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The average obstetrician/gynecologist receives training and gains experience in assisting with normal pregnancies and deliveries. Specialists in maternal/fetal medicine receive additional training in the care of more complicated pregnancies, births, and newborns. A reproductive endocrinologist's (RE) primary focus is on infertility and other matters related to the body's reproductive hormonal system. Once a patient has conceived, a reproductive endocrinologist will also see the pregnancy through the first trimester before referringthe motherto an OB.
Presumably, any OB/Gyn, RE, and even family practitioner has received training in handling miscarriage; however, if a woman has miscarried after experiencing conception difficulties or has miscarried more than once, she may want to talk candidly with her provider about his/her experience in dealing with pregnancy loss. As with any other profession, not all providers offer the same level of experience and skill.
Some questions to ask are:
These questions will give you some idea of whether or not you and your provider are thinking along the same lines.
If one defines infertility as the inability to have a child by birth, then technically, someone who experiences recurrent miscarriage may be thought of as someone who is experiencing secondary infertility. It is now believed that there is an increased chance of miscarriage with nearly every cause of relative infertility (and with most infertility treatments).
That said, it stands to reason that a background of infertility may be enough reason to investigate the cause of even one miscarriage, through karyotype of the expelled tissue. This test, although expensive, could rule out genetic probabilities (which are generally either random or incorrectable conditions), and thereby point to any number of other possible causes. Many RE's will evaluate a single miscarriage's etiology without waiting for recurrence.
Because their focus is on conception and the first trimester with women who are already as a group more susceptible to miscarriage, reproductive endocrinologists are by training and experience highly attuned to the latest knowledge on prevention of pregnancy loss.
The important thing to remember is that miscarriage is no longer the mystery it once was, and there are treatments to correct or prevent many of the known causes. Understanding these causes and treatments, using a medical practitioner who believes in aggressive diagnosis, and following through with your practitioner's advice may just save you from more grief and help you have that longed-for child.
© Tracy Morris
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