist with a degree in science writing, I had spent precious little time investigating miscarriage. Ryan's arrival made it clear to me that there was much that Shannon and I, and our doctors, didn't know. I began studying the literature, visiting leading research facilities and clinics and interviewing experts on miscarriage. Much of what I learned flatly contradicted the "facts" given by the experts who had advised us.

One of the first things I learned was that miscarriage is far more common than we had been led to believe. 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. The study determined pregnancy by testing the women's urine for human chorionic gonadotropin (hCG), a hormone that gushes from placental cells at implantation. This is the same hormone that home pregnancy tests measure.

The particulars of the New England Journal paper led me to the inescapable conclusion that more people miscarry -- and, logically, more people repeatedly miscarry -- than even that study indicated.

First, the study looked at relatively young, healthy women -- 95 percent of the participants were 35 or younger. Several studies have shown that miscarriage indeed does happen more frequently in women after the age of 35. (An authoritative Danish study, published in the British Medical Journal in 2000, looked at more than a half million pregnant women and found that clinically diagnosed miscarriages jumped from about 9 percent in 22-year-olds to more than 20 percent in 35-year-olds and nearly 55 percent in 42-year-olds.) Now consider that there's been a sharp increase in women who put off childbirth in the United States: Between 1991 and 2001 the number of women who had a first child between 35 and 39 jumped 36 percent; those in 40-to-44 age bracket skyrocketed by 70 percent.

Second, miscarriage can happen after conception but before the embryo implants on the uterine wall. But no test can detect those pre-implantation losses.

Given all of this, many experts believe, the true miscarriage rate is at least one out of every two conceptions. Learning this left me with the sense, for the first time, that Shannon and I were not freaks.

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