At a Loss

Apr. 17, 2008— -- It was May 2005, and I was quietly excited.

I believed I was 7 weeks pregnant. My doctor wasn't so sure. The embryo on the ultrasound wasn't big enough, and he didn't hear a heartbeat. I looked closer to 5 weeks along. This revised timing seemed unlikely -- I was sure of the exact date sperm met egg. But I wasn't going to let pesky details get in the way of my party. "Great!" I said. "When's the new due date?"

I'll say this for myself: The denial came from an honest place. I was 33. My husband, Scott, and I had been married for almost a year. We'd just bought our first house, in Los Angeles, with an extra bedroom (for a kid) and a sun-dappled backyard (also for a kid).

Our tangerine tree sagged with fruit. Hummingbirds sipped nectar from our flowers. So when the doctor said not to worry, I'd probably see a heartbeat at my next ultrasound in a couple of weeks, I didn't. I cheerfully filled my prenatal vitamin prescription. I began a list of baby names. I checked out pregnancy Web sites, including one that advised women who'd had ultrasounds like mine to "enjoy being with her pregnancy." I snickered, but put a hand on my belly and felt the presence of a baby. Tears filled my eyes, as crazy as that sounds.

Today, I'm grateful for my Hallmark moment. It was the only time I stepped away from fevered planning and enjoyed things as they were -- the finest minute and a half of my pregnancy. Two weeks later, the repeat ultrasound showed an empty gestational sac where a heartbeat should have been.

Every pregnancy is different. So is every miscarriage, though no one tells you this.

Books, Web sites, even physicians gloss over the subject. What to Expect When You're Expecting, which finds space for questions like "Is it necessary to shave your pubic hair before labor?", devotes only a few pages to miscarriage. These resources don't prepare you for the grief, guilt, and self-doubt that take the place of excitement.

And they don't fully describe the physical experience. They do mention that miscarriage can cause painful cramping and bleeding and sometimes requires intervention with drugs or a procedure called dilation and curettage (D&C), which involves dilating the cervix and removing the "products of conception." This sounds scary, but it's a piece of cake compared with what they don't warn about.

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I didn't tell many people about my miscarriage -- my parents and sister, my in-laws, and a friend -- so afterward I felt really alone.

Wacko hormones probably played a role. When you lose a pregnancy, estrogen and progesterone levels plummet, similar to PMS, says Dr. Robert Anderson, director of the Southern California Center for Reproductive Medicine in Newport Beach.

But it's ironic that isolation was such a big part of the mix, because anywhere from 10 to 25 percent of confirmed pregnancies miscarry. And in most cases, it's pretty much out of your hands. The March of Dimes estimates that as many as 70 percent of miscarriages result from one-time genetic glitches you can't control that make it impossible for the embryo to survive. Age affects genetic health: A 35-year-old is twice as likely to miscarry as a 25-year-old. But 10 percent of pregnancies in women under 30 fail too.

As for miscarriages not related to genetics? They can't always be traced to a specific cause -- most women get pregnant again after miscarrying once, so doctors don't bother with tests. But possible factors include diabetes, polycystic ovarian syndrome, and thyroid disease. A 2003 study found that women who have the common vaginal infection called bacterial vaginosis are nine times more likely to miscarry than those who don't. Research in British Medical Journal linked miscarriage to using nonsteroidal anti-inflammatory drugs (like ibuprofen) and aspirin around the time of conception. (All of which could freak a girl out, so see a doc as soon as you know you're pregnant.)

Booze, cigarettes, illicit drugs, or copious amounts of caffeine put you at risk too. But that espresso or glass of merlot you had before you peed on the stick probably isn't the cause. Something else to feel good about: factors proven not to cause miscarriage include sex, exercise, and your quest for a paycheck.

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