Infertility & Miscarriage
Frederick R. Jelovsek
Women undergoing infertility evaluation and treatment are concerned not only with getting pregnant, but also with whether they will carry that pregnancy to get a healthy baby. Miscarriage in the general population ranges from 10-20% but many of those miscarriages occur before the women knows she is pregnant and they just present as heavy menstrual periods. The miscarriage rate of clinically recognized pregnancies is about 8%.
Many pregnancies that are going to result in miscarriage (spontaneous abortion) never develop to the point where there is a heartbeat detectable by vaginal ultrasound. In fact recent studies have suggested that if a fetal heart beat is detected by ultrasound between 6 and 9 weeks of menstrual age (4-7 weeks after ovulation), then the chance of subsequent miscarriage is only about 2%. Physicians use this 2% number to reassure women who have had an ultrasound in which the baby's heart beat was seen.
Keenan and coworkers looked at this data in women undergoing infertility work ups to see if they have the same low miscarriage rate after fetal heart beat detection as do women who do not have infertility problems. Keenan JA, Rizvi S, Caudle MR: Fetal loss after detection of heart motion in infertility patients; Prognostic factors. J Reprod Med 2998;43:199- 202. In this study, they followed 231 women who were seen in their infertility clinic and who had fetal heart beats detected 28-38 days after ovulation by ultrasound.
Incidences Of Miscarriage
They found that the incidence of miscarriage was:
|Age less than 35
(and singleton pregnancy)
|Age greater than 35
(and singleton pregnancy
Patients who have infertility problems have mixed medical reasons for their infertility. They also tend to be older because they may have put off getting pregnant for various reasons. They appear to have much higher miscarriage rates than the general population, especially if they are over 35 years of age or if they have a multiple pregnancy. It is important that we are able to tell women what to expect under various conditions.
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