Episode 49: Feeling the feels for women facing multiple miscarriages

Dr. Sophia, ObGyn:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an ObGyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone, and welcome to the Dr. Sophia ObGyn podcast. Today is a little different than our usual topics in that I just kind of felt like talking about a few patients that I have right now that have really been on my mind. And the thing that they all have in common is something called recurrent pregnancy loss. And I realized that part of the reason why they've been on my mind is because every single time one of these young ladies gets pregnant, it puts me on edge and I realize that I'm on edge and I'm only their provider. And it made me think, wow, other women are probably on edge too, if they have this as an experience. And I just wanted to bring it to the forefront, something that probably a lot of people don't even think about or don't know about, which is this thing called recurrent pregnancy loss. It's basically miscarriage, and I wanted to talk about it. So of course it started off with a conversation with you Touseef, as all of our conversations do. And so without further ado, welcome please. My co-host and wonderful friend Touseef Mirza.

Touseef Mirza:
Hi everybody. So, yeah, I didn't even know about this term. I'm just gonna be very honest. Let's start from zero. What is recurrent pregnancy loss?

Dr. Sophia, ObGyn:
So recurrent pregnancy loss is when a woman has had two or more miscarriages consecutively. So meaning that they get pregnant and they have a miscarriage, then they get pregnant again whenever that next pregnancy is, they have another miscarriage, and once they've had two back to back. So there's no pregnancy that actually leads to a live birth in between. There's no termination in between. They've had two back to back losses from a natural cause.

Like it, it just happens. And as the term we usually use is miscarriage for that. So once they've had two or more, then they fall into this category of recurrent pregnancy loss. And usually we, at, at the third one, we would then start a workup. You know, like why is this happening? Definitely after the first miscarriage. We've talked about this before about the concept that, you know, up to 20 to 25% of pregnancies, especially in the very first, you know, couple of weeks of pregnancy up to the, you know, six to eight weeks of pregnancy can end up as a miscarriage.

Touseef Mirza:
What's the percentage again?

Dr. Sophia, ObGyn:
About 20 to 25%. That's a lot. So one in four can end up as a miscarriage. But a woman who gets pregnant has a loss, gets pregnant, has a loss, gets pregnant, has a loss-

Touseef Mirza:
At any point of a pregnancy though, not just like within that timeframe?

Dr. Sophia, ObGyn:
Usually we're talking about a pregnancy loss that happens early in pregnancy when we think about recurrent pregnancy loss. However, yes, we're talking about a consecutive loss that happens at any trimester, to be honest, if it's consecutive. So whether that's at 14 weeks, at eight weeks, at six weeks, even at 20 weeks, then it can still all fall under the category of recurrent pregnancy loss. If that loss was not of her own, like it was just her body, it just happened. And we don't know necessarily why, or we don't know why it was happening at that moment. And it's not necessarily something like if she's further along in the pregnancy that we can say, okay, this is due to premature labor, for example, or that we can identify certain other things, perhaps infection or things.

So those are things that sometimes can happen later on in pregnancy. So we don't usually consider those in that kind of scenario. And certainly once we get to the point of a pregnancy that's considered viable, then we have the potential for a live birth after 24 weeks, let's say. Let's use that as a cutoff. There's the potential for having a live birth. And so even if that live birth is with a lot of perhaps complications or et cetera, but different than when we think about a recurrent pregnancy loss, which tends to happen early and within the first trimester.

Touseef Mirza:
Within the first trimester. Okay. Alright. And the first trimester goes up to 14 weeks?

Dr. Sophia, ObGyn:
14 weeks, yeah. So 12 weeks, if we're thinking from the time of conception, 14 weeks, if we think from the time of the last period.

Touseef Mirza:
Okay. And then I believe that the longer that you are pregnant, the lower the chances-

Dr. Sophia, ObGyn:
Of miscarrying.

Touseef Mirza:
Of miscarrying.

Dr. Sophia, ObGyn:
Okay.

Touseef Mirza:
So it's almost like the body, the body at the beginning tries to test everything out and say, okay, is this gonna be a good one or not?
Dr. Sophia, ObGyn:
The growing embryo just becomes stronger and so is more resistant to loss, whereas there's some sense of fragility. That's one. And then two, early on we think about most recurrent pregnancy loss. Well, I shouldn't even say it, like most honestly, 50% of them, we have absolutely no idea why, if not more, oh. Of why it happens, of why a woman may have recurrent pregnancy loss. It's totally unexplained.

But we do know that there are some cases where it's genetic, right? Some kind of lethal chromosomal abnormality that simply is not compatible with life, and so therefore you have a miscarriage. But if that genetic problem is recurrent in that specific egg or sperm, and it just so happens the luck of the draw is, is that they get another egg or sperm that happens to have that same problem or another genetic problem.

For example, And so therefore that becomes constantly part of the recurrent pregnancy loss. But most of the time we just don't even know why. There's so many different issues that women have to deal with. On the one hand, it's, can I even get pregnant? So that's the, the women who are struggling and having infertility like can't even get pregnant. They're doing everything right and they can't get pregnant on this hand. You have the women who are getting pregnant, but are having a hard time staying pregnant. And they are having a hard time staying pregnant.

In the early part of pregnancy where we are talking about this recurrent pregnancy loss, there are other women who can get pregnant, they get past this point, and then they have another issue in terms of staying pregnant after the first trimester, after the first trimester into their second trimester.

And that's a whole nother issue. And so it was weighing on me, because here it is, I have a patient I'm excited for, but I feel apprehensive because here it is, she calls me up. And in these circumstances you tell the patient, look, the second you get your pregnancy test is positive, I want you to call because they've already told you that they're, they wanna get pregnant, that they wanna be pregnant. They've already experienced this concept of recurrent pregnancy loss. This particular patient who called me today this, she's had four consecutive losses, and this is now the fifth time that she has been pregnant. And I'm thinking to myself, I'm the doctor.

Like this is not even happening to me. And yet I'm feeling a sense of anxiety about it. I'm feeling a sense of, oh my gosh, is this one gonna stick? You've been through the four previous losses. I haven't been through all four, but I've been through three of them. And it's kind of like, how are we gonna make this okay? Like, is this gonna be okay? Is this gonna actually be the time that it's gonna lead to a pregnancy that's going to go through all of the trimesters and lead to a live birth?

Touseef Mirza:
The question that comes to my mind is, if this has happened three times previously with you, I mean, while she was your patient. Is there anything different that you asked her to do to try to move away from any type of risk that she might have been previously?

Dr. Sophia, ObGyn:
So here's the thing. In this particular patient, we've done all the things in terms of a workup, making sure she doesn't have any infections, making sure she doesn't have any issues with her uterus, making sure that she doesn't have something called like a thrombophilia, which is where she may be more prone to like blood clots and things like that. Doesn't have a thyroid disease, doesn't have diabetes. Like she's an average weight woman. So it's like there's no indicator as to why this is happening.

Touseef Mirza:
She's of childbearing age.

Dr. Sophia, ObGyn:
She's like 30 something years old. Like early thirties.

Touseef Mirza:
Okay.

Dr. Sophia, ObGyn:
So it's like, why does this keep happening? So now I'm like, okay, we're just gonna throw the book at this. But moreover, after she had the fourth one, I said to her, “I feel like my hands are tied. I don't know what else to do for you. I've done the workup. I haven't come up with an answer. I actually think you'd be better suited to see someone like a reproductive endocrinologist, which is a fertility specialist.” She's like that, but I'm not infertile. And I said, I know. I said, I know that you're not infertile. This is not the purpose. They do more than just treating women who have infertility in the sense that they have trouble getting pregnant, but they also help to treat women who have a problem staying pregnant. And maybe there's something that they'll see that I don't see.

Touseef Mirza:
Or, or they have other tests.

Dr. Sophia, ObGyn:
Tests or they have other tests or other experience, you know, that I don't have. And she said, yes, but you're the one who's seeing me through all of this. And I, and I feel like you're the one who's the most invested. And the reality is, I really do feel invested.

Touseef Mirza:
You're with them for the ride.

Dr. Sophia, ObGyn:
I'm with them for the ride. But it's, that's exactly it. It's a ride and it's like a roller coaster. Honestly, I just can't even imagine being in their shoes. Because in my own shoes, I feel a sense of anxiousness.

Touseef Mirza:
For them?

Dr. Sophia, ObGyn:
For them. So I cannot even begin to imagine what it is for them. That level of uneasiness, anxiety, apprehension, I can't believe I'm pregnant again. Do I even wanna be pregnant again? Or I wanna be pregnant again. And then all of the different emotions that they must go through.

Touseef Mirza:
But also, if you have had four losses previously and you're pregnant again, I feel like you would always be walking on eggshells. You know, like, you can't say, well, you know, I can't do this, or I can't do that, or I can't do this. And rightfully so. But at the same time, it's like this weight of guilt that is just waiting to get back at you if something goes awry.

Dr. Sophia, ObGyn:
I'm telling you, this is a subset of women whom I feel are so strong. I mean, women are strong, but to go again and again and again, and knowing that there's a possibility of loss, right. But the desire for motherhood is so strong. I look at them in awe, you know, because I think about it for myself and I say to myself, wow. Would I have been able to do that? Would I have been able to go back again and again knowing that there's a possibility that I may end up in the same place without the goal or the outcome that I'm searching for so desperately and it just pains me. You know? And that's why I wanted to talk about it. 'cause I just feel like it's a problem already.

We don't talk about miscarriage. Women don't have a space or a place to really open up and talk about miscarriage and then add to it the layer of those women who have had not one, not 2, 3, 4, 5 miscarriages in a row, you know, all in their quest to become mothers, like I said, different from those women who keep trying and can't get pregnant. And again, I don't have answers. Because this is like, almost like two halves of one coin. Because for a lot of women who deal with complete infertility, we don't even know why it's happening.

Touseef Mirza:
They can't get pregnant.

Dr. Sophia, ObGyn:
They can't get pregnant. Right. And then we have the subset of women who get pregnant and can't stay pregnant. Whew. So that's one. And so it seems like things happen like in threes. So I have this patient, another one now who's had about three or four losses. And one of the things that makes her case a little bit different is that she has some mental health issues. And so it's like, okay, how do we balance the medications that she needs in order to just manage her life? Like to manage her-

Touseef Mirza:
Illness from a mental health perspective?

Dr. Sophia, ObGyn:
From a health, from a mental health perspective, right. To be able to manage some of her illnesses in a way that still gets her to be fully functional feels very normal. But at the same time, we are not sure if any of those drugs that she needs to be on for her day to day are contributing to her history of recurrent pregnancy loss. How do we balance the drugs that she needs to be on while still understanding and managing her full desire to be a mom? And the real interesting part is, is that she's not on anything that would cause what we call teratogenesis. So that's when we think about drugs that are gonna cause birth defects, that's just a big word for birth defects.

Touseef Mirza:
Which are usually studied with any type of drugs.

Dr. Sophia, ObGyn:
Right. Which are studied typically. And you know, we have these different classes of drugs. And so we can usually say, okay, well what's the risk benefit here? And in her case, none of the drugs that she's on actually cause quote unquote birth defects. But we also don't know what role they may be playing in her situation of recurrent pregnancy loss.

Touseef Mirza:
So you're saying that the birth defects are really talking about once the fetus is developing versus in this situation, it hasn't even arrived at that point yet. Because we've had a miscarriage.

Dr. Sophia, ObGyn:
Well that's one, but two that we've acted on, these are drugs that have actually been studied and they do not cause quite unquote birth defects. Like they should be safe under the conditions that we would typically take them. That it should be safe. Even if a woman got pregnant while on the drug. The problem is the correlation between pregnancy loss may not have been studied. And so yes. Versus birth. Versus birth defects. Like is the baby gonna be born with a problem with its heart or its brain, or you, you get what I'm saying? And so we may have data that says, okay, there's no birth defects. But then we don't necessarily have data that says there's no problem in terms of recurrent pregnancy loss. And so we're at a crossroads because here she is, she comes to me, she's pregnant, and she's already anxious. She already suffers from a baseline level of anxiety for which she needs to be treated. And here I am saying, okay, I think you may need to come off of your anxiety medication. I think you may need to come off of your medication that helps you to function as a person on an everyday basis if we're trying to keep you pregnant.

Touseef Mirza:
Because that might or might not be a cause. So you're playing detective at this point. You're just like, what has changed from the previous time that you were pregnant? Okay. Nothing. But we do know that you were on the same meds as before.

Dr. Sophia, ObGyn:
Every time. Right.

Touseef Mirza:
So therefore maybe the way to do it is to remove that because there's no studies around it. So there might be, or not a correlation, but at this point the woman really wants to get pregnant again or wants to keep her pregnancy.

Dr. Sophia, ObGyn:
Exactly.

Touseef Mirza:
And you just have to try everything that you can.

Dr. Sophia, ObGyn:
Right. But then we're talking about women who are in their prime and they're dynamic and they're in their professions and they're trying to show up every day and still go through their reproductive part of their life and the desire that they have to be mothers. So to be like, well, I think you need to reconsider these medications, I think you need to come off of them. And then I get, but then how am I supposed to do my job? How am I supposed to show up in the world? How do I manage this? Either anxiety or depression or ADHD or whatever that mental health illness is. What's so hard is that when we think about mental health, we think about it differently than we do, like just diabetes, or we think about it differently than we think about things like high blood pressure.

You know, it's kind of like, oh, just come off of it. You'll be fine. Just go to your therapist. But, it's not that simple for a lot of people. Those are the drugs that help them to stay functional at their highest capacity. Right. that, that makes them feel their, the most themselves. That helps them get through their day-to-day challenges. So it's not so easy to just be like, just come off of it, or I'm just gonna change you to something else that may not be as effective . You know, in managing their illness. Whereas we have so many different options when it comes to perhaps blood pressure or asthma or diabetes. But when it comes to our mental health drugs, we're very limited. And then, so to then say, well, I have to take you off of even the ones that we consider as safe. It's like I don't know, my hands are tied.

Touseef Mirza:
So therefore, what is needed then? Is it more studies around understanding what can potentially cause recurrent pregnancy loss and or we just need more development of different types of solutions around this area altogether?

Dr. Sophia, ObGyn:
I mean, I wish I had the answer. I think my whole purpose here is to simply put it out there that it's a challenge. It's a challenge for the patients, and it's a challenge for the providers. And I just don't want women suffering in silence. We'll see our friends, you know, maybe they've been married for, you know, five or six years, and you go to that person and you say, oh my gosh, I can't believe you guys haven't had a baby yet. Not knowing that she's had four losses. Because that part hasn't been shared. And I, I guess the point here is to just be a little bit more sensitive, empathetic, not rush to have questions or conclusions. Or conclusions. And I did say that this came in threes, and here's the third final story that I wanted to talk about, because this one has had three losses back to back. Here it is her fourth pregnancy.

Here it is. She's now made it to nine weeks. We never made it this far. This is a milestone. This is a milestone. So she's, she does have some type of an autoimmune disease, but it's not the ones that we are like, okay, we know for sure like, like lupus or, or something where we can say, okay, we know what you need is to just be on anticoagulation throughout this pregnancy and this is gonna be okay. I mean, at this point, I was like, okay, let's go. We're gonna do everything. We're gonna try an anticoagulant, we're gonna try some progesterone supplementation. When she had the losses, I was like, okay, well what are you eating? How are you eating? What are you doing? Are you exercising? Are you stressed? You staying, are you stressed? How can we manage your stress? But getting to that marker, now you start to set these like little goals.

There are mini goals because it's almost like every single week that you're still pregnant is like an like, okay, we did this part. We got here, we got here. And so she continues on with the pregnancy and she makes it now to about 20 weeks. And we're both like, oh my god. Okay. Now I'm like, okay, the likelihood that she's gonna have a miscarriage is very unlikely now. Right. Because we passed the first trip because we passed the first trimester, trimester where we way past the first trimester. She's on her anticoagulation, she's on, you know, her, her vitamins and all the things in that sense, right? Okay, now we get to 21 weeks, she's getting her sonogram, her cervix is short. And I'm like, wait, what, what does that mean? We just got through the phase of being excited that we're not in the zone of miscarriage anymore. Uhhuh, . And now we're back in it because her cervix, which is supposed to be, let's say, I like to give people the example. Okay? Imagine I need your cervix to be four knuckles. Okay? So the length of four knuckles. Okay? And when we're in labor, what happens is our fist, that's our cervix, the knuckles need to kind of become thinner and thinner. So this is what it means to be thinner. And then it just, like each knuckle kind of melts away. And then your cervix also needs to open.

Touseef Mirza:
So this is right at the bottom of the uterus?

Dr. Sophia, ObGyn:
This is the bottom of the uterus in terms of what happens when you actually give birth.

Touseef Mirza:
So it's like elastic?

Dr. Sophia, ObGyn:
It's not even that it's elastic. Part of the process of for one to have birth, give birth, yes. Is that the cervix needs to both shorten and open. Okay. But we don't want that process to happen until they're like 39 weeks. Okay. Here we are at 21 weeks, and her cervix is like, let's say it's only one little finger. All of this is gone. She's just, this is it. We've only got one centimeter when it should be four. And I'm like, now what? Well, now what is, we gotta figure out how to keep it closed. We've gotta figure out how to get some extra length from it.

Touseef Mirza:
What happens if it stays short? What is

Dr. Sophia, ObGyn:
The risk? The prob here. Yes. You're, thanks for asking the question. The problem is that if she has a short cervix, we're only 21 weeks. Her risk of having a premature delivery is extremely high. And at 21 weeks, we're not even at the point of viability yet. We're not at the point where this baby can survive outside of the womb. So if she has a baby at that time, then that's a miscarriage.

Touseef Mirza:
Because it can't live after. It can't be a premature baby at that point.

Dr. Sophia, ObGyn:
No.

Touseef Mirza:
How many weeks can they, is it considered a, not a miscarriage anymore, but a premature baby?

Dr. Sophia, ObGyn:
I misspoke when I said miscarriage because at this point she would give birth perhaps at 21 weeks. If she did, she'd give birth. And because it could be an alive fetus, but it wouldn't be one that would survive.

Touseef Mirza:
Okay.

Dr. Sophia, ObGyn:
Okay. So I'm like, no, this can't be what's happening right now. And then to have to go back to explain to her that this is what's happening because she's not feeling anything. She was fine. She's like, what? What's going on? Your face has changed. You know, because now I can't hide that. . And it's not something to hide. It's just, now I have to figure out how to explain what's happening and what's the next step. What are we gonna do about it? I mean, I feel stressed now just remembering, you know?

And so at that point, we offered her to get back on progesterone, a therapy that we had started for her in the earlier part of the pregnancy, again, as part of the how to help keep her pregnant with the recurrent pregnancy loss situation. Then around 10, 11 weeks, 12 weeks, we take her off of progesterone because now her body is able to supplement and do all the progesterone that her body needs for the rest of the pregnancy, which it did. Here we are with 21 weeks. She's fine in terms of a live fetus, but then now her cervix has the problem. So we put her back on progesterone, which is to help with the cervix. And we also do a procedure called a circlage. Circlage. I kind of like this term, I like this word because it's like circle circle sounds French. It feels very much of what it is. Okay. And it's where you put a stitch around in a circle around the cervix in order to hopefully cinch it closed and to keep it closed.

Touseef Mirza:
And so the reason why you don't want the cervix to be in the situation that this patient was in is because maybe the fetus would literally come out.

Dr. Sophia, ObGyn:
The cervix could literally open without her knowing.

Touseef Mirza:
It's like everything has to work perfectly inside all these different things.

Dr. Sophia, ObGyn:
We are, I mean, every time, you know, us being here is a miracle. It is a miracle. Every birth, I say it all the time. That we are a miracle. And imagine the real miracle babies out there, this baby, thank God, that's still inside, she's still pregnant and we're still counting and still getting to each goal. That for me, it's okay. We made it to 21 weeks. We did the thing, we put the cerclage, she's on her progesterone right now. And every two weeks we're monitoring, is the cervix still closed? Is the cervix still holding? You know, and the next step was to get to 24 weeks. And we're like, hallelujah. We made it to 24 weeks. Why? Because 24 weeks is, she can go to an institution where at 24 weeks they can definitely, this baby can survive outside of the womb.

Touseef Mirza:
And by putting it them in an incubator.

Dr. Sophia, ObGyn:
In an incubator to continue to grow. But the likelihood is, is that that baby would survive at 20 weeks. Or even if she had a birth either, whichever way she birthed that baby, there's a chance, a high success rate that this baby will, after it's born, that we would have medical intervention that could keep that baby alive.

Touseef Mirza:
So 24 weeks is-

Dr. Sophia, ObGyn:
Another milestone.

Touseef Mirza:
A huge milestone

Dr. Sophia, ObGyn:
It is a huge milestone. Then we get from 24 weeks now we need to get to 28 weeks, another milestone. But in this case, it's like every week that we gain is a milestone. Mm. So every single time I see her I speak to her, I'm like, are you okay? How's it going, ? And at the same time, the reason why I bring up this particular case is because she has this history of recurrent pregnancy loss. I now tell her she's been going through the pregnancy, we've been so happy. And now I'm like, I need you to be on complete bedrest. I need you to not go out and be who you are in the world anymore as of today, and just grow your baby.

Touseef Mirza:
This is like around 26 weeks.

Dr. Sophia, ObGyn:
No, no, no. This is at 21 weeks.

Touseef Mirza:
This is at 21 weeks. Okay. Okay. Okay. I understand. Because now there's literally just a few weeks left until you reach that milestone of 24 weeks.

Dr. Sophia, ObGyn:
I want her to get to the end of the pregnancy. Yes. Which is 40 weeks at, let's be clear. Yes,

Touseef Mirza:
Yes, of course. Yes.

Dr. Sophia, ObGyn:
But I'm still trying to just get to certain milestones. But to be going along all fine, you're fine. Right? You're still going to work, you're still intimate with your partner. You're still, you know, being who you are, and now I've told you, stop everything. The only thing you are allowed to do right now is grow your baby. It's like putting a woman into prison.

Because now I've shut you off from the rest of the world except for your doctor's appointments and having to deal with the mental anguish of that now. So she already had to go through the mental anguish and anxiousness, et cetera, of having had all these losses. Now she finally gets pregnant and she's very happy about the pregnancy. And we are very happy about the pregnancy. And it looks like things are on the up and up. Everything is okay. And then we get to the halfway mark and boom, we are hit with another thing, which is now that the cervix is short, and it's so short that I don't think that it's a good idea for her to work. I don't think it's a good idea for her to do anything. I just want her to go home and raise her baby. But I can't just say that.

I mean, we talk about it, but where are we also talking about the impact of pulling someone out of work? What is their financial status? What is the financial impact of that? What is the mental impact of that? The emotional impact of that? And in her case, her best friend's wedding was coming up. Unfortunately, she had a cousin who passed away and her inability to participate in things that she would be in. Because now I've said, I want you resting at all times. If anything, I only want you doing the minimum that you need to do to care for yourself, and that's it. Right? Because I don't want to, just imagine the cervixes being like a, and we gotta keep it closed even in the storm. You know, we've gotta keep it closed, and we wanna get to the point where your baby is so well developed that we know that your baby's gonna be okay. And really that's not until, I mean, in all honesty, I want to get a baby as far as 37 weeks. When we normally deliver a baby, like I would say at the average, right, 40 weeks, that's your due date.
But it's like every, every step of the way is like, okay, we got to 24 weeks. Okay, we're 26 weeks. Okay, we just gotta get to 28 weeks and so forth.

Touseef Mirza:
And you have to keep assessing every single time.

Dr. Sophia, ObGyn:
And every single time we're assessing

Touseef Mirza:
To see like, okay, do we need bedrest or is it okay? Or how is it evolving?

Dr. Sophia, ObGyn:
No. This bedrest is until we have this baby.

Touseef Mirza:
Okay. That is, that is just what needs to happen no matter what.

Dr. Sophia, ObGyn:
Until of their, until you get to 36 weeks, then I can be like, okay, maybe now, because now at 36 weeks, at least, for example, that cerclage, that stitch that I put in, I would take out, because the anticipation is okay, after this point, your body may naturally want to go into labor, which is a normal process. And so I don't wanna have this thing holding it up. Now I actually want to take that out. So up to 36 weeks, I want her to just grow her baby. I really bring this up because I recognize the difficulty. With which women have to deal with this particular issue of whether it's the recurrent pregnancy loss, and in this particular case, she's overcome that part, and then have another setback within the pregnancy. A pregnancy every single time is its own little miracle. Basically. And the main point is to recognize that women, we just don't share enough. This is a topic that I don't think anybody really talks about. And I don't even bring it up because I have answers.

Touseef Mirza:
That's what I was gonna say. Like this episode, as opposed to other episodes, you know, we educate obviously, but then we provide solutions. But this one is to acknowledge that there is a gray zone, you know, to acknowledge that it's not something that automatically a provider is gonna know what to do, but they, they have to make assessments, and then they have to look how things are evolving and then fine tune in accordance, and then continue.

Dr. Sophia, ObGyn:
Yes. And in this particular case, you are working as a team. You know, I had to work with my high risk doctor, and I had to work with my geneticist. And then, you know, there's like, there are all these other things you have to do with these, with these patients in terms of sending them to different specialists in order to achieve the goal, which is a live birth. And I actually just wanna applaud the women who've had to deal with this to let them know that they're not alone. That this is actually, you know, it's, it's not super common, but it's common enough. I mean, about maybe 5% of women have experienced a recurrent pregnancy loss, and that's just having two consecutive losses. And then maybe about 1% of women of reproductive age have had three consecutive losses. But that's not a small number. It seems small when we're talking about it in terms of percentages, but I'm, I'm telling you about these three just in the last few weeks of me just working my regular work. I've seen this multiple times. It's not just, this is the first time. It's just because I had this little conglomerate that just happened all together that made me wanna talk about it because I see what it has done to the patients, how these women still remain resilient.

Touseef Mirza:
That was the word I was gonna say. I mean, I'm amazed that women go through this even just one time and then two times, and then three times, and they still wanna get pregnant. I mean, that level of resilience and determination. Yes. It is spectacular. Like, I don't even understand that. Really like that to go through that emotional rollercoaster, the physical aspects. Every time you have to get all these tests and figure out and Yes. And then it doesn't work, and you say, okay-

Dr. Sophia, ObGyn:
Back to the drawing board.

Touseef Mirza:
We're gonna try again. We're gonna try again. We're gonna try again. Yes. I'm gonna try again.

Dr. Sophia, ObGyn:
I love taking care of women because we're pretty incredible.

Touseef Mirza:
So sending love to all these resilient, amazing, beautiful women.

Dr. Sophia, ObGyn:
Yes. That's exactly what I'm doing. That's exactly what we are here for, what we are doing to all of the women who are experiencing miscarriage, recurrent pregnancy loss, this is an episode just for you so that you know you're not alone, and that you can continue to embrace your body and embrace yourself. Thank you for joining us on the Dr. Sophia ObGyn podcast. See you later. Bye. This is General Medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.