Ok, settle down class - come on, stop making that racket. Concentrate. Thankyou. Let's begin.

Now, can anyone tell me what's happened here?

Have a guess. Anyone? I won't bite your head off... yes, Bea.

"I'm not sure. Is it a chemical pregnancy? Or a miscarriage? When does a chemical pregnancy turn into a miscarriage?"

Well, to answer that question, we first have to know the definition of those terms. Can anyone define miscarriage? Ok, let me.

The most common definition of miscarriage is simply the loss of the products of conception before 20, or some say 24 or 28 weeks gestation. But there are many different kinds of miscarriage. You can have early miscarriages, late miscarriages, complete and incomplete miscarriages... Some people even use the term 'menstrual miscarriage', which is the same as a chemical pregnancy - ie a loss before implantation. So you see, the word 'miscarriage' can be quite a broad term, ecompassing many different situations. So let me go back to my original question: can anyone tell me what's happened here?

Silence? No-one. I see. Ah, over there - yes?

"I just don't feel comfortable using the term 'miscarriage'. I mean, it seems kind of dramatic."

Well that's ok. I don't think you have to use the term if you don't want to. Maybe you can think of another term you'd rather use?

Take a little time to think if you need to.

"Miss, was I pregnant? Because if I was, you could call it a 'Very Early Pregnancy Loss'."

You could indeed. Well, let's answer that first question, then, shall we? What do you think?

"The clinic said I was pregnant."

Very good! Anything else?

"Well, I had symptoms of pregnancy. I felt pregnant."

Ok, so what do you think?

"I think I was pregnant. For a little while. And then it was lost."

So shall we call it an 'Early Pregnancy Loss'? Yes, ok, I think we all agree on that one.

So we've had an Early Pregnancy Loss, or Very Early Pregnancy Loss, as Bea put it. Can anyone explain why? Bea?

"No."

Very good. That's the correct answer. What would be a better question?

"How?"

That's right. There are many different ways in which a pregnancy can be lost at this stage. The most common method is through some sort of chromosomal abnormality. The embryo develops as normal until it needs the faulty gene, at which point everything falls apart. What's by far the most common reason for a chromosomal abnormality?

"Chance event."

Very good, Bea! So it's almost always a random mistake, made somewhere along the line. Of course, there are tests which can indicate a high level of DNA fragmentation in the sperm, which may show an increased chance of this sort of thing happening, but recent studies show the test is more difficult to interpret than previously thought. And since the problem can show up in both normal and abnormal semen samples, there's no real reason to assume that this is a problem for you, just because your sperm is abnormal in other ways.

Can anyone tell me another way in which a pregnancy can be lost this early? Yes?

"Failure of implantation."

That's right - and what's the most common cause of a failure of implantation?

"Chance event."

Correct. Ok.

There are lots of other 'hows' in the question, 'How did this happen?' but many of them are quite rare disorders or problems we know don't apply to us. Statistically speaking, unless this happened several times in a row, there would be no reason to suspect any kind of underlying pattern to these events. So wrap it up for me now, what's the main lesson for today?

Come on, you were doing so well. Alright - yes?

"What happened was a Very Early Pregnancy Failure, probably due to some Chance Event."

Very good. And what does that mean?

"Well, it means we're no better or worse off than we were this time last month. We just need to pick ourselves up and roll the dice again."

Right. So that's what I want you to do for your homework. Any questions? Good. Class dismissed.