As I’ve mentioned before, one thing that concerns me about the mainstream approach to recurrent pregnancy loss is that too many doctors tell their patients they have ruled out immunological causes, when in fact they have not. They have performed standard tests that merely touch the tip of the iceberg.
This happened to me with both reproductive specialists I saw in Pittsburgh. They ruled out lupus anticoagulant, anti-thyroid antibodies and antiphospholipid antibodies – immune problems commonly linked with miscarriage. They also ruled out immune problems in general because my routine antibody testing during pregnancy was normal.
As a result, many fertility specialists resign their patients to the “unexplained loss” category and send them on their way. “Take luck!” as comedian Brian Regan would say.
So how is a woman to know she could have an immunological problem if her best doctors are telling her they ruled it out? I never would have, except that I encountered a very interesting questionnaire in Susan Rousselot’s book, Avoiding Miscarriage. According to her book, you may have an immunological reason for miscarrying if you can answer “yes” to any of these questions:
- Do you or your close family (blood-related) have a history of clotting problems, heart disease, or stroke before the age of 50?
- Are you prone to skin rashes or migraine headaches?
- Have you had previous immune problems (e.g. rheumatoid arthritis, lupus) or any thyroid disorder?
- Do you or your family have the MTHFR gene mutation?
- Have you experienced infertility?
- Have you had a pregnancy where ultrasound showed slow growth after seven weeks, clots in the placenta, placental insufficiency, or intrauterine growth restriction?
- Have you had two or more miscarriages after eight weeks where genetic causes were ruled out?
- Have you miscarried after proof of heartbeat where genetic causes were ruled out, OR, had two or more unexplained losses after proof of heartbeat?
- Have you had two unexplained losses after 12 weeks?
- Have you had an unexplained second or third trimester loss?
- Do you or anyone in your close family (blood related) have a history of three or more unexplained miscarriages?
- Have you ever had pre-eclampsia, placental insufficiency, or an unexplained stillbirth?
(Taken from Avoiding Miscarriage: Everything You Need To Know To Feel More Confident In Pregnancy, Copyright 2007 Susan Rousselot, page 104. All reasonable efforts were made to contact the author for permission to reprint, but the contact information is no longer up-to-date.)
You can find a similarly useful list of indicators and explanations of testing on the Alan E. Beer Center’s website.
I would also add to this discussion, simply based on my own personal research and experience, that if you have Celiac disease or gluten sensitivity, then you most likely have heightened immune activity and inflammation, because food sensitivities and allergies are themselves immune issues. You need to know that gluten sensitivity/intolerance itself is associated with miscarriage (see sources, below). (My theory, un-doctor-like as it may be, is that miscarriage is not necessarily caused by eating gluten (wheat), but that both the miscarriages and the gluten sensitivity are “fruits” of having an overstimulated, inflamed immune system. But I could be wrong!)
So not only is it important that we find the right kind of doctor to help us find the reason we are miscarrying, but we need to educate ourselves on the myriad of other factors affecting our bodies.
What should you do if you think you might have an immunological problem contributing to miscarriage? I cannot know everything you have been through, and I am certainly no expert in fertility, but it may be well worth your time to seek out a reproductive immunologist, or a fertility specialist who will look at a larger panel of immune issues. Educate yourself (you could start with the Books & Articles I’ve compiled) and don’t be afraid to break away from your current doctor if need be. Remember: it’s your life! It’s not your doctor’s life, and they aren’t the ones who have to live with your future! I truly believe no person should be shut into a box by a doctor who has simply closed their mind or formed an educational bias so strong they cannot see past their own line of thinking. I appreciate Mrs. Rousselot’s encouragement (page 118):
“While your regular doctor or obstetrician-gynecologist might not be convinced of the merits of reproductive immunology, there are many specialist doctors in this field who are. If you believe you could benefit from immunological assessment – or simply want to speak with someone knowledgeable about immunologic causes of miscarriage – then seeking a specialist in this field is worthwhile.”
Sources for Miscarriage & Gluten Sensitivity: