Achieving Success After Pregnancy Loss
Join Dr. Elie Hobeika as he discusses the latest research, causes, treatment options, and shares inspiring stories of achieving success after pregnancy loss.
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Learn more about Elie Hobeika, MD, FACOG
Elie Hobeika, MD, FACOG
Dr. Elie L. Hobeika strives to deliver the highest level of compassionate, individualized, and evidence-based care to all of his patients. Dr. Hobeika is board certified in obstetrics and gynecology and earned his medical degree at the Université Saint-Joseph in Beirut before going on to complete his residency in obstetrics and gynecology at the Hofstra Northwell School of Medicine at Staten Island University Hospital.Learn more about Elie Hobeika, MD, FACOG
Transcription:
Deborah Howell: Going through fertility treatment is a very poignant process for everyone involved. In this episode, we'll deepen our understanding of the fertility process by discussing what you should know about recurrent pregnancy loss, from the latest research, to causes, treatment options, and inspiring stories of success. Joining us today is Dr. Elie Hobeika, a Board Certified Physician of Obstetrics and Gynecology at Fertility Centers of Illinois. This is the Time to Talk Fertility Podcast. I'm your host Deborah Howell. So Dr. Hobeika, how common is miscarriage?
Dr. Hobeika: In general, we estimate miscarriage to occur and 15% of couples trying to conceive. However, one needs to always keep in mind the age of the female partner in a couple, a miscarriage can increase to 20 to 25% between the ages of 35 and 40 and up to 40% after the age of 40.
Host: Got it. So how do you define a pregnancy loss?
Dr. Hobeika: Pregnancy loss is defined by going from a pregnant state to in non-pregnant state, without delivery of a viable child. And this can occur at any point throughout the pregnancy.
Host: And how does that definition change, based on the progression of the pregnancy?
Dr. Hobeika: So, pregnancy loss is a very general term. If a pregnancy loss occurs too early, maybe a couple of days after having a positive home pregnancy test, then we call that pregnancy loss, a chemical pregnancy loss or biochemical pregnancy loss, miscarriages occur later, maybe a couple of weeks after the first positive pregnancy test. And this is when we actually can see a pregnancy on ultrasound and stillbirth can occur later in pregnancy, usually in the second or third trimester. So it really depends on the gestational age of the pregnancy.
Host: Okay. And in your experience, what's the most common reason for loss?
Dr. Hobeika: The most common reason for loss by far is genetic errors that occur while the embryo is formed.
Host: And what are other causes for miscarriage?
Dr. Hobeika: Other causes of miscarriage include uterine anomalies, such as polyps, fibroids, or scar tissue. Some may be hormonal, such as related to thyroid dysfunction or abnormalities in the level of milk hormone in the body. Others can be, auto-immune the presence of certain antibodies that can attack a pregnancy. And others could be from a genetic reasons that are already present in the partners and their parents. And they can be transmitted from generation to generation.
Host: Women often blame themselves. Is there anything they could have done? What do you say to that?
Dr. Hobeika: This is very common for women to blame themselves, but I always try to encourage them not to in the vast majority of cases, miscarriages are not preventable. So it's not an event that they attended or something that they did or a medication that they took. And the vast majority, they are not preventable. And we try as much as possible to encourage patients not to blame themselves or others for a miscarriage.
Host: It's really true because miscarriage is so, so at what point does a loss or losses indicate a problem? And at what point should a couple seek medical guidance?
Dr. Hobeika: Medical guidance in general is recommended throughout the process. So it is much better for a couple or a patient undergoing a pregnancy loss to be followed up by her gynecologist or by a provider to make sure that this pregnancy is resolving the right way. And there's no complications that arise from this pregnancy loss, but in general, doing a workup to see why the cause of miscarriage. What are the causes of miscarriage is usually recommended after having two or more pregnancy losses.
Host: And you mentioned workups. So what kinds of tests do you recommend and what do they do?
Dr. Hobeika: The best thing that are done, usually aim to delineate various causes of miscarriage that I previously mentioned, and they include blood work and ultrasound, preferably a saline infusion sonography, or a water ultrasound to rule out anomalies of the uterus and endometrial biopsy to rule out infection that could predispose to pregnancy loss.
Host: What kinds of treatment options do you recommend Doctor?
Dr. Hobeika: Treatment options are mainly based on the etiology of recurrent pregnancy loss. I clearly, if the etiology is infectious, treatment would be a course of antibiotics. If the etiology is the uterine anomaly most likely treatment is surgical in this case. And if the etiology are endocrine anomalies at that point, treatment would be via medication based on the endocrine anomaly.
Host: I see. And is there anything couples can do to improve their chances of sustaining a pregnancy?
Dr. Hobeika: You just mentioned that pregnancy losses are usually unpredictable and unpreventable, with that being said, I would recommend that couples seek care after having two or more pregnancy losses. And if they have a treatment course that is recommended by their provider to be compliant to that treatment course. A good way also for couples to improve their chances, conceiving is to treat any pre-existing medical conditions. Cause some medical conditions can predispose to miscarriage such as diabetes or thyroid disorders or obesity. So in those situations be compliant to treatment, having optimal control of their medical condition. And in case of obesity, a certain degree of weight loss may be very beneficial and to carrying a pregnancy to term.
Host: And here's a big question. A lot of couples want to know, how long do you recommend waiting before trying again?
Dr. Hobeika: From a medical perspective, we usually recommend having one period spontaneously occur without trying to conceive and then trying again, but it really comes up to the couple and see when they are, when they feel comfortable trying again. And when do they want to try again? And the vast majority of cases, this applies to early pregnancy losses.
Host: And this might seem obvious, but to a lot of women, it is not. How does someone know if they're having a miscarriage?
Dr. Hobeika: In the absence of Medical follow-up of their pregnancy, patients can have various symptoms that may predict the chance of having a miscarriage. Those include the disappearance of pregnancy symptoms, such as nausea and vomiting. Others include spotting or lower abdominal pain or cramping. However, it is important to mention that in the vast majority of cases, those symptoms do not mean that a miscarriage is about to occur. And the vast majority of women who have, who experienced those symptoms will end up carrying a pregnancy to term.
Host: And at what point, if any, in pregnancy is someone safe from a loss?
Dr. Hobeika: Unfortunately, those chances are never going to be zero. Pregnancy losses are, could be up to 10 to 15% early in pregnancy. After a woman crosses the 10 week gestational age, mark, this chance decreased to approximately 3%. And in the second and third trimester, chances of pregnancy loss are down to half percent or 1%. So unfortunately we can never say zero, but chances are significantly reduced whenever patients cross the 10 week gestational age mark
Host: Dr. Hobeika, can you share some words of hope with our listeners?
Dr. Hobeika: Definitely. The first point that I discussed with patients who come to my office is that the chances of them conceiving a pregnancy and carrying it to term and having a baby in their arms after their consultation is over in their favor. So this is regardless of their age and regardless of the number of previous miscarriages that they have. My number one message is to always be hopeful because the chances are in their favor.
Host: Oh, it's so good to know. Well, Dr. Hobeika we can't thank you enough for being with us today. You gave us a lot to think about and also a good amount of hope.
Dr. Hobeika: Thank you for having me.
Host: That was Dr. Ellie Hobeika, a gynecologist and obstetrician at Fertility Centers of Illinois. Find out more about the services FCI provides for patients by calling (877) 324-4483, or head on over to FCI online.com to schedule a tele-medicine appointment with one of our wonderful physicians. And if you enjoyed this podcast, you can find more like it in our podcast library, and be sure to give us a like, and a follow if you do. This has been the Time to Talk Fertility Podcast. I'm your host, Deborah Howell have yourself a terrific day.
Deborah Howell: Going through fertility treatment is a very poignant process for everyone involved. In this episode, we'll deepen our understanding of the fertility process by discussing what you should know about recurrent pregnancy loss, from the latest research, to causes, treatment options, and inspiring stories of success. Joining us today is Dr. Elie Hobeika, a Board Certified Physician of Obstetrics and Gynecology at Fertility Centers of Illinois. This is the Time to Talk Fertility Podcast. I'm your host Deborah Howell. So Dr. Hobeika, how common is miscarriage?
Dr. Hobeika: In general, we estimate miscarriage to occur and 15% of couples trying to conceive. However, one needs to always keep in mind the age of the female partner in a couple, a miscarriage can increase to 20 to 25% between the ages of 35 and 40 and up to 40% after the age of 40.
Host: Got it. So how do you define a pregnancy loss?
Dr. Hobeika: Pregnancy loss is defined by going from a pregnant state to in non-pregnant state, without delivery of a viable child. And this can occur at any point throughout the pregnancy.
Host: And how does that definition change, based on the progression of the pregnancy?
Dr. Hobeika: So, pregnancy loss is a very general term. If a pregnancy loss occurs too early, maybe a couple of days after having a positive home pregnancy test, then we call that pregnancy loss, a chemical pregnancy loss or biochemical pregnancy loss, miscarriages occur later, maybe a couple of weeks after the first positive pregnancy test. And this is when we actually can see a pregnancy on ultrasound and stillbirth can occur later in pregnancy, usually in the second or third trimester. So it really depends on the gestational age of the pregnancy.
Host: Okay. And in your experience, what's the most common reason for loss?
Dr. Hobeika: The most common reason for loss by far is genetic errors that occur while the embryo is formed.
Host: And what are other causes for miscarriage?
Dr. Hobeika: Other causes of miscarriage include uterine anomalies, such as polyps, fibroids, or scar tissue. Some may be hormonal, such as related to thyroid dysfunction or abnormalities in the level of milk hormone in the body. Others can be, auto-immune the presence of certain antibodies that can attack a pregnancy. And others could be from a genetic reasons that are already present in the partners and their parents. And they can be transmitted from generation to generation.
Host: Women often blame themselves. Is there anything they could have done? What do you say to that?
Dr. Hobeika: This is very common for women to blame themselves, but I always try to encourage them not to in the vast majority of cases, miscarriages are not preventable. So it's not an event that they attended or something that they did or a medication that they took. And the vast majority, they are not preventable. And we try as much as possible to encourage patients not to blame themselves or others for a miscarriage.
Host: It's really true because miscarriage is so, so at what point does a loss or losses indicate a problem? And at what point should a couple seek medical guidance?
Dr. Hobeika: Medical guidance in general is recommended throughout the process. So it is much better for a couple or a patient undergoing a pregnancy loss to be followed up by her gynecologist or by a provider to make sure that this pregnancy is resolving the right way. And there's no complications that arise from this pregnancy loss, but in general, doing a workup to see why the cause of miscarriage. What are the causes of miscarriage is usually recommended after having two or more pregnancy losses.
Host: And you mentioned workups. So what kinds of tests do you recommend and what do they do?
Dr. Hobeika: The best thing that are done, usually aim to delineate various causes of miscarriage that I previously mentioned, and they include blood work and ultrasound, preferably a saline infusion sonography, or a water ultrasound to rule out anomalies of the uterus and endometrial biopsy to rule out infection that could predispose to pregnancy loss.
Host: What kinds of treatment options do you recommend Doctor?
Dr. Hobeika: Treatment options are mainly based on the etiology of recurrent pregnancy loss. I clearly, if the etiology is infectious, treatment would be a course of antibiotics. If the etiology is the uterine anomaly most likely treatment is surgical in this case. And if the etiology are endocrine anomalies at that point, treatment would be via medication based on the endocrine anomaly.
Host: I see. And is there anything couples can do to improve their chances of sustaining a pregnancy?
Dr. Hobeika: You just mentioned that pregnancy losses are usually unpredictable and unpreventable, with that being said, I would recommend that couples seek care after having two or more pregnancy losses. And if they have a treatment course that is recommended by their provider to be compliant to that treatment course. A good way also for couples to improve their chances, conceiving is to treat any pre-existing medical conditions. Cause some medical conditions can predispose to miscarriage such as diabetes or thyroid disorders or obesity. So in those situations be compliant to treatment, having optimal control of their medical condition. And in case of obesity, a certain degree of weight loss may be very beneficial and to carrying a pregnancy to term.
Host: And here's a big question. A lot of couples want to know, how long do you recommend waiting before trying again?
Dr. Hobeika: From a medical perspective, we usually recommend having one period spontaneously occur without trying to conceive and then trying again, but it really comes up to the couple and see when they are, when they feel comfortable trying again. And when do they want to try again? And the vast majority of cases, this applies to early pregnancy losses.
Host: And this might seem obvious, but to a lot of women, it is not. How does someone know if they're having a miscarriage?
Dr. Hobeika: In the absence of Medical follow-up of their pregnancy, patients can have various symptoms that may predict the chance of having a miscarriage. Those include the disappearance of pregnancy symptoms, such as nausea and vomiting. Others include spotting or lower abdominal pain or cramping. However, it is important to mention that in the vast majority of cases, those symptoms do not mean that a miscarriage is about to occur. And the vast majority of women who have, who experienced those symptoms will end up carrying a pregnancy to term.
Host: And at what point, if any, in pregnancy is someone safe from a loss?
Dr. Hobeika: Unfortunately, those chances are never going to be zero. Pregnancy losses are, could be up to 10 to 15% early in pregnancy. After a woman crosses the 10 week gestational age, mark, this chance decreased to approximately 3%. And in the second and third trimester, chances of pregnancy loss are down to half percent or 1%. So unfortunately we can never say zero, but chances are significantly reduced whenever patients cross the 10 week gestational age mark
Host: Dr. Hobeika, can you share some words of hope with our listeners?
Dr. Hobeika: Definitely. The first point that I discussed with patients who come to my office is that the chances of them conceiving a pregnancy and carrying it to term and having a baby in their arms after their consultation is over in their favor. So this is regardless of their age and regardless of the number of previous miscarriages that they have. My number one message is to always be hopeful because the chances are in their favor.
Host: Oh, it's so good to know. Well, Dr. Hobeika we can't thank you enough for being with us today. You gave us a lot to think about and also a good amount of hope.
Dr. Hobeika: Thank you for having me.
Host: That was Dr. Ellie Hobeika, a gynecologist and obstetrician at Fertility Centers of Illinois. Find out more about the services FCI provides for patients by calling (877) 324-4483, or head on over to FCI online.com to schedule a tele-medicine appointment with one of our wonderful physicians. And if you enjoyed this podcast, you can find more like it in our podcast library, and be sure to give us a like, and a follow if you do. This has been the Time to Talk Fertility Podcast. I'm your host, Deborah Howell have yourself a terrific day.