Understanding Recurrent Miscarriage

Miscarriage

However you have conceived, whether naturally, by IVF or following a reversal of female sterilisation, experiencing recurrent miscarriages can be a devastating and emotionally challenging journey for couples hoping to build a family. However, there are now various investigations and management strategies available to help identify and address the underlying causes of recurrent miscarriage. In this blog post, we will explore the key aspects of recurrent miscarriage investigations and management to provide valuable insights for those seeking answers and support.

What is Recurrent Miscarriage?

Recurrent miscarriage is defined as the occurrence of three or more consecutive pregnancy losses before the 20th week of gestation and affects about 1-2% of couples trying to conceive. Whilst the definition is based on three consecutive miscarriages, many organisations recommend considering investigations after two consecutive miscarriages.

Investigating Recurrent Miscarriage:

Genetic Testing:

  • Chromosomal Abnormalities: A significant percentage of recurrent miscarriages are caused to chromosomal abnormalities in the embryo. Genetic testing, such as karyotype analysis, may help identify whether the miscarriages are linked to chromosomal issues.

Hormonal Assessments:

  • Thyroid Function: Thyroid disorders, particularly hypothyroidism, can contribute to recurrent miscarriages. Thyroid function tests help assess thyroid hormone levels, the presence of thyroid antibodies and guide appropriate interventions.
  • Progesterone Levels: Insufficient progesterone levels can lead to recurrent pregnancy losses. A history of spotting around the time of a positive pregnancy test, in the run up to a period or in early pregnancy may suggest insufficient progesterone support. Blood tests can also measure progesterone levels during the menstrual cycle and may be offered to identify any hormonal imbalances.

Immune system tests:

  • Antiphospholipid Antibodies: Certain autoimmune conditions, such as antiphospholipid syndrome, can increase the risk of miscarriage. Blood tests can detect the presence of antiphospholipid antibodies, guiding treatment decisions.

Evaluation of the womb, ovaries, and tubes

  •  Pelvic Ultrasound and HyCoSy testing: This imaging technique assesses the uterine cavity and fallopian tubes for any structural abnormalities that may contribute to recurrent miscarriage.
  • Hysteroscopy: A minimally invasive procedure that allows direct visualization of the uterine cavity, helping identify and correct issues such as polyps, septum’s, scar tissue or fibroids.

What can you do to reduce the risk of miscarriage?

Lifestyle Modifications:

  • Healthy Diet and Exercise: Adopting a balanced diet and regular exercise routine can positively impact overall reproductive health.
  •  Smoking and Alcohol Cessation: Smoking and excessive alcohol consumption have been linked to an increased risk of miscarriage. Quitting these habits can improve pregnancy outcomes.

Medications:

  • Progesterone Supplementation: In cases of identified progesterone deficiency, supplementation may be recommended to support a healthy pregnancy.
  • Anticoagulant Therapy: If antiphospholipid antibodies are present, anticoagulant medications may be prescribed to reduce the risk of blood clotting-related miscarriages.
  • Thyroid Hormones: In cases of abnormal thyroid function or in the presence of antibodies.

Surgical Interventions:

  • Cervical Cerclage: In cases of cervical incompetence, a surgical procedure called cervical cerclage may be performed to provide additional support to the cervix during pregnancy.
  • Hysteroscopy: Polypectomy, Myomectomy, and excision of uterine scar niche. Removal of uterine polyps, scar tissue, septum’s or fibroids through surgical procedures may enhance the chances of a successful pregnancy.
  • Laparoscopy: In cases where one of the tubes is swollen (a hydrosalpinx) this may be removed or clipped to reduce the risk of miscarriage and improve overall fertility.

In summary…

Navigating recurrent miscarriage requires a thorough understanding of the contributing factors and a personalised approach to investigations and management. Consulting with a reproductive sub-specialist, such as Mr Sam Dobson, is crucial for a comprehensive evaluation and the development of a tailored plan to increase the likelihood of a successful pregnancy.

If you would like more information or would like to book an appointment, please get in touch with Mr Dobson’s secretary (mandy.banbury@circlehealthgroup.co.uk or 01159662111).