Dr. Malpani: Understanding Recurrent Pregnancy Losses
Patient: Dr. Malpani, I’ve had multiple miscarriages, and it’s been incredibly frustrating. I’ve read so many different things about why this happens and what can be done, but it’s all so overwhelming. I just want to know—why does this keep happening to me, and is there anything I can do to prevent it?
Dr. Malpani: I’m really sorry that you’re going through this. Recurrent pregnancy loss is one of the most challenging issues in reproductive medicine, not just for patients but for doctors as well. The most common reason for these miscarriages is genetic abnormalities in the embryo, which can cause it to fail to develop properly. Unfortunately, even with all the advances in technology, we still aren’t able to fully diagnose, prevent, or treat these genetic issues.
Patient: That’s so discouraging to hear. But I’ve seen doctors recommend treatments like IVF with Preimplantation Genetic Diagnosis (PGD) to avoid genetic problems. Isn’t that supposed to help?
Dr. Malpani: IVF with PGD can help in some cases, but it’s important to have realistic expectations. PGD allows us to check for chromosomal abnormalities in embryos before they are implanted, which might reduce the chances of a miscarriage caused by those specific abnormalities. However, PGD isn’t foolproof. It has its limitations, including false positives and false negatives. Plus, PGD only screens for chromosomal issues—there are 23 pairs of chromosomes, but there are also around 30,000 genes, and we can’t screen for all of them. This means that even after doing IVF with PGD, some women might still experience miscarriages because we simply can’t catch every possible genetic issue.
Patient: That makes sense, but it’s still so frustrating. So, what should I do? Are there any other treatments that could help?
Dr. Malpani: This is where things get tricky. Because miscarriages are so distressing, patients are often desperate for solutions, and unfortunately, there are unscrupulous doctors who take advantage of this. They might offer expensive treatments, like immune therapy, claiming that these will prevent miscarriages by treating supposed immune rejection of the embryo. However, there’s no solid evidence that these therapies work—in fact, many of them are complete nonsense and can even be harmful.
Patient: Immune therapy? I’ve heard about that—something about the body rejecting the baby because of immune compatibility issues. Is that not a valid concern?
Dr. Malpani: The idea sounds plausible, which is why it’s so easy for doctors to convince patients to try immune therapies. But the truth is, these treatments are largely based on speculative science and often do more harm than good. What’s more, many women who have had multiple miscarriages and try these immune therapies end up having a healthy baby eventually, but this success isn’t because of the immune therapy—it’s in spite of it. In reality, even without these interventions, with just supportive care and time, many women go on to have a healthy pregnancy.
Patient: So, if these treatments don’t really help, why do some women still end up having a successful pregnancy after them?
Dr. Malpani: That’s a great question, and it highlights how confusing this issue can be. The truth is, many women who experience recurrent miscarriages are still likely to have a healthy baby eventually, just by chance. The success rates can be as high as 50% even without any medical intervention, simply with tender loving care and patience. So when a woman who’s had multiple miscarriages finally has a healthy baby after trying a particular treatment, it’s easy to mistakenly attribute that success to the treatment, when in fact, it might have happened anyway.
Patient: It sounds like a lot of this comes down to luck and waiting. But that’s so hard to accept when you’re going through it.
Dr. Malpani: I completely understand. It’s natural to want to do something, anything, to improve your chances. But it’s crucial to recognize the limitations of medical technology today and to be kind to yourself during this difficult time. Miscarriages can cause a lot of hidden grief, guilt, and shame, and it’s often hard to get the social support you need. That’s why I encourage my patients to educate themselves—read books on recurrent miscarriages, many of which are written by healthcare professionals who’ve gone through this themselves. These resources can provide much-needed empathy and truthfulness, helping you make informed decisions and giving you peace of mind, no matter the outcome.
Patient: That’s really good advice. I guess I need to be more cautious and informed before agreeing to any treatments.
Dr. Malpani: Exactly. Arm yourself with information, ask the right questions, and don’t be afraid to seek a second opinion if something doesn’t feel right. Remember, you deserve a doctor who respects your autonomy and prioritizes your well-being above all else.
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