Recurrent miscarriage

Losing pregnancies repeatedly is heart-breaking. Although most miscarriages occur without a detected cause, repeated pregnancy loss should be investigated to find out if it is due to conditions that can be treated.

 

Miscarriages are common, with as many as 1 in 3 pregnancies ending in a miscarriage. In most instances, there is no detectable causes for the miscarriage and, although it causes genuine distress, there is not much to be gained from detailed testing. However, if 3 or more pregnancies are lost, particularly if this happens consecutively, tests are indicated to try and determine a cause. In women of 40 and above, it may be reasonable to do these tests after 2 miscarriages. 

The Miscarriage Association is a great source of support and information http://www.miscarriageassociation.org.uk/

My approach is to offer a detailed consultation looking at your pregnancy and medical history (for both partners) to see if any indications can be found as to what might be causing the miscarriages. A number of tests are available including chromosome tests for both partners. I would normally recommend a full thrombophilia screen, thyroid tests and ultrasound for the woman. In some cases, ovarian reserve assessment is advisable and some men may benefit from a sperm DNA assessment.

The aim of testing is to identify any potentially treatable conditions. If a clotting disorder is found (such as Anti-phospholipid syndrome), specific treatment is available to reduce the risk of another miscarriage occurring. In other women, support and care during early pregnancy with an early ultrasound scan and perhaps progesterone supplements is advised. There may be a role for IVF treatment in some couples where recurrent miscarriage co-exists with difficulty in conceiving. If appropriate, Il discuss this option, including cutting-edge measures such as IMSI for miscarriages that may relate to sperm problems.