Tuesday, 31 December 2013

Why do I counsel my infertility patients?

Why do I counsel my infertility patients?

Well, truly speaking a lot of my energy goes in the process of counseling my patients. People sometimes feel strange about it. Why counseling plays such a critical role in resolving infertility issues when it is a physical problem?

In reality infertility problem is not a physical problem completely, but involves a lot of mental and emotional aspect. Therefore, infertility experts have to put great amount of time, energy and resources in counseling the patients and keeping their morale level high.

In some cases, the couples are so frustrated that they do not have belief in the process of infertility treatment. In such cases, we call expert counselors that use psychological techniques to regain the faith level. Regular sessions improve the situation and the clinical procedures can be resumed. Counseling is an integral part of the treatment and hence, can’t be overlooked.

I categorize counseling process broadly in the following categories:

Emotional Counseling

It is the most important aspect. Infertile couples undergo a tough time. The moments of frustration and stress are unbearable. Men and women perceive infertility problem in a different way and the perception is entirely different. Therefore, I counsel both separately and then together to understand the common pain points. In some cases, it is needed to take professional assistance from professional counselors. I arrange individual sessions or joint sessions depending on the severity of the case.

Couples discuss their concerns, sorrows, doubts and worries about the problem. They discuss the probable cause and remedy of their problems. Couples find it extremely encouraging and exciting experience that recharges their spirits to overcome the problem.

Physical counseling

There are various cases where the couples are unaware about the reproduction system and its functionality. As an infertility expert, I counsel them to explain the human reproductive system and the exact problem they are facing. I explain the mechanism of various tests and the outcome to them.

Financial counseling

It may sound strange, but I spend considerable time on the financial counseling part. Infertility treatment is a costly affair and not all patients can pay higher fees for the treatment. However, a few offers reduce the overall cost to make it affordable.

Community counseling

When the infertile couple comes to me for infertility problems, I always counsel them to form community groups and support groups. While the modern special networking tools offer brilliant platform to do so, the conventional methods of forming support groups is equally effective idea. It is important to bring a feeling of self-confidence in the infertile couples. By making communities, the infertile couples realize that there are many people who are sailing in the same boat.

It is surely a physical, mental and emotional turmoil to go through a phase of infertility. When I treat infertility problem, it is not just treating the physiological aspect, but the mental aspect as well.

Counseling is, therefore, incredibly important in resolving the issue completely. I train the patients to leverage the strengths to boost the chances of a successful pregnancy!

Sunday, 29 December 2013

Who Needs CGH Embryo Testing?

Who Needs CGH Embryo Testing?

When I treat infertility problems, there is an obvious need of tools and techniques. Modern medical science brings some of the best methods to understand, analyze and correct fundamental problems that were not possible earlier.

Transfer of embryo is a critical step in the treatment of infertility and testing procedures like Comparative Genomic Hybridization (CGH) makes it possible to increase the possibility of success dramatically. We call this test a game changer in the history of infertility treatment.

What is CGH embryo testing?

CGH embryo testing is an effective technique to indentify the most competent and strong embryo based on chromosome testing.

A typical human genome contains 23 pairs or 46 individual chromosomes. If an embryo doesn’t contain these many chromosomes, then we call it an incompetent embryo that can’t produce successful pregnancy.  We call them aneuploid embryos. Most of the embryos will not reach to the stage of blastocyst. If some incompetent cases reach to the stage of blastocyst, then they will not get attached to the wall of the uterus. The pregnancy will get terminated in the first trimester.  In very rare cases, the pregnancy will continue with fundamental genetic problems.

To make the problem further complicated, it is not possible to find the difference between an incompetent embryo and a competent embryo by the conventional methods.

CGH Embryo testing, the effective tool
Experts say that the competency of embryo does not depend on the quality of the sperm, but on the egg.  A competent embryo will result in a live birth almost 80% of the times, provided all other factors like internal environment of the uterus, age, overall health  etc.

Since it is clear that competent embryos result in higher chances of pregnancy, we recommend doing CGH Embryo testing for such cases.

With respect to various research and studies, I emphasize CGH Embryo testing in the following scenario:
•    Female partners suffering from PCOS, it is recommended undergoing CHH embryo testing because higher percentage of eggs are problematic in such case.
•    In case of known disorders of chromosomes, I recommend it.
•    In case of women with old age (usually more than 35) will have to undergo this test to ensure higher pregnancy rate.  The chances of success in such case are relatively low and CGH testing will eliminate one major possibility of failure.
•    Cases of unexplained IVF failures or unexplained termination of pregnancy.
•    Older women with a decreasing trend of ovarian reserve must go for this test to ensure higher chances of pregnancy.
•    Women with genetic problems.
It is quite clear that CGH Embryo testing is the paramount technique of chromosomal testing. Although there have been new techniques like Polymerase Chain Reaction (PCR) emerging on the horizon, but it will take some time for credibility establishment of these methods. CGH has been a proven method with fantastic results.

Modern tools help us in identifying typical factors that cause infertility problems. With the help of such modern tools, we are able to bring happiness in the life of an infertile couple!

Thursday, 26 December 2013

Uterine lining damage and infertility, a case study

Uterine lining damage and infertility, a case study

The severity of agony and frustration could be felt very clearly during the discussion with an infertile couple sitting in front of me. We were going through the case history and it was surely quite pessimistic.

It was a peculiar case of secondary infertility after successful full-term childbirth. The first baby boy was quite healthy and the pregnancy was smooth.

However, the secondary infertility has really tested their patience a lot and 3 IVF attempts and equal number of Frozen Embryo Transfers. Each pregnancy had resulted in bleeding, pain and a lot of physical discomfort. They had undergone every possible test and everything seems to be normal. Her ovulation was great, her tubes were fine and her husband was producing enough sperms! However, the pregnancy was not happening in spite of all these supporting factors.

I checked the case papers. To my surprise, they had tried all the aspects of infertility treatment;Laparoscopy, hysteroscopy, IVF and FET. After getting disappointed from everything, they were sitting next to me for a second opinion!

The strange case of uterine lining problem

It wasn’t less than a Sherlock Homes mystery for me and I decided to play the role of master detective. First of all I convinced the couple to undergo fresh set of investigations. Not because I didn’t trust the earlier reports, but to do the investigations in my way. Secondly, I assured the couple about the success of the pregnancy. The female had conceived once and delivered a healthy baby, so there were always better chances of success.

As the first step, I decided to perform Hysterosonogram to confirm the uterine cavity and checked the IVF records to understand the thickness of the uterine lining. Hormonal tests were conducted to confirm the uterine lining and… BINGO!

I found the fundamental cause of her problem. Investigations concluded that basal Endometrium was incapable of getting stimulated by estrogen, the female hormone. It is the internal germinal layer that gets refreshed every year. The layer was damaged severely and the chances of recovery were nil. There was no option left other than trying for surrogacy!

The treatment

Treatment method was equally peculiar in this case. We found some surrogates and the couple selected the best according to their choice. We prepared both the ladies by giving hormonal stimulation. For the patient, it was done to achieve matured eggs whereas in the surrogate to prepare the uterus for pregnancy. The matured eggs were fertilized with her husband’s sperms in the laboratory and the embryos were transferred to the uterus of the surrogate.

Hormonal treatment was the most important part of the whole process. We need to match the timings of fertilization and transfer of embryo to make sure the success of implantation. The process was successful and the couple was blessed with a cute baby girl after full-term pregnancy.

The case was certainly a challenge for me and my team because of the symptoms of unexplained infertility. However, with the determination of the patient and a dedicated work by our team, we could achieve a happy ending!

Tuesday, 24 December 2013

Understanding the process of cervical cap insemination

Understanding the process of cervical cap insemination

Treatment of infertility is a complex procedure and timing is extremely important. Fertilization has to be achieved in the window of three to five days and hence, we need to schedule it with 100% perfection. As an infertility expert, I always keep track of the minute points and act accordingly.

The treatment methods vary from case to case and there is no single path for every incidence of infertility. Among various methods, some are simple and fast. At the same time, some methods are lengthy and complicated. However, each method is suitable for a particular type of infertility. It is not possible to use a single method for all.

What is cervical cap insemination?

Cervical cap insemination is an optimized way of conception in typical cases of male infertility when the count and mobility of the sperms is low. We use this method in the rare case of hostile mucus in females when the internal environment of the vagina is harmful for the sperms. Studies indicate that the method has been useful in couples having immunological problems.

Cervical cap insemination is relatively less popular category used for the treatment of infertility. The process is quite simple. A small cap is taken to collect the semen and it is inserted in the vagina through cervix. As the sperms enter in the environment of the uterus, mucus present inside helps the sperms to reach towards mature egg. This mucus gives adequate protection to the sperms and without it the sperms die within minutes. When we cap the semen across the cervix, it makes sure that the spermsswim up to the fallopian tubes and the uterus. The cervical cap method is ideal in treating the problems of tilted cervix, low sperm motility and low sperm count.

Use of cervical cap insemination has been there from last three decades in the treatment of infertility caused by low sperm count or tilted cervix. Doctors have successfully tried it in treating unexplained infertility as well.

It is a cost-effective method

It is a fact that cervical cap insemination is one of the cheapest methods of infertility treatment. While the cost of few other treatments has touched the sky, this method is still within the reach of many patients. Couples who can’t spend huge amounts in the treatment of infertility can afford it easily.

When we prescribe fertility medications to maximize the ovulation process in females, cervical cap insemination is the best method to achieve pregnancy. Even for couples undergoing IVF cycles, it can work as an aggressive treatment plan to achieve pregnancy.

Today, many variants of user-friendly cups are available easy to wear. Soft implantable grade silicone versions can be worn in the daily routine. It is a confirm way to achieve positive pregnancy.

When I talk to the patients and have a detailed analysis of the problem, it is easier to decide a particular line of action without any ambiguity. Not so popular methods as cervical cap insemination are quite useful in specific cases of infertility.

Sunday, 22 December 2013

Thrombophelia the culprit behind miscarriage!

Thrombophelia the culprit behind miscarriage!

Human reproduction system is a sequence of surprises. The successful pregnancy is a miracle against hundreds of odds. As an infertility expert, I always believe that it is a roller-coaster ride with various ups and downs. The peak fertility years between 20 to 30 years of age have greater chances of success. As the age progresses, we have feeble chances of pregnancy. Even during the peak years we experience as high as 15% cases of miscarriages due to various reasons. The percentage rises up to 50% in the old age women.

In many cases, pregnancies terminate at so early stage that we do not know about it. It is typically called a biochemical pregnancy. As the pregnancy proceeds further, the rate of miscarriage drops significantly. However, the same is not true in case of women more than 40 years of age. Abortion is the technical term for any kind of miscarriage, either induced or spontaneous. However, miscarriage is more common term for spontaneous abortions. We have to deal with a large number of abortions as an infertility expert, in fact more than successful pregnancies!

It is important to note that recurrent miscarriages need to be handled with additional care. We infertility experts work out every possible step to prevent reoccurrence of the same.

We can classify recurrent pregnancy loss into several categories, e.g. genetic, anatomic, hormonal, infectious and Thrombophelia, etc. In case of genetic category, the female inherits the tendency of termination of pregnancy. There is no apparent cause of it, but the pregnancy can’t survive more than a few weeks. In case of anatomic cases, the female reproductive system has structural failures causing abnormal termination. In the hormonal cases, the hormonal combination gets disturbed in the body causing a tendency of miscarriage.

Thrombophelia, a major cause of miscarriage

Out of the total cases of abortion, a major chunk is due to Thrombophelia. It is a peculiar case of blood clot that causes pregnancy loss. Bleeding and blood clotting is a delicate process peculiar to the humans.

Clotting is the reflex action against excessive bleeding. In case of genetic disorders like hemophilia, the clotting process does not happen resulting in excessive bleeding. In the same way, some people have a tendency of excessive blood clotting resulting in pregnancy loss and intrauterine fetal demise or intrauterine growth retardation. There are multiple causes and treatments of Thrombophelia.

It is a fact that if a patient has no other apparent causes of miscarriage, then it is high probability that Thrombophelia is the culprit. It is important to evaluate the presence of the same and treat it accordingly. Usually the success rate is very high (almost 90%) and the side-effects are minimal. With the correct diagnosis and perfect medication, the problem can be controlled up to a large extent.

Recurrent miscarriage is a traumatic experience for the couples, especially the mothers. We have to keep a close monitoring on the mental and emotional status of the patients while treating the physiological aspects of the problem.

Thursday, 19 December 2013

Take care of yourself while undergoing infertility treatment

As an infertility specialist I talk to my patients on various topics other than infertility. It is part of the treatment because the patients need to be counseled and motivated. I speak a lot about self care and underline the importance of it repeatedly.

Why self care is so much important? 

Well, there are fundamentally two reasons of it.
a) It is very much possible that the patients forget about self care during the treatment cycles. Infertility treatment is a long-term process. There are unending iterations of treatment, medication, clinical examinations and tests. The patients forget everything else during the treatment; about the job, business and self care.
b) Treatment cycles of infertility are tiring and frustrating. Hence, the patients should take extra care of them to keep fit, young and charming.

What is self-care?

When we say self care in this context, there are basically two aspects of it, physiological and psychological. Infertility treatment involves very high physical and emotional involvement. Failure cycles generate intense agony and frustration. Higher stress levels, feeling of isolation and dejection are the most common symptoms. The treatment process demands more physical energy and affects the overall health.

Self care means keeping the morale high and maintaining physical and emotional fitness in the proper manner.  There are no fixed parameters for it. We can say that every single effort to enhance the personality is self-care. However, there are some tips for it:

1. Sleep well: Sound sleep is essential for good health. Couples undergoing infertility treatment must sleep for at least six to seven hours. It reduces the anxiety. The procedures and steps involved in the treatment are quite tiring. Inadequate sleep may cause fatigue, drowsiness and depression.  I always suggest reducing the intake of caffeine and alcohol because it creates chemical imbalance in the body.

2. Try something different: It is a great idea to do something very different that takes you away from the thoughts of infertility, childbearing and everything related to it. Believe it or not, but it is a great way to take care of yourself. It reduces the tension and frustration caused by infertility problem. You develop positive attitude and look at the brighter aspect of the life.

3. Exercise regularly:  It is recommended doing exercise daily not just to stay fit, but to enhance the positivity. Exercise makes the body energetic and you feel happy, enthusiastic and alert. Indulge in any kid of exercise you feel suitable. It may be light jogging, aerobics, weight-training or meditation and Yoga!

4. Build a support system: It has become quite challenging in the modern times, but you can build a strong support system if you decide. Meet people who have overcome infertility problem. Talk to them and understand the way they fought against infertility. Discuss with your doctor regularly about the distress and agony. You will find new ways of dealing with it.

It is very important to take good care of yourself to conquer infertility problem. After all, you need a lot of stamina to fight against it!

Tuesday, 17 December 2013

Post Coital Mucus Test, the best tool to determine sperm quality

Post Coital Mucus Test, the best tool to determine sperm quality

As an infertility expert I use multiple tools to diagnose infertility. Some of the tools are not generic and used in very special case. Post Coital Mucus test is one of them. It is a post-intercourse test to determine the movement of sperms and their ability to survive in the mucus. We check the movement of the sperms immediately after the intercourse and understand the overall quality and quantity of the sperms.

How does it help?

This test identifies the problems in the cervical mucus and its relation with infertility. Also, it helps
in determining the level of bacterial infection, thickness of the mucus, disorders pertaining to the
ejaculation, antibodies in the mucus that reject the sperms and the semen related disorders. It gives valuable results about the probability of pregnancy. Importantly, this test gives significant information about the male infertility, in case the male partner is not ready to undergo fertility test.

The procedure

I suggest the patient to chart the menstrual cycle at least three to four months prior to the test. It gives accurate timing to perform the test. I call the female one or two days prior to the ovulation. Ovarian follicles release one mature egg during that time. The couple is asked to have intercourse before two to eight hours of the appointment.

There is significant change in the mucus at the time of ovulation. The body produces extra estrogen resulting change in the viscosity, thickness and color of the mucus. It becomes clearer, less viscous and more slippery to give favorable environment to the sperms. They are able to swim easily and survive for a longer time.

The test is very simple and quick. It doesn’t need any hospitalization and performed in the clinic. Post coital Mucus test is performed just like a Pap test.

The Results

The beauty of this test is the quick results. It takes hardly a few minutes to determine the results. This test is quite inexpensive. We share the results with the patients immediately.

The result of the test is NORMAL if:

• Adequate number of sperms are visible in the sample
• The sperms show forward movement through the mucus
• The mucus is at least 2 inch long
• The mucus shows a fern like pattern while drying

The result of the test is ABNORNAL if:

• Very few sperms or no sperms are visible in the sample
• Dead sperms are visible in the sample
• The mucus is less than 2 inch long
• The mucus does not show a fern like pattern while drying

Possibility of errors

Post Coital Mucus Test gives quite accurate results, but we infertility experts have to take utmost precaution while performing the test. Maintaining perfect timing is important to obtain correct results.

In some cases the inflammation in the vagina or irregular menstrual cycle could generate erroneous results. Therefore, we do it with extra care.

Infertility experts worldwide recognize Post coital mucus test a great tool to determine infertility.

Sunday, 15 December 2013

Is there a dramatic increase of infertility problems recently?

Is there a dramatic increase of infertility problems recently?

Has there been significant increase in the infertility cases in the recent years? This is perhaps the most frequently asked question to infertility experts. Many people believe that it is true. However, to your surprise, the reality is not like that. In fact, the percentage of infertility has shown quite static trend. The awareness and acceptance of infertility has greatly increased. Now people come forward boldly for infertility treatment. The utilization of infertility treatment services has increased multiple times. The availability of modern methods and increase in the expertise of the doctors has given a boost to it.

The history

The history of modern infertility treatment goes back to 1978 when the first baby was born through a revolutionary technique called In Vitro Fertilization (IVF). It was popularly called as Test Tube Baby. The options to treat infertility were very limited that time. Tubal microsurgery and ovulation using hormonal drugs were the only options available to treat infertility.

The present
The times have changed now and so many effective treatments are available today to handle multiple aspects of infertility problems. There has been dramatic increase in the success rate of infertility treatment due to the modern techniques. Statistics reveal that more patients are visiting the clinics today to get rid of infertility problem.

We can see incredible change in the way people look towards infertility today. The stigma and taboo of infertility problem has been reduced considerably. Couples are ready to about it openly. People are more aware about the problems because of the information explosion. The Internet has become a major source of information today. Couples come prepared for the infertility treatment and they know the basics of their problem.

The future
Although we have not seen a dramatic increase of infertility cases in the past, but experts say that it will surely happen in the future. There are multiple reasons of it:

a) Delayed childbearing:
It is a common trend today to delay the childbirth in lieu of career and education. As we know that the reproductive capacity decreases with the age, the cases of infertility problem will shoot up in the future. It is a trend in the upper crust of the society to think about expansion of the family in late thirties. It is very obvious that the chances of pregnancy lower about this age. Also, it increases the chances of interrupted pregnancies.

b) Lifestyle and pollution:
Experts indicate that the human reproductive system has direct linkage with the pollution and lifestyle related issues. Exposure to various chemicals, living in a highly polluted areas and addiction of toxic elements are the major causes of infertility problem.

c) Stress and fatigue: Modern lifestyle generates a lot of stress and fatigue that affects human reproduction system adversely.

It is a fact that we infertility experts will have to work harder to get rid of infertility problems in the future. However, with the advancement in medical treatment and increased support and cooperation of the patients, we will be able conquer the battle against infertility!

Thursday, 12 December 2013

There is no link between fertility drugs and ovarian cancer

There is no link between fertility drugs and ovarian cancer

When we plan infertility treatment, medication plays an important role. As an infertility expert I need prescribe several drugs to the patients. Some of these drugs are swollen and some are injected. It is a known fact that infertility drugs have some or the other side-effects because the drugs directly interrupt the hormones in the body. Some of these side-effects are hardly noticeable while a few are quite visible and irritating.

There has been a lot of misconception and misunderstanding about infertility drugs and as an infertility expert I spend considerable time in counseling the patients and convincing about these baseless theories. People come with the fear of ovarian cancer mostly and it is quite hard to convince them about no linkage between infertility treatment and ovarian cancer. The scary thought sometimes forces couples to stop infertility treatment. This is an unfortunate situation and therefore, we do not leave any chance to correct it.

What does the recent study say?

Undoubtedly there is no relation between the ovarian cancer and infertility drugs. These drugs neither induce nor boost the chances of getting affected by this fatal disease. However, there has been a recent study conducted that clearly suggests that there is no direct or indirect harmful effect on the reproductive system.

The results of the research indicate that ovarian cancer is rare as compared to uterine and breast cancers. It develops in the later part of life and therefore, no significant correlation with the age group that undergoes infertility treatment. However, researchers recommend doing further research for long-term use (more than a year) of infertility drugs.

What are the risk factors then?

It is a fact that infertility treatment is not directly associates with ovarian cancer, but there are some risk factors clearly associated with it:

a. Age of the female: Ovarian cancers normally occur after menopause because the female reproductive hormones prevent it.

b. Family history: If anybody in close family (mothers, sisters) have been diagnosed with ovarian cancer, then the female is very likely to have it. Doctors recommend frequent checking of the disease in order to prevent it in the early stage.

c. Females who have never conceived: Ovarian cancer is more common in the females who have not been able to conceive even once.During the fertilization process body secrets hormones that prevent ovarian cancer.

d. Secretion of male hormones: Sometimes we have to prescribe drugs that cause androgen secretion in women. It increases the risk of ovarian cancer.

e. Endometriosis disease: It is very common in women and the treatment involves a few drugs that increase the risk of the ovarian cancer.

The prevention

When we convince the patients about no link between the ovarian cancer and infertility drugs, we also tell them about the probable symptoms of it. Menstrual irregularities or pain in the stomach is the common symptom. Normally women ignore it and the problem gets identified in the later stage. Regular check-up and immediate medical attention could prevent and treat the problem quickly.

Wednesday, 4 December 2013

Donor insemination, a bold decision to defeat infertility

Donor insemination, a bold decision to defeat infertility

Infertility treatment is a long running process and needs a lot of research to determine the best method for a couple. Each case of infertility is different and involves a different approach to resolve the issue. Egg donation, IVF, surrogacy, ART and many more are there. Donor insemination or DI is a typical solution to overcome male infertility.

In many cases, the male partner is unable to produce healthy sperms for fertilization. Sometimes the sperms are totally absent and sometimes quality of the sperm is inferior. Couples select DI to build the family because it is the only possible solution for them. It is surely a bold decision because the baby will carry the genetic characteristics of the donor and not the male partner. However, couples go for it with a few arguments in the support of it:

a) If the donor selection process is carried out sincerely, then it is possible to carry forward some great traits present in the donor.

b) Female partner (the recipient) can still experience the thrill and excitement of pregnancy and motherhood without bothering about the sperm donor, the male partner or an anonymous donor?

c) It is a simple and painless process as compared to the other ones. It doesn’t involve any surgical process and it is not needed to stay in the hospital.

d) The treatment is less costly, quick and confidential.

e) Sperm banks take care of the legal formalities.

Infertility expert plays a vital role

Infertility expert is important in the whole process. When it is decided that Donor Insemination is the best option for a couple, I start the process of searching the best suitable donor. Donor selection process takes some time and need attention.

Select the donor

Selecting the perfect donor is a critical aspect. It may take some weeks or more. Ask the infertility expert about reputed sperm banks that store frozen sperms. Some people call them “Cryobanks” because the sperms are stored in very low temperature. Modern sperm bank offer list of donors online and you can select the best one according to your choice. Some banks offer personalized services to make selection easy. There are various regulations and norms for donor screening process and every sperm bank has to comply with the norms. Regular audits and inspections are carried out to ensure adherence to the norms.

It is possible to see relevant information of donors either online or visiting the sperm bank. Couples can select the best suitable donor based on social, cultural and medical background. Physical characteristics and cultural aspects are also considered while selecting donors. They study the personal profile, traits and habits as well. It all depends on the individual preferences and choice.

Buy the sperms

Once you are satisfied with the donor profile and ready to buy the sperm, the sperm back should be informed accordingly. Being the infertility expert I coordinate with the sperm bank and decide a shipping date based on suitability of all three parties. The sperms are shipped to the clinic and ready for donor Insemination process.
DI is a great option to resolve infertility problem and many childless couples bring happiness of parenthood by choosing it!

Sunday, 1 December 2013

Miscarriage and How to deal With Miscarriage

Miscarriage and How to deal With Miscarriage

What is a miscarriage?
A miscarriage is as a loss of pregnancy prior to the 20th week of gestation.  A pregnancy loss after the 20th week of gestation is considered a stillbirth. The different types of miscarriages create different signs and symptoms, ways of coping with miscarriage, and how to attempt conceiving after miscarriage.

The simple definition of miscarriage is the spontaneous termination of a pregnancy. Miscarriage affects about 25% of all expectant women, and generally happens between four and six weeks. Miscarriage almost always happens before the 13th week of pregnancy. The chances of a miscarriage are higher in first pregnancies than in later ones.

Miscarriages happen for a wide variety of reasons. About half are due to abnormalities in the fetus or the placenta, including chromosomal problems. Sometimes the egg attaches in the wrong place resulting in an early miscarriage. Recent studies have linked environmental pollution or excessive caffeine consumption to higher risks of miscarriage. So the short answer is that most times, miscarriage occurs totally outside of the control of the expectant mother.

The different types of miscarriages are listed below:
- A "Chemical" Pregnancy        
- Missed Miscarriage
- Blighted Ovum                    
- Molar Pregnancy
- Completed Miscarriage        
- Recurrent Miscarriage
- Ectopic Pregnancy                
- Stillbirth
- Incomplete Miscarriage        
- Threatened Miscarriage
- Inevitable Miscarriage

What are the impacts of a miscarriage?
For the mother it is both physical and emotional, and there are a number of painful and unpleasant impacts of a miscarriage. There will usually be significant vaginal bleeding and the passing of large clots. This in and of itself is a little unnerving for the mother and her partner. After all, how much blood is too much or how many clots are too many? How can you tell what is to be expected and what is not? In addition, mom's body often reacts like it does when she gives birth, so, for example, her breasts may enlarge and be tender. Her hormones will likely cause unexpected emotional and physical reactions, which only complicate the feeling of loss.

Emotional impacts - For both mom and dad, there are significant emotional issues. The feeling of emptiness a mom experiences is both physical and emotional. There may be feelings of guilt or of failure. And there may be a sense of overall depression or discouragement.

How should I deal with my grief, and that of my partner?
Know what to say and what not to say. Many moms who have miscarried have suggested that their husbands not try to console them with a message that "you can still have other kids." For mom, this baby was unique and special. Having more kids in any number will not eliminate the feeling of loss. Talking about other pregnancies may be our male way of trying to fix it. What mom needs is a listening ear, sympathy and a reassurance of your love for her. This kind of attitude will help her deal more effectively with her loss.

Socialize and share. Men typically don't call other men on the phone to talk about their feelings, even in the case of a miscarriage. It is just not our way of grieving. But some dads have experienced some peace and healing by writing down some of those feelings and "giving them life" on paper. That can be very therapeutic for a grieving father.

Support each other for your partner. Your partner will often feel the loss of a child more keenly that you will. So take the time to sit with her, hold her, and listen to her express herself. Just being there and supporting her through her grief will really help her process the experience.

Do more creative work and get busy. Men will often turn to a project to help assuage the feelings of grief and loss. It is not a bad way to deal with everything that is going on around you. Being busy (but not too busy to be supportive to your partner) will help with the passing of time and will focus you in a positive direction.

Miscarriage is a huge blow to an expectant couple. By staying focused on supporting each other and by realizing that time will help the healing process, you can find peace even as you grieve for the loss of that one special life.