At the start of this journey it wasn’t clear to me what the difference was between infertility and recurrent miscarriage treatment. I found myself entangled in a web of complex terminology I didn’t know how to handle. Am I infertile if I can conceive? What does a person do when they can’t either get pregnant or keep the pregnancy? So I am going to try and dissect it clearly on this post. I have to say that I am not a medical professional and I only have a rustic understanding of these processes.
On the one hand, you have fertility treatments that aim at making conception happen. Conception can be prevented for a number of reason. Most common causes are blocked Fallopian tubes, an-ovulation and sperm factor. Then you have the treatments that will help with these problems such as IVF, IUI and clomid treatments to make ovulation happen. All of these help with the conception side of things. However, once conception happens, everything needs to be in place for the egg to develop and then implant in the uterus. IVF takes the pressure off of the Fallopian tubes and develops the blastocyst outside of the uterus, then that embryo is transferred to the woman’s uterus with the hope that it continues to develop, then implant. There is a window of a few days where no one knows what happens. This is called the 2 week wait. And at this point women in the community like to say they are pupo. Pregnant until proven otherwise. At the end of the 2ww, women will take a pregnancy test, then know if the embryo has implanted. This 2ww also happens in natural conception with the added pressure that you don’t know if sperm met egg or not.
So now we are clear about that, in our case, everything looked perfect. Sperm quality was good. I was ovulating and had clear Fallopian tubes. So potentially, conception shouldn’t have been an issue. This is called unexplained infertility because no one knows why you cant get pregnant. My instinct led me to think that our problem wasn’t conception but implantation that was failing. Those mysterious 2 weeks!
When you get into this territory everything is enigmatic. Implantation failure can manifest itself in the form of failed IVF treatment or early miscarriage. It is believed by scientists that the majority of pregnancies end before the woman even knew they are pregnant. The whole thing is shrouded by mystery. The factors that come into play in this are numerous and complex. Implantation problems can be caused by an abnormally shaped uterus, infections and chromosomal abnormalities in the embryo.
This brings us to the territory of miscarriage and recurrent miscarriage. It is believed by scientists that the majority of miscarriages are caused by chromosomal abnormalities in the embryo. Because the embryo doesn’t develop properly, nature takes its course and rejects it naturally. However, the more miscarriages a woman has, the less probable that the cause of them is chromosomal abnormalities. Now, here is where egg and sperm quality play a part. There is a test that can ascertain sperm quality but there are no tests that can ascertain egg quality. (Nature is sexist, right?). So doctors tell you to take vitamins to enhance it, in particular, folic acid and vitamin D, and hope for the best.
Right, where were we? There is no way to tell from an early loss if the embryo was viable or not. When recurrent miscarriage comes into play, then doctors look at other potential causes of it. They make sure you have all the bits in the right places, they look at blood clotting disorders that prevent the embryo from being suitably fed and they look at your hormones to make sure they are doing the right thing at the right time. However, 50% of people who suffer from recurrent miscarriage will never find out why they are going through that. More mystery!
From a subjective point of view, I knew that hormones weren’t a problem for us, as we had been tested at the fertility clinic. I was perfectly supplied. at the same time, I felt each month that something was happening. I’ve been blessed or cursed to feel pregnant even before I can take a pregnancy test. At times, I had terrible cramps and nausea on the 2ww. This pain went undiagnosed and brushed off by doctors as just being ‘period pain’. So I thought to myself, is it possible that I conceive all the time, but the embryo doesn’t implant? I felt mad at this point. Doctors told me that it couldn’t be. But I was convinced. Took to Google. And stumbled across a field called reproductive immunology. I then found Alan Beer’s book ‘Is your body baby friendly?’ And the doors of heaven opened to me. In the book, he describes that a woman’s immune system works in a delicate balance that has to be just perfect for implantation. In the patients he treated the immune system was out of control and was killing off the embryos before they could implant or right after they implanted. Some of these patients suffered from unexplained infertility, some of them recurrent miscarriages. Eureka! The only theory that marries both infertility and miscarriage. What a discovery. To my utmost surprise, I found out that these theories were not mainstream, or accepted by doctors on the NHS. Hence all of my frustration when I was trying to explain that my pain was caused by me trying to get pregnant!! Mind blowing. All made sense to me. Might I add, I am still not sure that this is the cause of our plights. But it is a promising field that I have come to believe in despite the scepticism. With regards to our recurrent miscarriages, everything is pretty much a question mark right now. But now we have the knowledge that we need to keep pushing forwards. I like to speculate anyway because the waiting is loooooong!