Dr. Alexander Kofinas
There is a way
I HAVE EXPERIENCED LOSS
You were able to get pregnant, but something happened. Now, you need answers.
You know you’re more likely to miscarry again and don’t know what to do next.
You’re dealing with a painful loss but can’t let go of the hope of having the family you dreamed of.
You don’t have to give up.
There is hope.
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 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 felt 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 extreme emotions 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 sure 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 SUFFERING
You 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 how lucky they have been to get to this point, despite all the suffering.
NURTURING YOUR SUFFERING
The 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 ANSWERS
If you 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 essential step on your path to healing and trying again.
HOW TO TRY AGAIN
Donʼt wait to get evaluated because each loss is less about untreatable genetic causes and more about underlying factors that can be treated and prevent the subsequent loss.
Every woman must be evaluated after every single loss. When a woman loses her first pregnancy, 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 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 being unable to have a baby.
So, when is the right time to try to conceive again?
This is not a physiological medical question. Emotional trauma is the defining factor here in deciding when to start trying again. You will be ready when your heart is healed and feel strong enough to risk another potential loss. Only then can you feel confident that you can resume the journey.
So, when you are 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 have problems sustaining a pregnancy. On the other hand, many patients with recurrent miscarriages 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 answer “unexplained infertility for you finally.” 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, you can best be proactive and aware because it is your body, baby, and life.
