- The Washington Times - Sunday, March 26, 2000

Miscarriage probably will never be completely cured. Many miscarriages happen for unknown reasons, and about half of all first-trimester losses occur for chromosomal reasons, an area science is not yet able to correct, says Dr. Michael R. Berman, clinical professor of obstetrics at Yale University.
"We're not getting much closer in that area," says Dr. Berman, founder of the Hygeia Foundation, a miscarriage support and awareness group. "I think there are always going to be miscarriages. It is a natural selection process."
Chromosomal abnormalities usually are not based on the chromosomes of the parents. Rather, they are abnormalities that occur when the fetus is formed, sometimes days after the fertilized egg begins to divide. Most women who suffer early pregnancy loss because of chromosomal abnormalities go on to deliver a healthy baby in the future, says Dr. Keith Blauer, a reproductive endocrinologist at the Genetics and IVF Institute in Merrifield.
For women who have suffered repeated pregnancy loss, tests can be performed on both parents and on the fetus to determine whether a more serious genetic problem is preventing a healthy pregnancy.
There has been more significant progress in preventing other types of miscarriage, Dr. Blauer says.
"Where things have really gotten better is in surgical correction of uterine abnormalities," he says. "We have been successful in correcting incompetent cervix [which is a weakened cervix and a common cause of second-trimester loss] and surgical removal of fibroids."
Breakthroughs also have come for hormonal causes of pregnancy loss. Blood tests can determine whether a woman lost the pregnancy because of a lack of progesterone, a hormone that supports the uterine lining, and hormonal supplements can be prescribed for the early part of the pregnancy.
Immune causes of pregnancy loss are an important and controversial area of research, Dr. Blauer says.
Normally, the mother's body protects the "foreign" fetus from attack by her own antibodies. In some cases, though, this protection is absent, causing the woman's body to reject the pregnancy.
"I do think in the future, [more] immunological reasons for miscarriage will be discovered and will be able to be treated," Dr. Berman says.
Currently, immune factors are treated with low doses of aspirin, steroids, the drug heparin or immunoglobulin, Dr. Blauer says.
In some cases, injecting white blood cells of the man into the bloodstream of the woman can help the woman's body recognize and retain the fetus. However, studies have not yet supported the success of this treatment, Dr. Berman says.
"It is still considered out of the scope of mainstream medicine," he says.
Dr. Blauer says he is not convinced this is the best option for most women who suffer recurrent miscarriages. About 60 percent to 80 percent of women who have three or more losses will go on to have a successful pregnancy without any specific therapy, he says.
"I believe there probably are immunotherapy treatments that help women," he says, "but I am not convinced we know which therapies will help which women."

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