Study Links Stress to Miscarriage

There is little in the world of infertility quite as stressful for patients as recurrent miscarriage. So, with the release of a new study identifying stress itself as a possible cause of miscarriage, infertility specialists are now examining ways in which their patients can heighten their chances of a healthy pregnancy by reducing stress.

The study concluded that stress releases a "cascade of hormones" that can lead to spontaneous abortion. It followed 864 pregnant women ? 55 of whom miscarried. Those who miscarried were more likely to have identified themselves as experiencing stress before or during pregnancy, and were also more likely to have lower levels of progesterone and progesterone-induced blocking factor (PIBF) in their blood, than those who did not miscarry.

Progesterone and PIBF are both critical to a healthy pregnancy, in that they prevent the immune system from attacking the placenta and the fetus as foreign substances. In another leg of the same study, pregnant mice that were exposed to high levels of noise responded with elevated serum levels of cortisol, a hormone liked to progesterone suppression.

Mark Leondires, M.D., a board-certified reproductive endocrinologist and Medical Director at the Reproductive Medicine Associates of Connecticut (RMACT) in Norwalk, agrees that stress can play a factor in recurrent miscarriage. "It can be a vicious cycle," he explains, "wherein each subsequent loss can exacerbate feelings of hopelessness or anger. And these feelings can cause hormonal imbalances." Dr. Leondires maintains, however, that stress reduction therapies such as counseling, support groups and even moderate physical activities must be incorporated in a full treatment plan for recurrent infertility.

"There are many other causes of recurrent miscarriage; indeed, there are many other causes of biochemical imbalances," Dr. Spencer Richlin, reproductive endocrinologist at RMACT notes. For instance, a February, 2004 study published in the Journal of Clinical Endocrinology & Metabolism determined that women who suffered from polycystic ovarian syndrome (PCOS) ? a common cause of infertility ? were more likely to miscarry due to insufficient levels of two important proteins secreted by the endometrium during pregnancy. Women with PCOS are up to three times more likely to miscarry than those who do not have the condition, the study also found.

What's more, structural abnormalities involving the uterus or the cervix can also play a part in recurrent miscarriage, as can maternal chronic disease or genetic defects. In fact, while approximately one percent of women experience recurrent miscarriage, it is estimated that a definitive cause can be found in only about 40% of cases. Dr. Leondires advises, "If a patient suffers from recurrent miscarriage ? defined as the loss of three or more consecutive pregnancies ? she should seek out an infertility specialist for a complete examination. It is important that we gather as much factual data as possible about each patient's medical history and condition, before incorporating any aspects of a treatment regimen, be it a physical or emotional component."

When stress is identified as a contributing factor in his patients' history of recurrent miscarriage, Dr. Leondires refers them to qualified counselors who specialize in infertility issues, and to local support groups like RESOLVE or the American Fertility Association. "It's important that patients have the opportunity to share their concerns with a professional who can provide positive strategies for de-stressing," he says, "just as it is beneficial to patients when they find families going through the same difficulties they are, so they know they are not alone." However, he encourages patients to be sure to choose a support group that is facilitated by a skilled professional who specializes in fertility issues. At RMA-CT, Dr. Leondires and his colleagues have established several support groups that meet regularly under the supervision of a certified infertility counselor.

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