Thursday, April 25, 2019

Chemical Pregnancies: The Silent Loss

An African American woman in obvious emotional pain with tears streaming down her face.
Home pregnancy tests have come a long way since they became available to the public in the 1970's.  Some brands are now so sensitive that they are able to detect hCG levels as low as 5-10mIU, meaning you may only be one to two days past implantation when you get a positive result.  For women who are trying to conceive or who have been struggling with infertility, these highly sensitive home tests provide answers faster and shortens the dreaded "Two Week Wait" in between ovulation and awaiting their cycle in hopes for a pregnancy.  Unfortunately this also can cause a lot of confusion and heartbreak for women.  Imagine seeing a faint positive line form on your test - your long awaited pregnancy is now a reality! - only to have your cycle start a few days later.  Or worse, having a negative result at the doctor's office when you go in to confirm the pregnancy.  This is what is known as a chemical pregnancy and is the earliest type of miscarriage that can occur. 

Approximately 50% of all pregnancies end in a miscarriage, with 80% of those occurring in the first trimester.  It is speculated that these numbers may be even higher but prior to the high sensitivity levels available with home pregnancy tests on the market today, most of these losses went undetected.  

Chemical pregnancies are defined as a miscarriage that occurs within the first 5 weeks of pregnancy.   With a chemical pregnancy, a woman may have no or very few pregnancy symptoms.  Often times with a chemical pregnancy, any pregnancy symptoms are attributed to PMS.  Her menstrual cycle may be on time but unusually heavy, or perhaps a day or two late with more intense cramping than usual, or she may have no noticeable difference than any other menstrual cycle.  Unless she was purposefully testing early, as is the case for many women who are trying to conceive, she may never have even suspected that she was pregnant for that brief time. 

Chemical pregnancies can be a very isolating and profoundly life-altering experience for women, especially those who have been trying to conceive for many cycles or who are struggling with infertility.  Since this type of loss occurs before many women even have a chance to announce their pregnancies to friends and family, it can be very difficult to find the support one would usually receive during a miscarriage.  This means that the majority of women who experience a chemical pregnancy often suffer alone and in silence.  

All known pregnancy losses take an emotional, physical, and mental toll on the mother and the length of the pregnancy does not correlate with the amount of grief they mother may experience.  As mentioned before, one of the biggest issues for mothers experiencing a chemical pregnancy is lack of support and understanding from friends and family.  Most people do not understand what exactly happened, are misinformed about early losses and either assume that the mother couldn't possibly be attached to the pregnancy that quickly, or feel that a chemical pregnancy doesn't "count" as a miscarriage.  Partners may also struggle with supporting the mother, or may not understand why she may be experiencing such profound grief and confusion.  

Care providers and well-meaning friends and family members my try to downplay the depth of grief and the sense of loss that can accompany this type of pregnancy loss.  You may hear that things are "better this way" as it is speculated that these types of miscarriages are due to chromosomal anomalies, like Down Syndrome or Trisomy, and that by miscarrying you are being "spared" a child with severe learning or physical disabilities.  These statements, however, do not lessen the pain or provide any sort of relief for a woman navigating the emotions and thoughts of a miscarriage. 

Women who experience a chemical pregnancy may worry that it means there is something wrong with her and that she may not be able to carry a pregnancy to term.  Most chemical pregnancies, however, do not indicate any underlying fertility issue with the mother or the father and many women who have had a chemical pregnancy go on to have healthy, full-term pregnancies within the next year.  If you have had multiple chemical pregnancies or first trimester losses, it is important to be seen by a provider who can assess if there are any health or hormonal issues that are preventing you from carrying a pregnancy past this point of development.  Usually in these cases it is discovered that the mother has a hormonal imbalance that prevents her from producing enough progesterone to sustain the pregnancy in the early weeks of gestation.  This issue can sometimes be resolved by using a progesterone cream for the first few weeks of pregnancy, or through dietary and life-style changes if the mother has a form of insulin-resistance known as Polycystic Ovarian Syndrome (PCOS).

It is important to remember that everyone handles loss and grief differently and there is no right or wrong way when dealing with a pregnancy loss.  It is normal for a mother to feel anger, confusion, and sorrow with this type of loss just as it can be normal for her to feel nothing more than a mild sense of disappointment before moving on.  There is no time-line for grief, just as there is no measurement for the depth of pain she may or may not experience.  Acceptance, empathy, and support are the best ways to help a mother as she deals with her loss in her own way.  It is appropriate and should be encouraged for a mother to seek counseling or therapy if she is really struggling with her emotions after a chemical pregnancy. 

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