Finding support and speaking about pregnancy loss

Written by Virtus Health
15 Oct

Today is International Pregnancy and Infant Loss Remembrance Day, a day when many Australians come together to remember their loss, including those who have experienced early pregnancy loss and miscarriage.

Sadly, we know that pregnancy loss occurs in around one in four pregnancies. And this month, we are on a quest to bring this topic to light.

Virtus Health has partnered with a new documentary on Stan, the Misunderstandings of Miscarriage, which follows Australian actress and filmmaker Tahyna MacManus on her four year journey of pregnancy and miscarriage.

You can read more about the film here. After creating the film, Tahyna had more questions she wanted to explore, with the help of our fertility experts.

It can be such a difficult topic to speak out loud about. How do you speak to a family member or loved one who has experienced miscarriage? And as someone who has experienced miscarriage, how do you navigate sharing the news with your own loved ones – and should you?

Watch the video below as Tahyna explores these questions alongside some of our specialists.

 

We also spoke to Melissa Stephens, one of IVFAustralia’s fertility counsellors, as she gives her advice for how to speak to loved ones with kindness and understanding.

Speaking to loved ones who have experienced pregnancy loss:

How should I talk to my friend who just experienced pregnancy loss?

Melissa: Asking how they are is the main thing, and acknowledging their sadness and grief. Give them space to talk if they want to – saying ‘I’m here if you need me but if you don’t need me right now I will always be here.’
There’s no need to have an answer or to ‘fix’ the situation, since there’s nothing that will fix it. Listening is the most important and helpful thing you can do.

My best friend just experienced miscarriage, but she is usually a private person. How can I be there for her to help her through it?

Melissa: I think if you acknowledge that she may be a private person, but still saying to her that if she wants to share you are there. 

You can check in by asking how she is, you can gently ask if she would like to talk about her miscarriage or would she prefer you to leave it and to wait until she brings it up with you. Be led by what she tells you is the best way to be there for her. Simple ways to reach out could be a text ‘I’m thinking of you’. Understand that you may not receive a response in reply, and that’s ok. 

What should I avoid saying when speaking to a loved one who’s experienced miscarriage?

Melissa: There are many things people tend to say that are definitely not helpful, such as, ‘At least it happened early’ or ‘At least you know you can get pregnant’, or telling stories about other people they know who’ve had a miscarriage.

It’s very important not to minimise their loss, because to that woman the minute they find out they’re pregnant it’s their baby. It doesn’t matter how early the loss is, the pain is the same.

It’s also important to recognise that their grief may last for quite some time– and that’s normal. Give people enough time to heal, and expect it to take time for them to be ok. 

Question: What is the right thing to say?

Melissa: I would say that if you acknowledge the extent of their grief, and acknowledge that this is a very sad time, that you are sorry they’re going through this – that’s a good place to start.

Approach it with empathy, care and sensitivity. 

Know that people experience grief differently. However they’re coping, it’s ok. Some people withdraw, or seem outwardly unfazed, or can be very tearful, we all respond and grieve differently. 

Let your friend or loved one cry if they need to. Sit alongside them their tears, even if it’s uncomfortable for you, because that will mean a whole lot more than anything you can say to try and ‘fix it’.

Questions for parents who have lost:

How do I tell my family about my pregnancy loss?

Melissa: It’s a very difficult question because it really depends on you, whether you feel like you want to tell your family. 
If you feel that telling your family will help provide support, or if they have been a part of your pregnancy journey, I would say approach it with the knowledge that the news will of course make them feel sad. 

Sometimes prefacing the conversation with ‘I have some sad news to share with you’ can help prepare them. It can also help if you share a few ways that they can support you. 

And if you don’t feel that you’re in a good space to share this news with your family yet, that’s completely up to you. There’s no concrete timeframe on this. 

Do I need to tell work?

Melissa: This is one of those things that is very dependent on the individual. 

It can be really helpful for some to share the news with a trusted colleague or manager at work, so that they are aware and know that you may need to take some time off and give you some extra support if you need it.

For others, they don’t want to tell work about their miscarriage, which is also ok and completely up to the individual. I think people who have experienced pregnancy loss can become afraid of all the questions that might come up at work if they take time off without giving a specific reason. But there’s really no need to tell work if you don’t want to – if you do need time off to heal, you can have your GP write a letter to excuse you. And if people ask about it later, you can always say that you’ve had a few family things come up and leave it at that.

I think this is why compassionate leave around miscarriage is an important initiative for companies to consider. By recognising that grief from pregnancy loss is very real, women can start to feel more comfortable taking time off work without feeling the need to justify it.

Why is my early pregnancy loss so difficult to come to terms with?

Melissa: When you find out you’re pregnant, your mind automatically projects forward to a whole new life alongside this baby.

There are so many hopes and dreams that form extremely quickly with pregnancy, and then all of a sudden they’re just taken away. Of course this is going to be difficult to come to terms with. You’re going from the excitement of pregnancy and dreams of the future, to sudden loss. And that loss includes your future hopes, not just the baby. 

Be kind to yourself, and give yourself time to heal. 

What resources are there for support?

Our counselling team is here for you. Counselling is free of charge to patients of IVFAustralia, Melbourne IVF, Queensland Fertility Group, and TasIVF, and it is available at all clinics. If you would like to access support from our counselling team, please contact us to book an appointment.

There are also a number of support groups and resources available including:
The Pink Elephants Support Network
Bears of Hope
Sands
Pregnancy Loss Australia
Still Birth Foundation

Contact

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We hope this article was informative and useful to you. If you have any questions or feedback, feel free to get in touch at info@blogivf.com.au.



Related Articles

Conceiving in your 40s, what are the chances?

I was recently asked to comment in a Sun Herald article on 26th August (also published online here: Sydney Morning Herald) on Collette Dinnigan, who pregnant at the age of 46, has called on women not to leave it too long to try for a baby.

It is always news when a high profile personality such as Ms Dinnigan, has a child, particularly when the personality in question is a bit older.  The difficulty is that these occasions, while very happy for the people involved, give a misleading picture of the actual likelihood of conception in these circumstances.  Remember that high profile personalities such as Ms Dinnigan, are human beings who quite rightly value their privacy and so very rarely (quite understandably) talk to the press when things aren’t going so well.  It was therefore, a particularly courageous action of Ms Dinnigan, while celebrating her own happiness, to so publicly, point out the difficulties that may face other women, seeking the same fulfilment.

What then, are the issues for women in their forties who are planning to have a child?

The main difficulty is that conceiving is simply harder at that age and, even once a woman does conceive, the risk of miscarriage is higher.  Surprisingly, although we have very good data about the effects of age on IVF conception (more shortly), we don’t have very good statistics about the effects of age on conceiving naturally. The limited available data about natural conception comes from old population studies or studies of unique populations, such as the Hutterites of North America, who do not use contraception.  Interestingly these data, such as they are, seem to be entirely consistent with the more modern and abundant IVF data.  Generally, in one year of trying, 75% of women under 30 years and 66% of 35-year-old women but only 44% of 40-year-old women will achieve a live baby naturally.

The main explanation for this, is that women are born with a finite number of eggs, and from that moment onwards, the number of eggs is declining all the time, until women go through their menopause at around 50-51.  Nonetheless, women in their 40s do still ovulate each month.  What is it about their eggs that cause all these problems?

A common misunderstanding with some women is that the fact she looks and feels young, and leads a healthy lifestyle, means that her eggs will be healthier. I regularly see women who have taken enormous care with their fitness and their health.  The rest of their body is in great shape, completely fit and ready to carry that longed-for pregnancy.  Sadly, despite this, the eggs still can’t do it.  The effects of time are remorseless and, sadly, there is no wonder drug to fix it.

Scientists have shown that eggs from older women are more likely to have an abnormal makeup making pregnancy less likely, miscarriage more common and increasing the risk of Down Syndrome, a condition where a child is born with an extra chromosome number 21.

Nor is IVF a cure for this problem. For women, in their early 40s, IVF is still a good thing to try and gives significantly higher success rates than trying naturally.    However, IVF success rates fall sharply after the age of 40 and by the time a woman is 45 are close to zero.

So, what’s the good news?  Well despite all of the above, many women do conceive in their forties, either by IVF, or naturally, and have very happy healthy families.  It is obviously better to have your family earlier, if you can, but all hope is not lost, just because you’re past 40.  Conception and early miscarriage are the big problems but, if you do conceive and get past the first few weeks, by far the most likely outcome will be a healthy child.  While the risk of Down Syndrome is increased, most of the other problems that affect young children are not increased by being conceived a later maternal age.

Finally, many women worry that by having their children later, their long term health and emotional development may be affected.  On the contrary, we now know that the children of older mums grow up to be as healthy and bright as any other child.

Virtus Health
15 Oct

What every woman should know about her fertility

How much do you know about your fertility? Is having a family something you’ve considered, but haven’t really given much thought to?

As Australia’s leading fertility specialists, we know all too well the impacts of women trying for children too late – especially considering that a woman’s age is the number one cause of fertility issues. But for many, high school was the last time they received any education about their fertility, and the focus then is generally on what to do so you DON’T fall pregnant.

For this reason, we commissioned a study amongst women of reproductive age to find out if they really understand their own fertility. 
Some of the results may surprise you:

  • 64% of respondents didn’t know their fertility rapidly declines from the age of 36
  • 60% believed infertility in their 40’s would be easily resolved if they underwent IVF
  • 20% incorrectly believed it only became difficult for a woman to fall pregnant naturally in her late 40’s
  • 80% knew a pregnant woman in her late 30’s and early 40’s had an increased risk of having a baby with chromosomal abnormalities, however 42% did not know this age group also has an increased risk of miscarriage
  • 92% of women knew that being overweight could affect their fertility
  • 74% knew that excessive alcohol consumption could also affect their fertility

Is there a lack of understanding about fertility?

There appears to be a critical information gap about how a woman’s age and egg quality affects her fertility and chance of falling pregnant. As an example, at 30, when trying to conceive, a woman has a 20% chance of falling pregnant in any given month, compared to less than 5% chance when she is in her 40’s.

It’s a real misconception that women can delay motherhood until their late 30’s and rely on IVF to easily resolve their problems and conceive well into their 40’s. Although IVF is very effective and may dramatically improve a woman’s chances of having a baby – it is not a guarantee.

Unfortunately, the effects of age on a woman’s fertility cannot be reversed.  As a woman ages so do her eggs, and it is not possible to improve the quality of a woman’s eggs – which impacts her chance of conceiving both spontaneously and with IVF.  The increase in media stories of celebrities having babies in their mid-40s has given people a false sense of security as to how age impacts their fertility.

But, it’s not all bad news.

The survey results did demonstrate that women are well informed regarding lifestyle factors impacting their fertility such as weight and excessive alcohol consumption.

While we can’t do anything about the impact age has on a woman’s fertility, we can provide women with the facts about how their age and health affects fertility, so that even if they’re not ready to start their family now, they make informed decisions about their future.

For example, it might be a good idea for women who are concerned about their age and are wondering about their fertility window to consider an AMH test, or Anti Mullerian Hormone Test. Otherwise known as the ‘egg reserve test’ or ‘egg timer test’, this simple blood test can provide insight into the remaining quantity of eggs and number of fertile years you may have, but it cannot tell us much about the quality of those eggs.

Learn more about the AMH test by contacting your GP or fertility specialist. 

Find out more here:

For NSW
For VIC
For QLD
For TAS

The survey of 1038 Australian women aged 18-55 was conducted by Research Now, April 2014.

 

Virtus Health
15 Oct

What is embryo screening and is it right for me?

One significant development in assisted reproductive technology (ART) in the last 25 years is our ability to remove cells from a developing embryo and perform genetic testing. The procedure is termed preimplantation genetic screening or preimplantation genetic diagnosis depending on its application.

As technology has improved we have seen the use of PGS and PGD in IVF rise, with the latest Australia and New Zealand Assisted Reproductive Treatment Database (ANZARD) reporting a 20% increase.

embryo screening

What is Preimplantation genetic screening?

Preimplantation genetic screening (PGS) or ‘embryo screening’ is a method where embryos from presumed chromosomally normal genetic parents are screened for abnormalities. It involves screening all 24 chromosomes in a developing embryo to select the embryo/s without any chromosomal errors that is most likely to result in an ongoing pregnancy.

PGS is an evolving technique that is now recognised more arguably as a way to improve pregnancy rates in women experiencing repeated IVF failure and recurrent miscarriage.

What is Preimplantation genetic diagnosis?

At this stage of medical science we are not able to routinely ‘screen’ embryos for faults in the 20,000 or so genes located on our 23 pairs of chromosomes. Therefore we cannot tell if an embryo is destined to develop a particular genetically inherited condition unless we are specifically looking for it. This is known as Preimplantation genetic diagnosis - PGD for short. Some couples may require this when there is a known genetic condition that runs in their family, such as Huntington’s disease, Cystic fibrosis, Thalassaemia and Fragile-X.

How is PGS & PGD performed?

Both PGS & PGD involve taking cells from a developing embryo usually at the day 5 (blastocyst) stage. This step is called an embryo biopsy. The biopsied cells are then tested to assess the embryo and health of any potential baby. The embryos are frozen whilst we wait for the results. The embryo then determined to either have no chromosomal errors (PGS) or be of low risk for the genetic condition we are testing for (PGD) is transferred back into the woman’s uterus.

Embryo selection in an IVF cycle

During an IVF cycle, selecting an embryo for transfer has traditionally been based on appearance alone, called morphology.  A ranking of which embryo is likely to result in a baby, based on an appropriate number of cell divisions at a given time is established. Then, each month, the next best embryo is transferred into the woman’s uterus. Unfortunately, many embryos do not result in a baby. The reasons for this are mostly related to genetic factors of the embryo and not the uterine environment.

What causes an embryo transfer to fail?

There are many reasons the transfer of an embryo does not lead to an ongoing pregnancy. An important requirement for an embryo is that it is genetically normal and has 23 pairs of chromosomes, which are labelled 1 to 22. There are also 2 sex chromosomes, XX (female) or XY (male).

Sometimes an embryo can have an extra chromosome, such as three copies of chromosome 21, which we call trisomy 21. This embryo would be destined to have Down syndrome. If an embryo is missing a chromosome, for example chromosome 4, we call this monosomy 4. These major structural errors, also called aneuploidy, commonly lead to a negative pregnancy test or result in miscarriage.

How common is it for an embryo to be genetically abnormal?

We know that approximately 30% of embryos from women aged 30 have genetic errors and this rises to 80% of their embryos at the age of 40. The reason for this is due to the ageing process that inevitably occurs in the egg. 

Women are born with all the eggs they will ever have and as a woman’s eggs get older, these errors become more frequent. Unfortunately, even the best embryos based on their appearance can have these errors. The result is that most of these embryos when transferred will result in a negative pregnancy test or miscarriage. This is largely the reason that the chance of pregnancy declines as women get older. The chance of miscarriage also increases for the same reason. At 30 years, 1 in 6 pregnancies end in miscarriage. At 40 years, this has risen to 1 in 3 pregnancies.

How can embryo screening increase pregnancy rates?

When we identify and exclude abnormal embryos from transfer, the likelihood is that the time to achieve an ongoing pregnancy will be reduced. Fewer procedures and less dreaded two week waits make IVF treatment easier.

It’s important to remember that transferring an embryo without genetic errors does not guarantee a pregnancy. An embryo must also be normal in other ways that we cannot test for.

Who could benefit from embryo screening?

Women recognised to benefit from embryo screening are those experiencing recurrent miscarriage or implantation failure. There is also increasing evidence to support the use of embryo screening for women 38 years and older. 

Since the embryo screening process involves comparing embryos to see which one is more likely to lead to a successful pregnancy, it is more appropriate for couples that have more than two day five (blastocyst) embryos.

What can I do next?

If you have questions about PGS or PGD, consult a fertility specialist. They will be able to advise whether the technique is appropriate for your situation and answer any questions you might have.

Read more about PGS at Virtus Health:  Victoria»  New South Wales»  Queensland»  Singapore»

 

Virtus Health
15 Oct

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