Latest / Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss / Recurrent Miscarriage Explained: Genetics, IVF Failure, Hormones & Why Pregnancy Loss Happens

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Recurrent Miscarriage Explained: Genetics, IVF Failure, Hormones & Why Pregnancy Loss Happens · Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss

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Crying Out Loud, a podcast by Chasing the Rainbows with your
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host Bernice Quisenberry. Today's episode of Cried Out
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Loud is one that so many in our community have been asking for a
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deeper conversation around reoccurrent pregnancy loss,
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infertility, and the medical questions families are often
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left searching for answers on to their own.
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For parents who have experienced miscarriage after miscarriage,
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loss after loss, the grief is devastating, but the uncertainty
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can be just as painful. Questions like why did this
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happen? Was it genetics, hormones, the
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embryo, my body? Will this keep happening again?
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Too often families are told it's just bad luck or just simply try
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again. But recurrent pregnancy loss is
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complex, and many parents are already doing deep dives trying
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to understand the science behind what they've experienced.
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That's why today we are joined by Doctor Ryan Martin, a board
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certified reproductive endocrinologist and infertility
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specialist with Shady Grove Fertility.
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Doctor Martin earned his medical degree from Yale University
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School of Medicine, completed his residency at Yale New Haven
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Hospital, and went on to complete his fellowship and
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reproductive endocrinology and infertility at Yale.
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His work focuses on infertility, IVF, genetic screening, and
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helping families navigate complex fertility challenge.
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Beyond his medical expertise, Doctor Martin's story is one of
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incredible perseverance after a tragic injury at age 12 left him
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paralyzed from the waist down. He went on to become the very
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first wheelchair bound graduate of Yale Medical School,
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dedicating his life to helping others beyond their families.
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Today we're going beyond surface level conversations and diving
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right into those real questions lost parents are asking about
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genetics, embryos, sperm health, uterine factors, why early term
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baby loss can still happen even when everything appears normal.
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Doctor Martin, thank you for joining us and for helping our
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listeners better understand the science behind recurrent
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pregnancy loss while honoring the grief so many families
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carry. Yeah, happy to happy to help.
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Hopefully I can answer any questions that might help me get
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through all this. Absolutely.
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Well, thank you. And we'll dive right in because
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we got a lot. We did hear you, listeners.
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We appreciate your feedback, things that were submitted.
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And yeah, we'll go right into it.
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So medically recurrent pregnancy loss, RPL is often defined as
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two or three consecutive miscarriages.
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Do you believe we're waiting too long before doing a full
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evaluation, or should parents be offered testing after two losses
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instead of three? Well, the traditionally it was 3
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losses. That's like the, the old
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definition of it, like start to evaluate after three.
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But most of us, including me, thought that was a little crazy
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to say, well, after two losses, we're not going to check you.
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Let's, let's then so, you know, wait for three, but we don't
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really do that in, in, in practice nowadays.
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We start to really check it after 2, you know, if you have
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two in a row and you know, there's things that we can look
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at and to start an evaluation and try and decrease the chance
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of having a third. And we should definitely do
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that. And so almost all my patients
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really, it's that early that we see them.
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And sometimes people come in at 2 and say, I don't know if I'm
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here too early. And I say, no, you're here at
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the perfect time. That's great, Ryan, just to be
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able to go in to, you know, feel validated in their losses too,
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because I know like 1 feels like a lot, you know, and then two
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and it's, it's just, it is devastating.
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So having a, you know, person who understands a provider to go
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to and to turn to who? Tees it with.
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Much care. Yeah, I mean, to come in and
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say, well, we're really not going to do anything to give
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another one is like a terrible thing to say and a terrible
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thing to hear. Isn't it?
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So we don't do that. Yes, I feel that so much.
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Thank you. You know, we're often told a
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miscarriage was due to a chromosomal abnormality or bad
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luck. Can you explain the difference
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between a random genetic error and something inherited like a
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balanced translocation? And when should parents have
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karyotype testing to check their own chromosomes?
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It's it's hard to hear unexplained.
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A lot of times we don't get those answers, especially in the
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early term losses. Yes, so, so this is a great
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question. You know, I answered these types
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of questions every day. And so one of the things that we
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think about is all right, how do how do we know that that
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pregnancy losses are related to abnormal chromosomes?
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We refer to that term as anuploidy, an embryo that is the
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wrong number of chromosomes. We know that because when people
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have DNCS or have surgery to take pregnancy tissue out, 2/3
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to 3/4 of the time we find that there's a genetic abnormality.
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Now, that can change based on a woman's age, but the general
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idea is we see it often enough to know that that is a major
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cause for losses. So what happens is they do some
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genetic testing on the products of conception and lo and behold,
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we find there's the wrong number of chromosomes.
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There are a couple ways that that happens.
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One of the ways that we think that happens most often is
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related to eggs. And a lot of that has to do with
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biology, meaning women are born with all their eggs.
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Men mix sperm all the time. So eggs used to get pregnant are
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the age of the woman. Plus, you know, eggs were made
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when they were 20 weeks in utero, right?
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So if you were 36, the age of your eggs is probably 37.
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And whereas sperm that is used to 'cause that pregnancy is
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about 90 days old. So there's a lot more biologic
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complexity to eggs than there is with sperm.
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And So what often happens is women ovulate an egg that
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happens to be genetically abnormal.
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Most of those eggs don't fertilize, but sometimes they do
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and they do chromosomes. The embryo starts to implant
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into the wall of the uterus, does the things that needs to
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do, and then stops when it doesn't have the next
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information to do the next thing, like throw a heartbeat or
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whatever it is. And so that's the main etiology
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for losses. From a genetic point of view,
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sperm also play a role, and I think you'll probably ask me
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some questions about it later, but sperm also plays a role in
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aneuploidy as well. But in general, from a biologic
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point of view that that is that's the case now, that is
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someone with a normal genetic makeup, 2 parents with a normal
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genetic makeup can have these aneuploid embryos.
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It's a random event. Now, you asked a question about
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whether or not there's a parental contribution to having
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losses. And one of the genetic things
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that we think about related to that is something called a
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translocation. A translocation is something
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that you can be born with that has no health implications and
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shows up solely as recurrent losses.
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And you can sort of think of it like our chromosomes are like an
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encyclopedia, a set of encyclopedia books.
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And we used to have those, and they're supposed to be an order,
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and you're supposed to have the whole book, and they're supposed
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to be an order. Now you could be born with an
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abnormality in those in the order of those chromosomes or
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whether or not you have a whole book or not.
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And and that's called the translocation.
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So pretend we're reading, reading a book and it's 10
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chapters and chapter 10 and five are switched.
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So we're reading chapter 1234 and then chapter 10.
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So books now out of order, books going great, but it's out of
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order. We have the entire book.
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So we have all the information we need, but it's out of order.
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The same thing can happen with your chromosomes.
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We refer to that as a translocation.
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When I talk to my patients about this translocation, it is an out
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of order book. And basically what that means is
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that if a woman has the the balance translocation, then you
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can have more abnormal eggs. If the man has it, then you can
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have more abnormal sperm. And so when they get together,
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they make embryos that are abnormal and lead to losses.
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And so part of our standard work up is to do karyotypes on both
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parents to try and see if they have a translocation.
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So as part of our standard loss work up, that's what we do.
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So after 2-3 losses when someone comes in to me, this is part of
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the things that we look for because it's about 2% of the
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time in recurrent losses that we see something like this.
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But it's a really bad thing to miss, so is there something we
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can do about it? And so checking for that is
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super important. I love how you Simply put that
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with the chapters being out of order because it it makes so
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much clearer sense, you know, then sometimes the medical way
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of describing it. So thank you, Ryan for that.
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Sure. Yeah, and you know what's
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interesting? So yes, focus a lot on, you
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know, eggs. I, you know, with my husband and
9:55
my secondary infertility journey, a lot of it was, you
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know, me, it was me. And so, yeah, it, it's
10:02
interesting. So I, you know, never really had
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to have the conversations around sperm health.
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But, you know, with you mentioning that, how significant
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is sperm, you know, DNA fragmentation and recurrent
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pregnancy loss? And when should couples consider
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advanced male factor testing? So this is a controversial
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subject, and probably a reproductive urologist is going
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to answer this in better ways than I can.
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But the general idea is that we do know that sperm contributes
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to recurrent pregnancy loss. And we know that for a fact that
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I don't think there's any ambiguity about that.
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But the question is, what do we do about it?
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So the idea is, is that sperm can have DNA that's a little bit
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fragmented or abnormal and that can happen as the sperm is in
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the testes as opposed to part of its how it was being generated.
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So it has to do with like the storage, how long is it being
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stored in creating this oxidative stress that leads to
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fragmentation of the DNA. This then in turn could lead to
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an abnormal sperm fertilizing an egg, making an abnormal embryo,
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leading to aneuploidy. What we've been talking about
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the wrong number of chromosomes. Now, in general, we don't really
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test DNA fragmentation unless there's an abnormal sperm count
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as a general rule. There are times where we can
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certainly test DNA fragmentation and certainly can do it with
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recurrent pregnancy loss, but it's not our part of our
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standard testing because there's not a lot of things we can do
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about it. Meaning you can put somebody on
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antioxidants, Coq 10, oxidative stress reducers, things like
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that to try and help with that. If someone has like a structural
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abnormality within the within the, the, the vasculature of the
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testes, taking that out can certainly help if that's
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contributing to DNA fragmentation.
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There's some evidence that's very controversial that getting
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sperm directly, surgically, directly from the testicle may
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avoid some of the oxidative stress and and decrease DNA
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fragmentation. That is a very controversial
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thing that you'll see reproductive urologist lean
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towards or lean away over time, but there's not a lot of things
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to do to fix it. And so the question is like, how
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much do you want to check those things when there's not much you
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can do about it? Right.
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At least you know getting pregnant on your own.
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Right. Wow.
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Thanks for explaining that. Yeah.
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And yeah, that's really interesting actually, and that
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doctors fall either way with it. Yeah, as more evidence comes out
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and, you know, in reproductive medicine, it's really
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complicated to get some great answers that really isolate the
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problem that you're looking at. So some studies will like kind
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of lean in One Direction, others will not.
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And so that when you get like a full evaluation, you take a full
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picture of things, you don't see it necessarily definitive in one
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way or the other. And that's why people start to
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kind of waffle between how can I really help somebody or not.
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Yeah, and sometimes it, I mean not to speak or anything running
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out of turn, but almost trial and error with some of these
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things too is what it almost feels like.
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And some treatments are more effective for specific
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individuals than others. And we just don't change no
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more. Yeah, trying to figure out what
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works best. Yeah, woof.
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So with families who go through IVF with pre implantation
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genetic testing, miscarriages still occur.
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You know, can you explain mosaic embryos, the limitations of
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embryo testing, and why a genetically normal embryo
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doesn't always guarantee a live birth?
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Yeah. So as I was saying to you, one
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of the leading cause of losses is related to an embryo that's
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abnormal. But there's many other factors
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that can be involved with losses and so we can't control all the
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things from an embryo point of view.
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Testing of the embryos is one way that we can try and reduce
14:45
miscarriages by avoiding transferring an embryo that has
14:48
the wrong number of chromosomes. It's called pre genetic testing
14:52
of the embryos and specifically we take a few cells off the
14:55
outside of an embryo and then freeze the embryo.
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The cells that we take off we send to a lab.
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That lab will then tell us how many chromosomes does each
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embryo have from a So from a selection of an embryo point of
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view, it's very helpful because I can then say to you that
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embryo with the wrong number of chromosomes is not going to lead
15:19
to a live birth or it's going to lead to a miscarriage.
15:23
Whereas these other ones that are that have the right number
15:26
of chromosomes are far, far more likely to yield a healthy
15:30
pregnancy. So pre genetic testing in the
15:35
embryos is helpful in that way to decrease the chance that you
15:39
would have a loss due to amuplity, which is a big reason
15:42
for losses. So I can reduce that, but I
15:46
can't really reduce the chance. We have losses due to other
15:49
factors that are either unknown or uncontrollable to us.
15:54
So I think each lab is different.
15:58
But I think, you know, in our lab probably we can get
16:01
miscarriage rates down to about 13 percent or so when we
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transfer euploid embryo. So we can get it down, but we
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can't get it down all the way because there's a million other
16:12
things that we don't know is the I don't know category that kind
16:20
of that can contribute. So the idea when people come to
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see me with recurrent losses and they want to do IVF and test
16:26
their embryos, it's a good start to really decrease the chance of
16:32
a loss due to the wrong number of chromosomes.
16:34
But there's other factors that I can't control and I'm super
16:38
transparent about that with people because I just, I want
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you to know what we can control, what we can't.
16:43
Some of this is random that I don't have control over and the
16:48
patient doesn't have control over, and so some of that is
16:51
that lost feeling, like I can't control all of it.
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But it's important to just transparently know that.
16:57
Really it is. And especially, you know, with
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someone who's gone through loss after loss, having a, a care
17:03
team, a provider who is saying to you, listen, this is what we
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can control. This is what we can't.
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I'm going to be clearly transparent with you, but also
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I'm going to be honest and very upfront.
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And that's really like what we're looking for because, you
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know, with trauma, we're already feeling like isolated shut down.
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Who do we trust? You know, who's our safe space?
17:25
And when we have those open commutative, you know,
17:28
conversations with that, whoever's treating us, we feel
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like we can almost break down those barriers more.
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And we know going into this a lot more than we would if we
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didn't have those conversations. It's so important.
17:41
Yeah. I mean, I, I sort of, you know,
17:43
this is like one of the mainstays of how, you know, we
17:46
communicate with people is to say, look, these are the things
17:49
to expect when we get our testing done, when we go over
17:52
the testing, These are the things that I'm going to talk to
17:54
you about. These are some of the things
17:56
that I know and just don't know, but I'll be super transparent
17:59
and we'll discuss it all together.
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I think that just kind of allows you to absorb the information in
18:06
a more informative way. Absolutely.
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I know we can't preach that enough around here.
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So thank you, Ryan, for that. Yeah.
18:15
You know, how often are uterine abnormalities like a septum,
18:21
scar tissue or fibroids overlooked on routine
18:25
ultrasounds? When someone you know requests
18:28
more advanced imaging, when should they do that?
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Like a saline sonogram or MRI? So it is part of our standard to
18:38
evaluate the structure of the uterus both with fertility, I do
18:42
that with infertility patients, but also with recurrent loss
18:46
patients. There are some conditions that
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we think are associated with losses, specifically septums for
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sure. But there are other conditions
18:54
with abnormal development of an, of, of a uterus or things that
19:00
can change over time like fibroids, polyps, endometriosis,
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adenomyosis, things like that, that can affect things.
19:09
But so a salient sonogram is absolutely the first thing that
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I do. And I'm wanting to know, is
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there anything about the structure of the uterus that's
19:21
that that's contributing to this?
19:23
Now, if someone has a septum, we're actually kind of cheering
19:25
because it's like, great, I could take care of that in 10
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minutes. I can do a hysteroscopy and even
19:32
out that septum and return your chances back to normal in terms
19:37
of losses just with that. So when someone has that great
19:41
news, I always kind of go back to the story when when I was
19:47
first out of fellowship and I was practicing and I saw a
19:50
patient who had had a child before but then had a bunch of
19:56
losses as well. And she had a child, had AC
20:00
section losses in a row. Came to see me and said, and I
20:05
told them about the recurrent loss work up and part of it was
20:07
the saline sonogram to look at the lining of the uterus.
20:10
She said I've had losses. I've had all these ultrasounds
20:13
with my losses. I had AC section, they had my
20:16
uterus out. They were cleaning out the
20:17
placenta. Like people have looked at my
20:20
uterus, I'm sure it's fine. I said, well, let's check it
20:24
out. And she had a big septum.
20:27
So it had been missed on many ultrasounds with the losses it
20:33
had missed been missed on the C-section.
20:36
And so we fixed, you know, I fixed her septum and then she
20:40
went on to have a kid. And it's just like one of those
20:42
things that I remember early on as a, as a doc saying, you know,
20:46
remember this one because these are things that are probably not
20:51
the most common, but it's sort of clarifies the reason for, for
20:56
looking. And so we look.
21:00
And looking out of a different lens right too.
21:03
So for example, have had fibroids and cysts removed over
21:07
the years. You know, the doctors were
21:08
really focused on removing those, not necessarily what it
21:12
was causing with fertility or anything like that, right?
21:14
Because that was their main focus when I was, you know,
21:16
getting treated for those things and then, you know, needing
21:19
corrective surgeries and things like that.
21:22
It's, it's almost like, you know, because then when we were
21:26
trying to get pregnant and couldn't, our doctor was looking
21:28
at it from a different way, an angle and everything.
21:31
And it is really interesting you're saying this, Ryan,
21:33
because it, I really think and then, you know, looking at lab
21:36
work is kind of the same way where if you're looking at it,
21:40
is this person surviving or are they thriving for getting
21:42
pregnant? It's a whole different way
21:44
you're looking at things. Yeah, and it kind of makes me
21:47
think of like when people come to talk to me about PCOS, right,
21:52
And elevated male hormones, for example, I've got dark hairs
21:57
that are growing that I that, that I have the polar plaque,
22:00
right? I've got some acne, but my
22:02
testosterone levels are normal. So I don't have PCOS.
22:06
Well, that's not the that's not the situation.
22:08
You might have testosterone levels that are on the scale
22:13
normal but not normal for you. And so you have to kind of take
22:17
all this stuff with a grain of salt, which is and directed more
22:21
to the individual patient to say, wait, look at all these
22:23
things, this is the right pattern.
22:26
Even if their blood tests are normal, that doesn't mean it's
22:29
normal for them. So it just kind of reminds me of
22:32
that thought. Yes, absolutely.
22:34
That individualized approach, yeah.
22:37
Oh, Ryan. Yeah.
22:40
And endometriosis, it's, you know, the silent inflammation
22:45
isn't just about pain, but the inflammatory piece of it.
22:49
How can that chronic inflammation affect implantation
22:53
or early pregnancy even when ovulation and fertilization are
22:58
happening, especially with the reoccurring losses?
23:02
Well, you know, what we know is that there are some inflammatory
23:05
conditions that can lead to difficulty getting pregnant and
23:09
staying pregnant. Endometriosis is a very common
23:14
thing for us to be aware of, but also a very difficult thing to
23:18
diagnose. Part of the reason for that is
23:21
the only way you can truly diagnose endometriosis is to do
23:24
a laparoscopy. So you do a surgery, you look
23:27
for the condition, you take a biopsy of it, and you give it to
23:30
the pathologist. They look under a microscope and
23:33
say yes, that's endo. But it's really not a good way
23:41
to do this. In other words, why would you
23:43
take the risk of a laparoscopy when you don't need to?
23:47
So in general most reproductive endocrinologist will advocate
23:51
not having a surgery and to just be aware that endometriosis may
23:56
be playing a role in this, especially if someone has
24:01
painful periods. But the reality is, is that over
24:06
the years, reproductive endocrinologists have gone from
24:10
doing a laparoscopy on many people to look at tubes and
24:12
endometriosis to saying, why am I exposing people to risk with
24:17
this surgery when I can just get through treatments that are very
24:23
successful to work whether or not you had a laparoscopy or
24:25
not. So the general idea is we tend
24:28
to do laparoscopies only if someone has such severe pain
24:34
that it warrants the surgery. You don't do it specifically for
24:37
fertility. And there's one old study that
24:40
said that you would need to do 37 laparoscopies on people to
24:45
have one additional pregnancy. So basically it was saying doing
24:49
these surgeries are not helpful from a fertility perspective.
24:52
Now if you have a lot of pain with your parents and it
24:54
warrants a surgery and endometriosis taken back, you
24:58
may get some fertility benefit from it.
25:01
But the reality is we tend not to do that.
25:06
But in general, endometriosis and its cousin adenomyosis,
25:12
which is in the endometriosis that's in the wall of the
25:15
uterus, those are things that are basically hyper inflammatory
25:19
conditions that can lead to difficulty implanting.
25:23
And there's different ways that we handle adenomyosis and
25:28
endometriosis depending on what kind of treatments people are
25:30
are involved in. But it definitely effects
25:34
implantation. It can make, even if you do
25:38
implant, for example, with adenomyosis, it can make the
25:41
placenta less effective at finding the bloodstream, which
25:45
can, which can compromise the growth of the baby over time.
25:48
So there are longitudinal problems that can happen during
25:54
a during a pregnancy, not just getting pregnant itself, but
25:58
trying to get through the pregnancy.
25:59
So those are all things that we consider when we're taking care
26:03
of people with these conditions. Wow.
26:09
Wow. Yeah.
26:10
And this, I mean, just to go into, you know, after loss too,
26:14
and, and hormones and things like that.
26:16
Many women, myself included, were prescribed progesterone
26:21
after loss. How common is that in the, you
26:27
know, to supplement that and meaningfully to improve
26:30
pregnancy outcomes? So the way that I talk about
26:35
this with my patients is to say, do I give progesterone in the
26:41
second-half the cycle when people are doing any sort of
26:44
treatment here? And the answer is yes.
26:47
But the reason I do it is not because I know it works, but
26:50
because there's not a lot of downside.
26:52
So people come to me and say my cousin had trouble getting
26:58
pregnant. They were given progesterone and
27:00
I had a baby and they had a baby, you know, And so there's a
27:03
lot of these associations that people have.
27:05
But what people don't realize is that if someone has their
27:10
progesterone checked and it's low, we don't truly know if it's
27:15
low because progesterone is secreted in a, what they call a
27:18
pulsatile way. So, so if you checked it over
27:23
and over again over 10 hours, you get a wildly different
27:25
numbers. So seeing a low number is not
27:28
necessarily meaning that you've got a low progesterone level.
27:32
And if you truly did have a low progesterone level, it's likely
27:36
because the pregnancy was abnormal, not because you just
27:39
have a, you're not producing progesterone.
27:42
So I can give you progesterone, which fixes the progesterone
27:46
level, but doesn't fix an abnormal pregnancy.
27:49
So while we give it, I talk to my patients and say, look,
27:54
transparently, I don't know if this is helping, but there's not
27:57
a downside. If you were one of the very rare
27:59
people who had an issue with making progesterone, here it is.
28:05
But not to say that giving progesterone fixes an abnormal
28:10
pregnancy. So it's a little controversial.
28:14
Some people shy away from giving it.
28:17
I don't think there's really a downside to doing it.
28:19
So we often will give it to people.
28:22
But with the transparent angle to say, I don't know how much
28:26
I'm helping, but I'm not hurting, let's cover that as a
28:29
possibility. And so that's the, that's the
28:34
way I typically talk about it, yeah.
28:36
No, and I think that's great to understand, right, because even
28:39
thinking back when I, you know, was on it, they had there wasn't
28:43
really any risks or long term effects or anything like that
28:47
that, you know, and I'm grateful to hear that it's still like
28:50
that, you know, Brian. Yeah.
28:52
The only thing that you have to be aware of is theoretically it
28:55
could delay a pregnancy, sorry, a bleed if you weren't pregnant.
29:01
Theoretically, when I see patients, they're coming to see
29:05
me for a pregnancy test. Yeah.
29:07
Specific time and so if their pregnancy test is negative, we
29:10
stop the medications. But if you're doing that on your
29:12
own, you could delay your pregnancy, your bleed after
29:17
negative pregnancy test a little bit with it.
29:20
But I encourage people to just take the pregnancy test at home
29:23
if that's what you're doing. And if it's negative, stop it.
29:26
Yeah, most of the times we are. We're testing everything at.
29:29
Home too. Right.
29:32
Yeah. And you know, for the IVF like
29:37
reducing risks with miscarriage, you know, when we're having
29:41
reoccurring pregnancy losses, when does IVF with genetic
29:44
testing statistically reduce that risk and when might it not
29:49
significantly improve outcomes compared to natural conception?
29:53
Well, what I would say to you is I think the, the, the real
29:58
statement is to say it's a faster time to a successful
30:01
pregnancy. So it doesn't necessarily
30:05
increase the pregnancy rates, but the testing of the embryos.
30:10
But it does allow us to select an embryo that has the
30:15
capability of a live birth faster than if we didn't do
30:21
testing. So for example, if we had five
30:25
embryos to work with and they were not tested and two were
30:31
abnormal and three were normal, I am transferring an embryo one
30:35
at a time based on how the embryos look, the more the
30:39
grating and whether that embryo is normal or not is kind of
30:43
random. It's not necessarily related to
30:45
the grading. So I'm a one in five chance of
30:48
transferring it, you know, or two in five chance of having an
30:52
embryo that transferring an embryo that is the wrong number
30:54
of chromosomes, that is not going to work.
30:57
So I would say to you it's a faster time to a successful
31:00
pregnancy because I can select an embryo that has a or deselect
31:07
an embryo that. Cannot be right.
31:10
Yeah. Well and it's going into a very
31:13
evidence based, you know, based on seeing what you're able to
31:17
test with the embryos and everything ahead of time.
31:19
And with this testing, really all we're testing is the number
31:23
of chromosomes. I can't tell every little single
31:27
thing about an embryo. The way to the way to kind of
31:29
think about it is back-to-back to the encyclopedias that I can
31:35
tell if you have the right number of books in the
31:38
encyclopedia set. But I can't tell you in book 3
31:44
that chapter 2 is written backwards, right?
31:46
I can't tell little details, but I could tell the main building
31:50
blocks to say, look, this has the right number.
31:53
Once the don't have the right number or embryos that we should
31:55
have put, Yeah. That's good to know.
31:57
Thanks for clarifying that, Ryan.
32:00
And down to our last one and this is a big one.
32:03
I know that I saved this for last and we already were talking
32:06
about eggs a little bit, but this is what our community, you
32:09
know, we always feel like our eggs are on timers.
32:12
And I know we touched on it a little bit.
32:13
You know, when looking at if we're 36, it's really 37 for our
32:18
eggs because we're born with all of them.
32:20
You know, we hear about age and egg quality.
32:22
Are there biomarkers beyond AMH that better predict miscarriage
32:27
risk? And how do you counsel patients
32:30
without oversimplifying fertility decline?
32:36
I know it's a Josie. Well, I think what we, what I go
32:40
back to when I talk to patients is biology and I, I go through
32:44
the whole thing with all your eggs.
32:46
So over time there are, there are chances for eggs to become
32:50
abnormal over time. And remember, our parents
32:54
generation tended to have kids at younger ages, right?
32:58
And so maybe there was less of the age factor involved, whereas
33:03
our generation is a little different and people having
33:06
babies later in life, which now introduces more egg quality
33:10
issues over time. So the general idea is I can't
33:15
rate someone's quality of eggs. I can't say your eggs are an 8
33:22
out of 10. But I can say, look, your
33:26
birthday is what dictates the likelihood of having more good
33:32
eggs than bad eggs. And one of the ways that we know
33:37
all this information is not just the fact that miscarriage rates
33:42
go up over over a woman's age. That's evidence that we have
33:48
abnormal embryos or abnormal eggs leading to abnormal
33:51
embryos. But the other is when we test
33:54
embryos to see if they're genetically normal, we have
33:57
certain expectations about pregnancy.
34:00
Sorry, Aneuploid rates the rate of an abnormal embryo based on
34:05
the woman's age. So at the age of 30, about 75%
34:12
of beautiful blastocyst embryos are normal.
34:18
At the age of 40, about 75% are genetically abnormal even though
34:23
they look fantastic. And 35 to 36 is where you have
34:27
that 50. So if a woman has 6 embryos and
34:33
she's 35, I'm going to say maybe we've got 3 normals in here.
34:38
If a woman's 40, we're starting to say a lot less.
34:42
And so, so I think it's important to talk about some of
34:46
that biology and some of the expectations.
34:49
But when people talk about AMHS, I love AMHS.
34:53
It's a great way of understanding your egg reserve
34:57
over time. It's a hormone that is made by
35:00
the cells that are around your eggs.
35:02
So the more eggs you have, the more cells around the eggs, the
35:05
higher the number. So AMH is a fantastic way to try
35:09
and get a feel for your quantity, but it doesn't say
35:13
that there's a problem with quality.
35:15
So if someone has a low AMH and they're coming to see me, I am
35:20
saying to you, you have a low amount of eggs.
35:22
I don't know that you have bad eggs in any way, shape or form.
35:25
If someone is 40, I'm worried about their eggs.
35:28
If someone's 30, I'm worried about them less.
35:32
AMH is really more so to say what's my reproductive longevity
35:37
as opposed to my quality. So I think understanding that if
35:43
you get a test, kind of understanding what it's telling
35:45
you is super important. So AMH is more related to your
35:49
quantity. AMH does not tell us if it's low
35:54
that you're not going to get pregnant.
35:56
Wow. I don't know if I answered your
35:58
question, but that. Yes, yes, you did, you did
36:01
absolutely. Thank you and thank you for
36:05
answering all these, you know, questions.
36:07
A lot of survivors in our community go through reoccurring
36:11
loss. So, you know, and, and when this
36:13
happens, it's always nice when we can give them an expert who
36:16
can answer some questions for them that they don't feel
36:19
comfortable asking or they're not ready to ask themselves.
36:22
So they give it to us. So we just can't thank you
36:24
enough for that, Ryan. And I would love for you to
36:26
leave our listeners with words of advice or any you know little
36:31
ending that you would like to. I would say to you, if you feel
36:39
like you're having trouble to reach out to somebody, certainly
36:44
with reproductive endocrinology, there are some aspects that we
36:50
don't have answers to. But many times we do have some
36:53
answers and we can certainly talk you through them.
36:56
And whether or not you do something about it is a
36:58
different story. But if you want to get some
37:00
answers, there are things that we can do to help you avoid
37:07
either difficulty getting pregnant or recurrent losses.
37:11
There's some treatments that are quite effective.
37:14
There are other situations where they're not, but the testing and
37:18
confiding in somebody is probably the first step.
37:23
Thank you. Thank you for leaving our
37:24
listeners with that. Sure.
37:26
And thank you so much for joining us today for sharing
37:29
your expertise, your perspective, and a deeper
37:32
medical understanding beyond, you know, reoccurring pregnancy
37:35
loss. Conversations like this matter
37:38
because they help families feel less alone and remind them that
37:41
their questions, their grief, and their search for answers are
37:43
valid. So thank you, Ryan.
37:45
Yeah, happy to help. Thank you to anyone listening
37:48
who might be navigating infertility, reoccurrent
37:50
pregnancy loss, miscarriage, still birth, any type of
37:53
pregnancy, or infant loss. Please know your story matters,
37:56
your baby matters, and your grief matters.
37:58
Healing doesn't follow a timeline.
38:00
Trauma and loss don't have a schedule, and you deserve
38:04
compassionate support through every step of your journey.
38:07
At Chasing the Rainbows, we provide daily support services,
38:09
free and community for families impacted by infertility,
38:14
pregnancy, and info loss. Because every loss matters.
38:17
If this conversation resonates with you, please share this
38:20
episode with someone who may need it.
38:22
And if you are looking for support, want to
38:24
volunteerdonateorhostaneventinhonorofyourbabyyoucanlearnmore@chasingtherainbows.org. Thank you for being here, for
38:30
listening, and for continuing to break the silence around
38:33
infertility and baby loss. Until next time this is cried
38:37
out loud, thank you.