“When I couldn’t conceive even after 10 years of marriage, the doctors termed it as unexplained infertility. So we started the fertility treatment that went on for almost a year before getting pregnant with twins but the happiness lasted only for 8 weeks as I miscarried. I was totally shattered and gave up the hope of being a biological mother. There were instances when the people close to me avoided sharing pregnancy or baby-related news. This only made it worse and made me feel like an outcast. I stopped going to places to avoid answering people for “when is the good news?” I even quit my corporate job under the hope that less stress may help me to conceive! Though my husband and I had discussed adoption even before the fertility problems, the family kept insisting that we were too young to give up. But after the miscarriage, I couldn’t take any more physical or mental stress of the treatment as it puts pressure on us every day and thought of adoption when I conceived my son unexpectedly!” says Lalitha Kishore, a Chartered Accountant.
This is the story of one too many couples who even after years of trying to conceive, miscarry a few weeks into the pregnancy. While a number of medical problems cause miscarriages, sometimes there is no particular explanation for a few cases. Doctors all over the world are at a loss to determine causes of infertility and frequent miscarriages in otherwise healthy and normal couples.
A few months into marriage and a woman immediately feels the pressure of bearing a child building upon her. Our society still views marriage primarily as the purpose of reproduction. Though the narrative is changing slowly with new couples taking a stance and taking time to plan a family, the societal pressure itself can manifest into stress for the woman. If there is no “good news” in a couple of years, questions of infertility are raised more on women than men. This may not only be depressing for a couple and create a rift between them but can also create feelings of self-doubt and inadequacy in a woman. And very rarely these feelings are discussed and addressed. According to the rhetoric only motherhood “completes” a woman and also women are natural mothers and caregivers therefore she is naturally expected to take it all in her stride.
Miscarriages are common in one-fourth of pregnancies. According to a report, a per cent of women experience three or more miscarriages in their lifetime. But not always do they learn the reason for it. Experts believe that chromosomal or genetic abnormalities are the main culprit in most cases. Most miscarriages in the first trimester are caused by chromosomal abnormalities in the baby like the wrong number of chromosomes or damaged ones. After age 35, this risk for chromosome problems specifically, and miscarriage in general, increases.
Some other reasons for a miscarriage
- Ectopic pregnancies, where a fertilized egg grows outside of the uterus.
- Infections such as cytomegalovirus or German measles.
- Chronic diseases like diabetes or hypertension
- Blood clotting disorders, thyroid imbalances
- Autoimmune disorders like lupus.
- Structural problems in the uterus or cervix, such as fibroids, abnormally shaped uterus, or an incompetent cervix
- Poor lifestyle choices like smoking, heavy alcohol consumption, drug abuse.
- Toxic levels of metals from the environment that may be found in the body like mercury, lead, arsenic, pesticides and solvents.
Psychological impact of Miscarriages
Recurrent miscarriages and not knowing the cause takes a toll on couples and affects their mental health. In some cases, it may also affect their relationship with each other. A survey shows that 47 per cent of women reported they felt guilty after a miscarriage and 41 per cent felt as though they had done something wrong.
Women may try to second guess their choices and start living in guilt. Not knowing the causes becomes confusing and difficult for a woman always making her doubt her every move. This gives rise to a barrage of self-doubts, feelings of incompleteness, pressure from society. No sex education and an even poorer awareness about problems during conception, infertility and pregnancy complications, leaves a woman at the receiving end both physically and psychologically.
New advances in Genetic Testing may give parents closure
Genetic tests on fetal tissues cost thousands of dollars, and results can take weeks hence it may not be offered until a patient has had recurrent miscarriages of 4 or more.
Advances in rapid genetic testing may change that. According to recent news, Dr Zev Williams, director of the Columbia University Fertility Center in New York, has developed what he says is “A faster, cheaper method to test fetal tissue for genetic abnormalities by combining several new technologies”. Developed by Oxford Nanopore Technologies, United Kingdom, Dr Zev Williams DNA sequencer is being used to rapidly test samples for genetic abnormalities after women have miscarriages. Though it would be a while before this technology may be available and affordable in other parts of the world, he feels that the rapid test wouldn’t resolve all the questions around miscarriage, but it would give answers much faster to many grieving patients and their doctors.