This past Tuesday, October 15th, was National Pregnancy and Infant Loss Remembrance Day. It is a day to recognize those who have experienced the heart-wrenching tragedy of pregnancy and infant loss. There is still so much taboo and silence regarding these losses. The American Pregnancy Association states that miscarriage "is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage." Many endometriosis patients are often at a greater risk for miscarriages, preterm labor and ectopic pregnancies due to the effects of this disease and have experienced great loss.
There are many reasons that a woman with endometriosis can have a miscarriage and luckily, through medical intervention, some of the reasons can be helped.
At the Endometriosis Foundation of America’s last Medical Conference, there was a lot of talk about infertility and early pregnancy loss in endometriosis patients. Endometriosis affects everything from the quality of the eggs, to their maturation to embryo implantation. Doctors have always suspected that endometriosis can affect the uterine lining, often interfering with embryo implantation. But now doctors are realizing endometriosis can even affect the egg quality itself. A recent study found that women who did not have endometriosis, who used donor eggs from women with endometriosis, had a much lower rate of achieving a healthy pregnancy. This study suggests that women with endometriosis have a lower egg quality. One reason for this lower egg quality may be that women with endometriosis have cytokines in their peritoneal fluid, which is caused by inflammation. This fluid is part of the follicular fluid which encases the eggs and can affect them adversely. Doctors at the conference suggested that egg freezing is an option for young patients worried about their future family building. It is also recommended for endometriosis patients, especially those with recurrent pregnancy loss, to use in-vitro fertilization and preimplantation genetic diagnosis to help achieve a healthy pregnancy. These techniques will allow doctors to see the genetic makeup of an embryo to see whether it is genetically sounds. Only transferring healthy embryos will allow patients to have a better chance at avoiding pregnancy loss. Studies have also shown that women with endometriosis have a higher success rate using frozen embryo transfer as opposed to doing a fresh IVF cycle.
It is the belief of Dr. Seckin, along with other authorities in the field, that endometriosis has been found to have an immunological component that can lead to miscarriages. This immunological component is again due to excessive inflammation caused by endometriosis. The body's own impaired immune system can result in rejection of the early implanted embryo. He believes any patients who have gone on to become pregnant and miscarry after surgical intervention should arrange for a reproductive immunological profile. An expert reproductive immunologist can help correct or strengthen a women’s immune system leading to a better chance for a healthy pregnancy.
Unfortunately, endometriosis can leave a destructive path in a patient’s pelvis. Scar tissue and adhesions can form on the fallopian tubes which can lead to an ectopic pregnancy. This loss is not only devastating, but dangerous because it is very important to terminate the pregnancy before the tube ruptures. Also some women with endometriosis often have a uterine defects such as an abnormally shaped uterus (heart-shaped, or with a septum [wall] dividing it). This abnormality may interfere with maintaining a pregnancy. Dr. Seckin asks many of his new patients who have had children if they have had atypical births. Many have experienced pre-term delivery and emergency C-section.
After complete excision of endometriosis in the pelvis, all inflammation sources are eliminated. Dr. Seckin has seen a great number of his patients go on to have healthy pregnancies. He takes great care in carefully removing endometriosis on the uterus and the ovaries to help patients with their family building. He often can surgically correct uterine defects and also free up the fallopian tubes to help patients get pregnant. For those still have issues, he works with some of the best reproductive endocrinologists and immunologists to help patients have the best chance at achieving a healthy pregnancy.
Endometriosis is a disease that forces patients to live with chronic pain. It is cruel that is also can lead to the devastating experience of pregnancy loss. Please know that you are not alone.
Casey Berna is a patient of Dr. Seckin’s and an endometriosis and infertility counselor and advocate. To learn more about her story and her practice go to www.CaseyBerna.com. If you are a patient of Dr. Seckin’s and want to share your story please contact Casey at [email protected].
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