Patients often hesitate to discuss miscarriages, or spontaneous pregnancy losses. While one miscarriage might prompt a doctor's visit, experiencing two or more losses warrants a thorough examination for underlying reproductive issues. Yale Medicine’s Recurrent Pregnancy Loss Program assembles experts from various fields to provide comprehensive and compassionate care to patients facing this condition. We utilize cutting-edge technologies for diagnosis and tailor individualized treatments to address the root cause. Recurrent pregnancy loss is defined as two or more failed pregnancies, including those confirmed via pregnancy blood test or ultrasound. Miscarriage is relatively common, affecting 15% to 20% of known pregnancies within the first 20 weeks. However, experiencing two or more consecutive losses, which affects 1%-3% of pregnancies, may indicate underlying genetic, physiological, or anatomical issues. Anatomic abnormalities in the uterus, such as fibroids , polyps, adhesions, or the presence of a septum dividing the uterine cavity, can lead to pregnancy complications. Hormonal disorders, like uncontrolled diabetes or thyroid issues , can also contribute to recurrent pregnancy loss. Additionally, chromosomal abnormalities in embryos, autoimmune conditions, infections, and lifestyle factors, such as smoking, drug use, caffeine and alcohol consumption, toxin exposure, and obesity, may play a role. Our multidisciplinary team works closely with patients to identify potential contributing factors while offering emotional support during this challenging time. Initial assessments include a thorough review of medical history, physical examinations, specialized ultrasounds, and consultations with specialists, such as reproductive endocrinologists, maternal-fetal medicine specialists, reproductive immunologists, geneticists, and pathologists. We employ advanced diagnostic techniques, including genetic testing and analysis of fetal tissue, to pinpoint underlying causes. Our team includes psychological counselors, dietitians, and experienced nurses who provide comprehensive support throughout diagnosis and treatment. At Yale Medicine, our Recurrent Pregnancy Loss Program combines compassionate care with state-of-the-art genetic analysis. Following a definitive diagnosis, we offer customized treatment options, which may include surgical interventions to address anatomical abnormalities, in vitro fertilization (IVF) , or a genetic screening of embryos. Even in cases where a specific cause cannot be identified, the outlook remains positive, with the majority of subsequent pregnancies proceeding normally. Throughout the process, we remain dedicated to understanding the root cause of difficulties and providing empathy and reassurance to patients facing recurrent pregnancy loss.

The Sexuality, Intimacy, and Menopause Program is one of the only clinics of its kind in the country. By combining both medical and psychological interventions, it is designed to help women who experience sexual dysfunction after cancer. Sexual dysfunction after cancer is common; however, sexual side effects often go untreated after having successfully treated a patient’s cancer. Our doctors look to manage not only the physical issues, but also any psychological concerns that may arise. Founded by Elena Ratner, MD, MBA, associate professor of Obstetrics, Gynecology & Reproductive Sciences and co-chief for the Section of Gynecologic Oncology, and Mary Jane Minkin, MD, clinical professor of Obstetrics, Gynecology & Reproductive Sciences, the clinic began nearly a decade ago. Psychologist Dwain Fehon, PsyD, associate professor of Psychiatry and chief psychologist of Psychiatric Services at Yale New Haven Hospital, is a vital member of the team. He and his staff provide essential emotional care that helps improve our patients’ relationships and personal health. Many women have concerns related to intimacy and menopause because of cancer surgery or treatment. Our specialists consult with patients to address the difficult physical and emotional aspects of cancer care and treatment, and create a personalized care plan for each patient. We have developed a unique focus on menopause management for cancer survivors and “previvors”—healthy women who have their breasts or ovaries removed because of a genetic risk of developing cancer. What types of patients do we see? Women who experience: Changes in sexual function as a result of chemotherapy, radiation, or surgery for cancer Menopause symptoms as a side effect of cancer treatment Early menopause or sexual changes after surgery for cancer risk reduction What we provide: Menopause symptom management Resources for cancer survivors on maintaining sexual health Access to complementary and supportive services Access to individual and couples counseling What to expect from an appointment: Our team will first discuss each patient’s medical and cancer history, as well as what type of treatment they have had. They will be asked about symptoms of menopause and sexual problems, such as hot flashes, night sweats, changes in sexual desire, painful intercourse, vaginal dryness, or changes in mood or sleep patterns. Depending on their symptoms, patients may have a gynecologic exam. The team will then discuss options for symptom management and improving their sexual health. They will also have the opportunity to talk about emotional and relationship issues affecting their life. Women are welcome to bring their partners to the appointment.

Endometriosis, a common gynecological disease, affects one in 10 women in the U.S., and is diagnosed in up to half of women who experience infertility . Due to its nonspecific symptoms, endometriosis often goes undetected for years. Many individuals attribute their chronic pelvic pain to menstrual cramps rather than recognizing it as a symptom of endometriosis. Additionally, some may remain unaware of their condition due to silent symptoms. It can take up to a decade for some patients to receive a proper diagnosis. Normally, the uterine lining (endometrium) grows along the interior walls of the uterus, providing a cushioned and receptive environment for embryo implantation during pregnancy. However, in endometriosis, the endometrium grows outside the uterus, commonly on the exterior of the uterus, ovaries, fallopian tubes, bladder, intestines, or other pelvic structures. This displacement frequently leads to chronic pelvic pain and may cause secondary symptoms, such as irritability, difficulty sleeping , anxiety , depression , or low self-esteem. Over time, endometriosis induces inflammation, bleeding, and scar tissue formation within the pelvic cavity, regardless of whether the patient experiences pelvic pain. The presence of scar tissue can hinder fertility. Early diagnosis of endometriosis, before the formation of scar tissue, can help preserve fertility. A delayed diagnosis may pose challenges for conception, even with assisted reproductive procedures like in vitro fertilization (IVF) . To confirm endometriosis, clinicians biopsy a small sample of uterine tissue and examine it under a microscope for signs of the condition. For patients diagnosed with endometriosis, the news may bring emotional relief after years of pelvic pain without a clear cause. Our providers offer treatments to alleviate chronic pain and related physical and emotional symptoms, and assess whether endometriosis has contributed to infertility. Treatment options for endometriosis include medications and/or surgical procedures, such as excision surgery, to relieve pain, remove scar tissue, and improve organ function. These treatments may also prevent a recurrence. In cases of endometriosis-related infertility, clinicians may recommend IVF or other assisted reproductive therapies to enhance pregnancy chances. Many patients with endometriosis benefit from therapy alongside medical treatments. Additionally, we conduct various research projects, offering patients access to medication and testing at no cost. Throughout the infertility journey, our counselors support patients with endometriosis, explaining different assisted reproductive technologies and helping patients understand their options fully.