Another area that has really piqued the interest of researchers is antiphospholipid syndrome (APL). This tongue-twisting name refers to a group of conditions in which the mother makes antibodies to chemical structures in her body called phospholipids, which are found in the walls lining the blood vessels. APL, which is diagnosed through blood tests, causes blood vessels to constrict, leading to dangerous blood clotting which can cut off the flow of oxygen and nutrients from the placenta to the fetus. Studies have shown that approximately 15 percent of women suffering from recurrent pregnancy loss have APL, compared with less than 2 percent of women with normal pregnancies. Researchers are also busy debating the role of inherited blood-clotting disorders in recurrent miscarriage.
How it Works
Women who are diagnosed with APL are treated with subcutaneous (under the skin) injections of the blood-thinner heparin and daily doses of baby aspirin. Some researchers have also looked into the use of steroids such as prednisone, which can lower antibody levels but can only be given in low doses and only in first 10 weeks of pregnancy, because of possible severe side effects.
Promising. Recent studies have shown that the combined regimen of aspirin and heparin can reduce pregnancy loss in women with APL by 54 percent. Studies on steroids have been less positive, and this treatment is still considered too risky with little benefit. Dr. Grunfeld warns, however, that you shouldn’t be popping those little pink baby aspirins without consulting with your doctor and having the appropriate tests. “Aspirin therapy should only be used if you have real evidence of immune issues,” he says, adding that very few labs test for antiphospholipids. “Right now it seems safe, but you never know what we’ll find out down the line.”
Also on the Horizon
While most of the buzz these days is coming from labs specializing in chromosomal analysis and immunology, researchers all over the world are looking at every possible aspect of what keeps an embryo from making it through the nine months of pregnancy. Some intriguing work is being done on uterine receptivity—basically analyzing whether or not the lining of the uterus is “sticky” enough to allow implantation. Scientists are focusing on proteins such as integrins, glue-like molecules on the surface of cells that make them stick together. One type of integrin, called “aVB3,” has been found to be lacking in women who suffer frequent miscarriages. High doses of steroids such as progesterone may be effective in treating this deficiency.
Other scientists are convinced they can shed light on the causes of miscarriage by analyzing the placenta from unsuccessful pregnancies. Right now very few labs do this work, and it’s unclear how accurate these analyses are. “Some doctors claim they can tell if you have a uterine inflammatory condition by investigating the placenta, but after the embryo is terminated, the placenta is always inflamed, making it very difficult to make a correct analysis,” points out Dr. Grunfeld.
It’s a lot to take in: But after wading through the confusing information about state-of-the-art technologies and contradictory research about new treatments, couples should be happy to know that the most encouraging research of all is this: Even after three unexplained miscarriages, you still have a 60 percent chance of having a healthy, full-term pregnancy the next time around without any intervention at all. So the best treatment of all may be the most old-fashioned: Stop smoking and drinking, make sure you exercise and eat right, practice stress management, find emotional support—and then try, try again.
A version of this story originally appeared in the Spring 2006 issue of Conceive Magazine.