Coming to Term : Uncovering the Truth About Miscarriage

Rating:
Summary: Invaluable information unavailable elsewhere
Review: For anyone who has experienced a miscarriage (or, even worse, miscarriages), this is a must-read book. From Cohen's extremely detailed but easily understandable descriptions of how eggs and sperm are created and how they meet to create a human being to the debunking of common myths (still held by most doctors), you won't be able to stop reading.

One's first surprise is how humans ever manage to reproduce at all when approximately seven out of every ten conceptions fail. The next surprise is that early home pregnancy tests can be as much a curse as an announcement of happy news. By now knowing just days after conception that they are pregnant, most women will likely "experience" early miscarriages that would have gone unnoticed or been regarded as simply late periods a mere ten years ago. More of these women will believe they have a problem conceiving when what they are really experiencing is the body's very normal method of maintaining only those fertilized eggs most likely to develop into healthy babies.

Cohen describes extremely intriguing cellular studies of conceptions from the first moments of fertilization to weeks after implantation to demonstrate what really happens when sperm meets egg and the many things that can go wrong. Almost all of the early failures are due to either problems with implantation (often hormonal or a matter of bad timing) or chromosomal defects that occur at the very first stages of cell division, which are infinitely more common than anyone knew before. Even more surprising is the finding that it's not the age of the woman's eggs that causes the development of more babies with chromosomal defects (most commonly Down's Syndrome caused by an extra copy of chromosome 21) but rather how close the woman is to menopause (something she probably wouldn't even know without a uterine biopsy). In other words, and most beneficial to women looking for answers, it's not the woman's fault. A miscarriage is not caused by that glass of wine she had at the office party or the 5k race she ran last weekend or the shocking news that a loved one suddenly died.

In addition, the author explains, through many double-blind scientific studies, that many, if not all, of the "treatments" physicians offer for recurrent miscarriages are useless except as "something to do". The only "treatment" shown to have real, repeatedly verifiable, effects is a warm and nurturing relationship between the woman and her healthcare givers throughout her pregnancy. The good news is that even for women who have experienced up to 8 or more miscarriages, almost all will eventually bring a healthy pregnancy to term.

And, finally, Cohen acknowledges that, for most women who experience even one miscarriage among several successful births, losing a pregnancy, even it's just a week or two after conception, is an emotionally sad event that can be vividly remembered one's entire life.

Rating:
Summary: Required Reading
Review: This is by far the best book available on miscarriage. I found it invaluable for these reasons:

1) It provides detailed information about why/how miscarriage occurs which I have never read elsewhere despite (unfortunately) countless hours spent researching the subject. Cohen (who is a science writer) interviewed experts in genetics and recurrent miscarriage and scoured files and viewed slides collected in miscarriage studies. This book presents far more information than a typical book on pregnancy loss provides, and Cohen does a commendable job of making some really complex biology accessible to the average reader.

2) The book explains why there is so much controversy surrounding miscarriage treatments. In short, to prove a treatment really works, doctors need to design a trial that shows the treatment is more effective than doing nothing at all. But women miscarry for many different reasons and a treatment that might help a woman who miscarries due to hormonal problems obviously won't help one who has a structural problem with her uterus, for example. One scientist quoted says miscarriage is a "malfunction," not a sickness, so a study of miscarriage treatments is more difficult to design than a study of say, diabetes treatments, where patients are much more alike. There's also, Cohen says, little financial incentive for the pharmaceutical companies to do them, but that's another issue. The result is VERY FEW treatments are actually proven to work--they might or they might not, nobody has much data to show.

3) The book explains why doctors are so apt to tell you "just try again." This is the good news promised on the cover: Even women who have had 4 miscarriages in a row are likely to carry a baby to term with NO intervention whatsoever. The book includes anecdotes of women, including Cohen's wife, who miscarry again and again and then have a healthy baby, both with and without medical intervention, along with the science to explain how and why this can happen.

4) Cohen debunks the link between most environmental factors and miscarriage and raises serious questions about certain immunological treatments (if not the goodwill) of famous miscarriage doctor Alan Beer.

What I found a little frustrating about this book is that Cohen adopts--somewhat--the "it's best to do nothing" attitude shared by many MDs. Apparently there is science to support this up to 4 miscarriages but for those of us in the 5+ group, what's the answer?

However, it's not Cohen's fault that they're aren't lots of proven treatments, and his reservations stem from genuine concern for women's health (the DES chapter is a cautionary tale on the dangers of overconfidence).

Cohen approaches the topic with a sensitivity born of personal experience and the professionalism you would expect from a science writer. The book will help you become a more informed patient and give you hope grounded in fact.