How a reproductive pathologist can help you get--and stay--pregnant

by Carolyn M. Salafia, M.D., Ph.D.

Of the millions of women who have been diagnosed as being infertile, 10 to 15 percent of them are actually getting pregnant but are repeatedly unable to carry their pregnancies to term. About 80 percent of these women find some medical explanation for their losses via standard diagnostic testing. For the other 20 percent, the current standard battery of medical tests cannot point to any problem and, therefore, cannot identify a potential treatment.

If the probable cause for your recurrent miscarriages has not been identified, having the tissue from a current loss and/or glass slides from previous losses examined by a reproductive pathologist is especially valuable since it can help you identify any maternal issues that may be contributing to the loss of your pregnancies. Even if the probable cause has been determined, having your pregnancy tissue and slides examined can be of use since the examination may expose an underlying maternal health issue that may be contributing to your pregnancy losses but which may not be revealed by any other diagnostic method.

As a reproductive pathologist, I have spent close to two decades researching why pregnancies fail and how to make subsequent pregnancies succeed. I have found that the single most common problem in people with no documented clinical reason for pregnancy loss (such as a chromosomally abnormal fetus, a low progesterone level or infection) was an abnormality in how the maternal blood vessels were able to carry blood, nutrients and oxygen to the placenta. When the fetus does not get enough of these substances it is unable to thrive. It is important for women to realize that the knee-jerk treatment for blood vessel problems--giving a woman the blood thinner heparin--is not a cure-all. Preliminary research is finding that injections of human chorionic gonadotrope (HCG), the hormone secreted by a woman's body only when she is pregnant, improve the viability of pregnancies with a blood flow abnormality. You may need HCG injections even if your HCG blood serum levels are normal and increasing properly as your pregnancy progresses.

Most women are unaware of the fact that when a D&C is performed because of a lost pregnancy, the hospital's pathology department keeps glass slides from the procedure on file. To have your slides sent to a reproductive pathologist call your hospital's pathology lab. They will fax or mail you a release form. Once this is filled out, the hospital will forward your slides to the reproductive pathologist and, hopefully, you will be one step closer to finding a reason for all those lost pregnancies. Once you have identified the problem, you'll be one step closer to a solution. Good luck!

Carolyn Salafia, M.D., Ph.D., is board certified in Anatomic and Clinical Pathology and in Pediatric Pathology. 

Note: This communication is for educational purposes only and should not be used as a substitute for a consultation with your physician.