Should I Consider Seeing a Fertility Specialist for Pregnancy Loss?
By Arden Cartrette, Certified Birth and Bereavement doula
The views and opinions expressed are those of the authors and should not be considered medical advice. Always consult your doctor, or a mental health professional, for the most appropriate treatment.
Pregnancy loss affects one in four pregnancies. Miscarriage is the most common type of pregnancy loss, usually occurring during the first trimester or early second trimester (up to 20 weeks). Several factors such as chromosomal abnormalities, egg quality or ovarian reserve issues, and female or male infertility can contribute to pregnancy pregnancy loss. Although it is a relatively common occurrence, the emotional toll of a loss can be significant. Seeking support from a friend, family member, fertility coach or other mental professional is crucial for those going through this type of loss. Beyond social support, it may also be helpful to seek the support and guidance of a medical professional, like a fertility specialist, who can help determine why pregnancy loss may have happened, and determine the best steps forward to try to conceive again.
Understanding Pregnancy Loss
First, it’s important to understand what pregnancy loss actually is, and how it can affect the fertility journey as a whole. There are different types of pregnancy loss, and each can be cared for in different ways. Some people experience what’s referred to as a “chemical pregnancy,” which is an early pregnancy loss between the fourth and sixth week of pregnancy. A chemical pregnancy generally occurs before the ability to have an ultrasound. A “missed miscarriage” is another type of pregnancy loss. This occurs when the pregnancy stopped growing, and/or the heart stopped beating, days or weeks prior to the pregnancy loss confirmation at an ultrasound. It’s also possible to have a “spontaneous pregnancy loss,” in which labor essentially begins and the loss takes place outside of a medical environment.
Of the 25% of aspiring parents who experience pregnancy loss, about 5% of them will experience recurrent pregnancy loss, which is defined as experiencing two or more losses.
The causes and risk factors for pregnancy loss are vast. Some of the common causes are genetic concerns, like chromosomal abnormalities. Other causes are hormone imbalances (that often cause irregular periods), low ovarian reserve or low egg quality, and male fertility issues (such as low sperm motility or morphology). Also, if someone has PCOS (polycystic ovarian syndrome), female infertility, endometriosis, thyroid disorders, or uterine fibroids, or if they any other issue that makes it hard to conceive without the assistance of a fertility specialist, then they may be at a higher risk of experiencing pregnancy loss.
When to Consider Seeing a Fertility Specialist
If you’ve experienced pregnancy loss, you may have considered making an appointment with a fertility specialist. It’s one step in the family growing journey that may feel scary, but can give hope, as seeking professional medical support often takes a little pressure off people who are trying to grow their family. Some of the reasons why someone might consider seeing a fertility specialist instead of continuing their fertility care with their primary care doctor or OBGYN are listed below.
Recurrent Pregnancy Loss
Both the American College of Obstetrics and Gynecology (ACOG) and the American Society for Reproductive Medicine (ASRM) define recurrent pregnancy loss as the loss of two or more pregnancies. This definition has changed over the last ten years, as it previously was defined by three or more miscarriages. Recurrent losses can happen at different gestations and can have different diagnoses. They may be the result of conceiving naturally, or via fertility treatment like in vitro fertilization (IVF). They may also include ectopic pregnancy, which is one that happens in the fallopian tubes. If you’ve experienced pregnancy loss, and especially if you’ve experienced more than one loss, it’s important to see a fertility specialist.
Underlying Medical Conditions
There are various underlying medical conditions for both women and men that can affect their path to parenthood. Some of these conditions may be diagnosed throughout the trying to conceive journey, including after a pregnancy loss. However, other aspiring parents may receive this information via a prior fertility preservation cycle, when freezing egg or sperm before trying to conceive, or even through regular medical care (such as annual appointments with a primary care physician or OBGYN). Regardless, if there is a known medical condition, it’s important to seek the care of a fertility specialist when trying to conceive.
Some underlying medical conditions include PCOS (which can lower egg quality and cause hormone imbalances), ovarian reserve concerns (which may or may not have to do with age), endometriosis (which can affect an embryo implanting or being able to grow), male factor fertility (which may require insemination support to achieve pregnancy), blocked fallopian tubes, and genetic abnormalities (diagnosed by genetic testing with a provider). Seeing a fertility specialist for these conditions, or any other medical condition, can be helpful because these doctors are able to help the body prepare for and achieve pregnancy. They also continue to care for patients throughout the first trimester of pregnancy.
Age and Fertility Concerns
Another factor that is talked about a lot in our society is female age. We often refer to it as the “biological clock,” with the conversation focused on fertility concerns that come with advanced maternal age. The biggest concern with age is the ovarian reserve of the female patient. Female fertility declines with age, especially after the age of 35. Fertility specialists can check ovarian reserve by testing certain things like anti-mullerian hormone (AMH) levels. Age also impacts egg quality, which can affect the chances of conception and pregnancy health. Alongside age, lifestyle factors like diet, exercise, smoking, and stress can all influence fertility. Reproductive technologies like cryopreservation (egg freezing) and IVF offer options for age-related fertility challenges.
Previous Failed Treatments
Another reason why an aspiring parent may seek the care of a fertility specialist is if they previously had failed treatments in the trying to conceive process. Some also may proactively choose to seek treatment regardless of a previous treatment experience because of low ovarian reserve, irregular periods, chromosomal concerns, implantation failure, recurrent pregnancy loss, trouble conceiving, male or female infertility, and many other reasons. Aside from treatment like IUI and IVF, fertility specialists can also use advanced diagnostics and medicine to look closer at your reproductive system and determine the best course of action.
What to Expect from a Fertility Specialist
The first appointment with a fertility specialist is comparable to a consultation, where you’ll discuss your medical history (including any prior pregnancy losses), diagnostic testing, and genetic counseling before continuing with any fertility treatment protocol. During the initial appointment with your provider, you may also discuss potential treatment options based on the recommended test results.
It may surprise you to learn that your fertility doctor (and nurse) can play a role in your emotional and psychological well-being. They are the ones who handle difficult information, share good and bad news, and act as your medical support system while you’re under their fertility care.
Are There Benefits to Early Consultations?
Even though most insurance companies and primary care providers recommend seeing a fertility specialist following recurrent losses, there are benefits to seeing a specialist following one pregnancy loss. Especially if you’re someone who has underlying medical conditions, an early consultation would be a great step when deciding to grow your family. Some of the benefits may include:
- Completing genetic and fertility testing early and catching a diagnosis prior to experiencing two or more pregnancy losses.
- Identifying issues that may not be clear to a primary care physician (PCP) or OBGYN, since their specialty doesn’t revolve around fertility health leading up to pregnancy.
- Access to advanced fertility treatments such as IUI and IVF.
- Having time to plan financially for the cost of family building at a fertility clinic.
Are There Any Barriers To Seeing a Specialist?
Depending on where you’re located, you may come across some complications when it comes to seeing a fertility specialist. A major barrier may be the cost of testing and treatment, along with navigating insurance coverage (or lack thereof). In the United States, most insurance coverage depends on the state where you live, the insurance plan that you have, and your benefits. Another barrier is geographic access to care. Because fertility doctors are specialists, there are fewer of them than other doctors, like PCPs and OBGYNs. Therefore, they are not as easily accessible. Depending on where you live, you may need to travel hours away to access your nearest fertility clinic.
Advocating for Care Following Pregnancy Loss
If you came to this article seeking advice on how to advocate for yourself when it comes to fertility testing and care prior to two pregnancy losses (or more), then you’re in the right place. You are able to get access to most testing and care after any loss, at any gestation. The key to advocating for yourself is to communicate effectively with your provider.
Talk to your PCP or OBGYN, as they can help you navigate your loss, and help you find a fertility specialist that fits your needs. Also do your research and choose a fertility clinic that is local to you and offers the care and services that you desire. Once you find the clinic where you want to make an appointment, you’ll want to consider your personal goals and desired outcome for growing your family, and communicate that with your fertility clinic. This might look like making a list of things that will make you feel comfortable in trying to conceive after loss, questions that you have for your doctor, or tests that you are interested in having done.
But what if a doctor tells you that they can’t accept you as a patient after “only” one loss, or they claim that you don’t fit the prerequisites for their clinic? One thing you can do is call your insurance provider and see if you have coverage. If you don’t have coverage, then you would be a private-pay patient and they should have no problem seeing you. The biggest issue with early intervention is having coverage or the finances to cover the appointments. Making sure that you know which side of the line you’ll be standing on is helpful when it comes to advocating for your care and making an appointment.
So, Should You Consider Seeing a Fertility Specialist for Pregnancy Loss?
Yes! It’s worth considering, especially if you have underlying fertility concerns, irregular cycles, or want to seek medical support before (and during) a subsequent pregnancy. Everyone should feel comfortable and safe with their family building journey and oftentimes that’s taken from us in the form of loss, so it’s important to find ways to fill the gaps in where our comfortability lies.
