Miscarriage is surprisingly common, but that doesn’t take away from the fact that it can be a heartbreaking experience. Unfortunately for some couples, they endure recurrent miscarriage which can be not only frustrating but emotionally devastating. Many couples who have experienced recurrent miscarriage are left wondering if they will ever get answers.
“The good news is that with the appropriate investigations, and correct treatment, many couples who have had recurrent miscarriages do go on to have successful pregnancies.” explains Dr Amin Gorgy, Fertility Consultant at The Fertility and Gynaecology Academy.
What is recurrent miscarriage?
According to the Royal College of Obstetricians and Gynaecologists (RCOG), miscarriage is the loss of pregnancy before 24 weeks gestation. Recurrent miscarriage is defined as the loss of two or more pregnancies any time between positive pregnancy test and 24 weeks and not necessarily consecutive according to the recent world wide definition (American Society of Reproductive Medicine ASRM and Europe). After a second miscarriage your GP should refer you for tests. The benefit of choosing a private fertility clinic is that there are no waiting lists.
How common is recurrent miscarriage?
It is estimated that around 3-5% of couples trying to conceive are affected by recurrent miscarriage, though the real figure may well be greater.
Maternal age is known to be the primary risk factor for miscarriage, which means that women who are conceiving at an older age have a higher chance of having one. This is because the number and quality of eggs decline as we age, and happens more quickly after the age of 35.
One large study about maternal age and fetal loss found that:
Age 35-39 had 25% risk of miscarriage
Age 40-44 had 51% risk of miscarriage
Age 45+ had 93% risk of miscarriage
Will I find answers to my miscarriages?
Here at the clinic we aim to give hope to couples wanting answers.
There are many reasons why miscarriage occurs; in addition to maternal age some of the most common reasons include:
- Chromosomal abnormality
- Endometriosis
- Infection
- Abnormalities of the womb e.g. Fibroids and polyps
- Weak cervix
- Polycystic ovaries
- Sperm factors
- Thyroid issues
- Antiphospholipid syndrome (APS)
- Problems with blood clotting
- Hormone issues
- Immune System Abnormalities (Imbalance)
The good news is that most of these issues can be treated, and many couples will go on to have successful pregnancies.
Unfortunately for patients with chromosomal issues, there isn’t currently any treatment. However, all hope is not lost. In these instances your consultant may suggest that you consider having IVF with preimplantation genetic diagnosis (PGD) to put back only the embryos with normal chromosomes or using a donor sperm or eggs. This can bypass using the eggs or sperm with the abnormality and can increase your chance of having a baby. Your consultant will discuss all options with you.
Around half of the couples who undergo investigations for recurrent miscarriage won’t find out why they miscarried. This can be not only frustrating, but disheartening and hard to accept. Although immune testing is still controversial, many patients do find the answers they are looking for. Immune supportive therapy will help many of them to have a baby.
What tests will I need?
There are a range of tests available, designed to uncover problems and help us to plan the best course of treatment moving forwards. Your consultant will discuss with you the tests they feel are most appropriate for your individual situation during your consultation.
Investigations into recurrent miscarriage usually include tests for both partners. These tests will look for any abnormalities or medical conditions that may impact your ability to sustain a pregnancy. If genetic disorders and infections are excluded, then it’s possible there is an underlying immunological problem. For example, a deficiency or overreaction of antibodies.
Here at The Fertility & Gynaecology Academy we specialise in reproductive immunology, which analyses the immune system and its impact on pregnancy. Despite ongoing debate about the immune system’s role in promoting a healthy pregnancy, we have seen first hand how immune treatments have helped our patients become parents after recurrent miscarriage – some who have been trying for years. You can read about Katie’s experience and how we helped her have her second baby after 9 miscarriages and years of trying.
The tests we carry out include:
Immune testing: A wide range of tests used to measure different factors in the blood to ascertain if there are any immunological issues preventing successful pregnancy.
Infection screening: The likes of chlamydia, mycoplasma and ureaplasma are just a few infections that can impact your ability to carry a baby to term. These can go unnoticed and can recur for years.
Uterine cavity assessment: To check for any abnormal things happening in the uterus, including polyps, adhesions and scar tissue. This involves a hysterography (aqua scan) which lets the consultant visualise the uterus.
Karyotyping: Used as a tool for identifying any genetic problems. Karyotyping is used to check the chromosome set of both partners. This is because sometimes part of a chromosome can detach and attach itself to another, which means that whilst there is no visible abnormality in the parent, it may lead to a failure in the embryo implanting or miscarriage.
Sperm DNA fragmentation: A surprisingly large number of cases of recurrent miscarriage are associated with the male factor. Studies have shown that miscarriage rates correlate with sperm DNA damage levels. It’s important to check sperm for any abnormal DNA material which can impact implantation, create an unstable embryo or arrested development. Even men with normal sperm parameters can have high DNA fragmentation.
Immune treatment for recurrent miscarriage
There are a range of immune treatment options for recurrent miscarriage, but which are appropriate depend on your specific situation, plus other factors like medical history. No two treatment plans will be exactly the same as they are tailored to your individual needs and requirements. Your consultant will discuss which treatments are most suitable for your particular case once they have analysed any test results.
It’s important to remember that there is hope. We have the experience to help minimise recurrent miscarriage by providing highly tailored immune therapy for your individual needs.
To discuss testing and immune treatments in depth with one of our expert consultants, call us now to book an appointment on 020 7224 1880 or email us on info@fertility-academy.co.uk
