Deborah Howell (Host): Pregnancy loss is devastating. Sadly, it's also very common. One in four will experience a loss or even multiple losses. This is the Time to Talk Fertility podcast. I'm Deborah Howell and today Dr. Channing Burks Chatmon, a Reproductive Endocrinologist who completed her fellowship in recurrent pregnancy loss and reproductive endocrinology and infertility, is here to share her insight, perspective, and knowledge about this difficult topic. Dr. Burks Chatmon, it's so nice to have you with us today.

Channing Burks Chatmon, MD: Thank you so much, Deborah. I'm really excited to be here.

Host: We are thrilled and I'm going to dive right in if that's all right with you.

Channing Burks Chatmon, MD: That's fine.

Host: How common is pregnancy loss?

Channing Burks Chatmon, MD: Well, unfortunately, Deborah, it's very common. So, about one in four pregnancies will ultimately result in a pregnancy loss. So that means about 25% of women will experience miscarriage at some point, in their reproductive life while they're trying. And then approximately 5-10% of women will unfortunately experience more than one pregnancy loss.

Host: That's very high. I hadn't realized it was that high. So what causes pregnancy loss?

Channing Burks Chatmon, MD: So there are multiple causes. Most commonly, a pregnancy loss can occur due to a random chromosome error. And I'm guessing you're probably wondering what that is. So, at the time of fertilization, it's important for an egg and the sperm to meet, and both mom and dad have to kind of give off the right amount of genetic components to their embryo or ultimately their baby. And so what can happen is if that process doesn't occur correctly, then a baby can either be missing genetic material, or have kind of too much genetic material. So, an example would be like Down syndrome, where you have three copies of your 21st chromosome. And as humans, we should only have two copies.

So a lot of those random errors ultimately result in a miscarriage. Some other common causes would be a uterine factor. So that can be things that a woman is born with structurally, like a common one would be a uterine septum. It could also be acquired factors that they've developed over their life, such as fibroids or even polyps.

There's also autoimmune factors, such as antiphospholipid syndrome. There are endocrine causes, such as if you have an elevated thyroid or another hormone called prolactin. And also if you have uncontrolled diabetes, we know that can increase your risk for loss.

And just a couple more, so genetics, actually genetics of the parents, so we search for something called a translocation, which is actually, you have all of your genetic material as a parent, but the alignment is off and then it can be passed down at the time of miscarriage, in an incorrect fashion. And there's been developing research about chronic inflammation of your uterine lining and that is called chronic endometritis.

Host: Okay. So many, many factors. Is there any way to prevent pregnancy loss in those circumstances?

 Um,

Channing Burks Chatmon, MD: So I think the key is evaluation. So at the time of two losses or more, we really recommend evaluation for the factors that we just talked about, and then targeted individualized treatment based on what the evaluation shows. If a couple has experienced multiple losses due to those random chromosome errors, there's really no way to prevent those.

They do also increase with maternal age, but we do have a technology now called pre implantation genetic testing where we can screen embryos for those losses. So it's kind of a way to target what embryos to transfer.

Host: That's an amazing technology. How common is it to have a successful pregnancy after experiencing one or multiple pregnancy losses?

Channing Burks Chatmon, MD: So if you've had two or more losses, typically we know that eventually, most couples will have a success and by success we mean live birth. So about two thirds of couples will have a live birth but it could mean that they could have additional miscarriages along the way and that that's what we try to do the evaluation so that we can try to prevent if possible.

Host: Now how long do you recommend waiting before trying again after a loss?

Channing Burks Chatmon, MD: People used to think, oh, you should wait three to six months. And really over the past, you know, 10 years or so, we've really learned you don't need to wait that long. So now typical recommendation by myself, my partners would be to wait one month after a miscarriage or D & C to let your body reset.

And typically, we'll do some evaluation to make sure that process has happened, but then you're clear to try again.

Host: At what point does a loss or losses indicate a problem?

Channing Burks Chatmon, MD: So I would say, if you've had one loss, we typically would say that could just be due to bad luck, and when we say that, we mean it could be just due to a random chromosome error, which couples do not have any control of, and we would encourage you to try again. If you have had a second loss, then that is when we want you to come in to have a full evaluation for those other factors that we discussed to see if something is abnormal or if everything comes back normal; but either way to determine a treatment plan for your next pregnancy.

Host: Is there medical testing you would recommend for someone with a history of pregnancy loss? And what can those tests tell you?

Channing Burks Chatmon, MD: The most common cause would be the random chromosome errors. And as I mentioned, there's no way to prevent those, but you can screen for them if you happen to do IVF, with pre implantation genetic testing. But, to test for uterine factor, we'll typically recommend a cavity evaluation.

That can be done in different ways, such as a saline ultrasound, something called a histosalpingogram or HSG for short. Or sometimes even doing a diagnostic hysteroscopy, which is when we place a tiny camera inside of the cavity. And then we do blood work for most everything else. So for checking for antiphospholipid antibodies, thyroid, prolactin, checking for uncontrolled diabetes, genetics of both parents can also be checked via a blood sample. And then if you decide to proceed with the evaluation of the uterine lining, that is done in what's called an endometrial biopsy. So similar to a pap smear, where we just take a sample of the lining and then check it for infection.

Host: So many tools to give you the information you need. What kinds of treatment options do you recommend?

Channing Burks Chatmon, MD: So I really think that treatment should be individualized and it's based on what we note during your evaluation and also what the couple really wants to do. But some options would be perhaps using low dose aspirin. Some people will use additional progesterone, especially in the second half of your cycle.

Some couples will choose to try again with those tools such as a low dose aspirin or progesterone, whereas others, especially couples where our female might be greater than 35 or if they've had prior losses due to chromosome errors; those couples might choose to move forward with the IVF and the genetic testing.

Host: Okay, Dr. Burks, switching tracks just a little. How does genetic testing factor into everything?

Channing Burks Chatmon, MD: So, the pre implantation genetic testing, it is a wonderful technology. It has developed and kind of progressed a lot in the past 10 to 15 years, and is a tool to screen or select embryos for transfer. So, they look at the genetic component of the embryo, and they are checking to ensure that the embryo has two copies of every chromosome, which is what we should have. And so if they find that there's a trisomy, so an extra copy or a monosomy missing a copy; then those embryos we would choose not to transfer since we know those would increase your risk for miscarriage.

Host: Okay. And how about the latest medical research? What does it show about this issue?

Channing Burks Chatmon, MD: You know, we've learned a lot in the past 10 to 20 years. For example, how to best treat antiphospholipid syndrome. More research has come up about chronic endometritis, studies that have looked at perhaps using empiric progesterone in women who've had multiple losses and things like thyroid disorders.

But to be honest, we still have a lot to learn about recurrent pregnancy loss and all factors that are involved. And so there will be about 40 to 50 percent of couples that will do testing, and it will come up as unexplained recurrent pregnancy loss, meaning all the testing is normal, but we do still have treatments that we can recommend for couples that fall in that category.

Host: Yeah, that's got to be so disappointing. So, maybe I can ask, can you share some words of hope with our listeners?

Channing Burks Chatmon, MD: Of course, so you know what I would really just encourage listeners to hold on to hope in any form that you can and to know that it can be very hard, but that you should know that many couples will go on to have a live birth. I would encourage them to speak to their OBGYN, or to seek care from a fertility specialist if they've had two or more losses so they can really do that evaluation and kind of come up with the best plan for them as an individual couple.

Host: Got it. Now, what advice do you have for patients on coping with pregnancy loss?

Channing Burks Chatmon, MD: I would tell them that they should know pregnancy loss is very hard, that they should take time to grieve their loss. That it's important not only to be physically, but also to be emotionally and mentally ready to try again. I would also really tell the listeners that it's okay and absolutely should ask for help if you feel that you need it. So from your OBGYN, from your fertility specialist, support group, counselors, family, and friends. And additionally, I just want them to know that pregnancy loss, unfortunately, it's common, but they're not alone and it is definitely not their fault.

Host: On this same subject, can you tell us a little bit about the Pregnancy Loss Support Group at Fertility Centers of Illinois?

Channing Burks Chatmon, MD: Yeah, I would be happy to. So I believe it's a great resource that we can offer. It is available to all of our patients here at the Fertility Centers of Illinois, but also to any patient or, person that's trying. So you do not have to be an active patient, which I think is great. It's anonymous, it's virtual, so you can do it from the privacy of your own home.

And I just think it offers a lot of great support and resources and helps to reinforce that these women, these couples, they're not alone. And all meeting times and info can be found on our website, which is fcionline.com.

Host: And I'm just going to add the phone number, you can talk to a fertility specialist at 877-324-4483. Such great information, Dr. Burks Chatmon. Thank you so much for being with us today to share your expertise and your compassion.

Channing Burks Chatmon, MD: Thank you, Deborah, for having me and for taking the time to talk about such an important topic.

Host: 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 from Fertility Centers of Illinois. I'm your host, Deborah Howell. Have yourself a terrific day.