GUIDE: I HAVE EXPERIENCED LOSS

YOUR NEW JOURNEY TO
PREGNANCY

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THE KOFINAS PROTOCOL

Guide to Healthy Pregnancies
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IʼM HERE TO HELP

Welcome, I’m so glad you’re here now although I wish I could have met you sooner! I am very sorry to see that you are not in a good place. You have been in a “black hole” of anguish and torment. I could not pretend that I feel your pain. However, I have seen thousands of patients just like you and over the years, my heart and soul have been permeated with all the severe emotions that you have experienced during your coveted journey to motherhood. I am not sure if your losses came after a natural conception or after fertility treatments, but I am certain that the pain of each loss has been getting more intense every time. I cry with my patients, the cries of despair. And I cry with them also from the joy that only a beautiful, vibrant, and healthy baby can generate. A most cherished and sacred moment that I relish every time. I am glad we met at last. I want to assure you that I can help you. By trusting me and my process, I will hold your hand, and help you to the moment you will become the mother you have always wanted to be! Trust me, we can do it together!

FIRST COMES HEALING

VALIDATE YOUR SUFFERINGYou must realize that your suffering is immense and validated. Society tries to brush these feelings under the table and say, “you will be okay.” But this is not true, I believe mothers who experienced loss express a deeper appreciation and understanding of just how lucky they have been to ultimately get to this point, despite all the suffering along the way.NURTURING YOUR SUFFERINGThe emotional healing process is a long journey. You may be able to achieve it by yourself or seek professional help. Nurturing your suffering as part of a more meaningful way to reach your destination of motherhood can bring you immense wisdom and gratitude!GET ANSWERSIf youʼve experienced loss, you deserve to know why. Consulting a Maternal-Fetal Medicine specialist who is an expert in the causes of recurrent pregnancy loss and recurrent IVF failure is an important step on your path to healing and trying again.

HOW TO TRY AGAIN

Donʼt wait to get evaluated because with each loss itʼs less about untreatable genetic causes and more about underlying factors that can be treated and prevent the next loss.

Every woman must be evaluated after every single loss. When a woman loses her first pregnancy ever, in half of the cases of loss, there is a genetic cause. This is often wrongfully interpreted that there is no need to do anything about it. What about the other half? In the second loss, the number of genetic defects drops to only 30% and after the third loss, the number shrinks further to less than 10%. This tells me most of the babies who are lost in recurrent miscarriages were destined to become healthy babies and their loss could have been prevented. Women currently delay their first pregnancy and if they wait to lose three pregnancies or more before they are investigated, they run the risk of never being able to have a baby.

So, when is the right time to try to conceive again?
This is not a physiological medical question. The emotional trauma is the defining factor here on deciding when to start trying again. You will be ready when your heart is healed, and you feel strong enough to take the risk of another potential loss. Only then you can feel confident that you are ready to resume the journey.

So, when youʼre ready to conceive again, you must be evaluated for the potential causes of recurrent miscarriage. Only then will you have the opportunity to become pregnant and stay pregnant. Most patients with recurrent miscarriages have no problem conceiving but they have problems with sustaining pregnancy. On the other hand, many patients with recurrent miscarriage are mistakenly referred by their obstetricians to a fertility specialist. This is unfortunate and could delay reaching your destination further.

Here is what I consider the best strategy to solve your “unexplained infertility and pregnancy loss” mystery.


1

BASELINE HEALTH

Start With the Simple Stuff. Ask your provider to conduct a baseline assessment of your health. Test for thyroid function, autoimmunity testing, metabolic assessment to rule out insulin resistance, prediabetes, luteal phase defect, vitamin deficiencies, cardiovascular disease, and kidney disease.

2

CHECK-UP ON DAD

Oxidative Stress Can Take a Toll on Healthy Swimmers. Examine the semen of your partner. Environmental pollution, poor dietary habits, and lifestyles can cause oxidative damage and DNA fragmentation to the sperm.

3

CHROMOSOME CHECK-UP

Obtain a blood test known as karyotype for you and your partner to make sure your chromosomes are balanced and not causing any defects.

4

EGG QUALITY

Evaluate your ovarian function to assure that you still have enough healthy eggs. This requires a Day 3 hormonal testing with AMH and inhibin B for ovarian reserve assessment.

5

IMMUNE SYSTEM IMBALANCES

Ask an MFM or reproductive immunologist to conduct a thorough immune system assessment for you and your partner’s immune system; certain genes your partner passes to your baby, could be detrimental to the implantation process but if known, they can be managed successfully.

6

IT TAKES TWO TO TANGO

50% of all reproductive failures are the result of paternal health imbalances affecting the embryo. Have a thorough evaluation for genetic and acquired/immune thrombophilia of yourself and thorough genetic thrombophilia of your partner. (In cases of a donor egg or a surrogacy, things can be even more complicated, and you will need highly specialized care by a proper experienced specialist.)

7

WOMB INFLAMMATION

Womb inflammation is known as chronic endometritis. This could result from a microbial infection, uterine fibroids, uterine adenomyosis, endometriosis, and from an imbalanced endometrial immune system. Uterine inflammation acts as a contraceptive. Having an endometrial biopsy to evaluate the endometrial immune status is of paramount importance to rule out endometrial inflammatory conditions

YOU CAN DO THIS

Please, do not attempt another pregnancy, natural or IVF, before you ask your specialist to complete the workup described above (if he or she is not familiar, seek the help of an experienced specialist). All the above investigations might reveal clues that require further testing to finally answer “unexplained infertility for you.” Seeking out experienced and trusted specialists to uncover the clues as to why you have experienced loss will help you prevent it from happening again. I hope this never happens again, however, the best thing you can do is be proactive and aware, because it is your body, your baby, and your life.

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