Handling miscarriage is one of the most difficult clinical situations for both the patient and provider.  Although miscarriages are common, they are devastating for a patient trying to have a baby.  There are different definitions of “recurrent pregnancy loss” however most major organizations such as the American College of OBGYNs and the American Society for Reproductive Medicine define recurrent pregnancy loss as 2 or more consecutive losses with the same partner.  In some progressive states such as Massachusetts, recurrent pregnancy loss is recognized by state law as a form of infertility and insurance companies include it in the list of conditions that are covered.  There are several defined tests that have been found to be evidence-based approaches to evaluating recurrent pregnancy loss.  When the full evaluation is complete the underlying cause can be found in roughly 50% of patients.  This makes the discussion with the other 50% of patients very difficult because determining the problem is key to fixing it.
 
Infertility
 
For patients, each pregnancy loss is a reminder of infertility in many ways.  Even though pregnancy can occur, a healthy live baby does not result.  There are natural feelings that there is something wrong or that being a parent was not “meant to be”.  Patients can start questioning if they should continue trying because each loss is so emotionally and physically painful.  Instead of being hopeful and excited, each pregnancy is wrought with worry and finally the confirmation of a bad outcome when a miscarriage occurs.  This is made worse because supporters with good intentions may constantly pressure to “keep trying” even though it is hard to imagine enduring another miscarriage.  Patients with recurrent pregnancy loss are especially vulnerable to gimmicks found through online searches that claim fix the reason for their miscarriages – however these treatments are often not recognized by any professional groups due to lack of data and can be extremely expensive.
 
Infertility and recurrent pregnancy loss is so complex.  Overcoming recurrent pregnancy loss requires a team so being surrounded by supportive family and friends.  It is important for patients to work with a fertility specialist well versed in this condition to provide the most comprehensive and appropriate recommendations.  Patients are often surprised by others who share similar stories when they join support groups which are very common in most communities.  It is important to ask your fertility specialist about these resources so you remain connected early in the process.