Recurrent Miscarriage

Understanding the Causes, Diagnosis, and Treatment

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JIVA Fertility is not just for individuals or couples experiencing difficulty conceiving. Mr Harish Bhandari has clinical and research expertise in Recurrent Miscarriage. He will help you understand the possible reasons for your miscarriages. More importantly, we provide guidance and reassurance, supporting you in taking the next step toward pregnancy with confidence.

1. What is a miscarriage?

A miscarriage is the spontaneous loss of a pregnancy before 24 weeks. If this occurs in the first 12 weeks, it is referred to as an early miscarriage. Other types of pregnancy loss include ectopic pregnancy and molar pregnancy, which also happen before 24 weeks. Sadly, one in four pregnancies result in miscarriage.

2. What is a recurrent miscarriage?

• According to the Royal College of Obstetricians and Gynaecologists (RCOG), recurrent miscarriage affects 1 in 100 women and is defined as three or more early miscarriages, which do not have to occur consecutively—you may have healthy pregnancies in between.

• The European Society of Human Reproduction and Embryology (ESHRE) suggests that recurrent pregnancy loss could be diagnosed after two or more pregnancy losses.

3. What are the possible causes of recurrent miscarriage?

Many factors can contribute to recurrent miscarriage. Often, it is a combination of factors that can lead to a miscarriage.

General:

• Miscarriage risk increases in women over 35 years, with further increase after 40 years
• Being overweight, obese, or underweight
• Previous miscarriages
• Smoking
• Excessive alcohol or caffeine consumption
• Use of recreational drugs
• Family history of pregnancy losses
• Chronic stress (linked to miscarriage but not a direct cause

Conditions affecting the uterus (womb) or pelvis:

• Fibroids (can distort the womb cavity and impact implantation)
• Endometriosis & Adenomyosis
• Uterine septum or other congenital uterine anomalies such as heart-shaped womb
• Intrauterine adhesions (Asherman’s syndrome) – scar tissue inside the womb cavity
• Cervical weakness (incompetent cervix)
• Endometritis (chronic inflammation of the womb lining)

Clotting disorders & immune system issues:

• Antiphospholipid Syndrome (APS) (linked to abnormal blood clotting, affecting placental function)
• Inherited Thrombophilia (causes increased blood clotting risks)
• Increased Natural Killer (NK) cells (controversial, but some studies suggest they may play a role)
• Autoimmune disorders (anti-nuclear antibodies, Th1/Th2 imbalance)

Genetic factors:

• Chromosomal abnormalities (aneuploidy) in the embryo – a leading cause of early miscarriage
• Parental chromosomal abnormalities (Balanced translocations)
• Hormonal & Metabolic disorders
• Thyroid disorders (hypothyroidism, hyperthyroidism)
• Polycystic Ovary Syndrome (PCOS)
• Poorly controlled diabetes
• Vitamin D deficiency
• Anaemia
• High Prolactin levels

Sperm related causes:

• High sperm DNA fragmentation – Associated with a higher risk of miscarriage, even with normal sperm count and motility
• For more in-depth details on the causes of miscarriage, visit: Tommy’s Research on Recurrent Miscarriage.

4. How can we help you?

At JIVA Fertility, we offer a thorough evaluation to understand the potential causes of recurrent Miscarriage. Based on your circumstances, we may recommend a combination of diagnostic procedures:

Medical Evaluation: Comprehensive medical evaluations for both partners to identify potential causes of recurrent miscarriage (as discussed above).

Preconception Care: We offer preconception counselling and discuss optimising maternal health before further pregnancy to help reduce the risk of miscarriage and improve pregnancy outcomes.

Diagnostic Tests: Based in your medical circumstances, we offer appropriate tests.

• Blood Tests – To assess clotting disorders (APS, thrombophilia), nutritional deficiencies, hormonal imbalances, immune factors, and genetic abnormalities.
• Genetic Testing (Karyotyping) – In some circumstances, checks for chromosomal abnormalities in both partners.
• Pelvic Ultrasound (including 3D assessment) – To evaluate womb and pelvic health
• Hysteroscopy – A detailed camera examination of the womb to check for fibroids, intrauterine adhesions, or endometrial polyps.
• Semen analysis with DNA fragmentation test – To assess sperm quality and its role in miscarriage.

5. What treatment options are available for recurrent miscarriage?

Depending on the underlying cause, we tailor the treatment options for you.

Lifestyle Modifications

• Achieve a healthy BMI – Weight optimization to normal can improve pregnancy outcomes.
• Quit smoking, limit alcohol and caffeine
• Stress management – Relaxation techniques like yoga and mindfulness may help.

Medical Treatments

• Antiphospholipid Syndrome (APS) – medical treatment with low molecular weight Heparin injections & Aspirin tablets  
• Support optimisation of thyroid gland function, high prolactin levels and Diabetes Mellitus, if identified
• Optimise Nutritional deficiencies – such as vitamin D deficiency, anaemia

Progesterone Supplementation – may be recommended for women with a history of early pregnancy loss and early pregnancy bleeding to reduce the risk of miscarriage

Surgical Interventions

• Hysteroscopic Surgery – Removal of fibroids, polyps, uterine septum, or adhesions.
• Cervical Cerclage – A stitch placed in the cervix to prevent late miscarriage in women with cervical weakness. You will be given appropriate advice on how to get this.

Assisted Reproductive Technologies: If you need IVF/ICSI for other reasons, pre-implantation genetic testing for aneuploidy (PGT-A) may be considered as it has been found to be effective at reducing the chances of miscarriage for most fertility patients.

Genetic Testing & Counselling: Genetic testing may be performed to identify chromosomal abnormalities or genetic mutations that increase the risk of miscarriage. Genetic counselling can help couples understand their risk and make informed decisions about family planning.

For a personalised approach, we will tailor your treatment based on your pregnancy history and test results. You will receive appropriate advice on some treatments not available through our clinic. 

6. What happens when I book my appointment at JIVA Fertility?

After booking your appointment at the JIVA Fertility Recurrent Miscarriage Clinic, we will contact you to ensure this appointment is suitable for you. We will advise on the packages we have specifically created for our patients who have experienced recurrent miscarriage. We will provide information on consultation and package fees.

If you have opted for one of our packages, we will arrange all the tests as highlighted in the packages in preparation for your appointment. Please note that some blood tests will ideally have to be done three months after your previous miscarriage.

7. What happens at my appointment?

We encourage both partners to attend the consultation, as this helps us evaluate all potential contributing factors. You will be seen by Mr Harish Bhandari who has clinical and research expertise in Recurrent Miscarriage.

Your package consultation includes:

• Comprehensive Medical History Review – Discussing previous miscarriages, general health, lifestyle, and previous test results.
• A detailed Pelvic Ultrasound Scan, including:
  • 3D assessment of the uterus for womb cavity abnormalities
  • Endometrial lining evaluation
  • Hydrosalpinx (fluid in the fallopian tube) detection
  • Ovarian reserve evaluation via Antral Follicle Count (AFC)
• Discussion of the test results you have had so far
• Arrange further tests as appropriate
• Discuss various treatment options
• Keep a plan in place for future pregnancies
• A letter summarizing your consultation, test results and treatment options will be sent to you

8. What happens next?

• If investigations reveal an underlying cause, we will discuss further testing or treatment options tailored to your needs
• We will arrange appropriate counselling if you wish (separate fees apply), to prepare you psychologically for future pregnancies
• We encourage and support lifestyle modifications
• If no specific cause for miscarriage is identified, we provide reassurance and guidance on future pregnancy success rates, using prediction models to support decision-making
• In over half of the couple, no cause is found (unexplained recurrent miscarriage) – about 70 % of couples go on to have a successful pregnancy in the future with supportive care.
• We offer early reassurance scans from 6 weeks onwards in future pregnancies.

9. Can you make an appointment for a consultation without opting for one of our packages?

Yes, you can arrange a New appointment (40 minutes) and we will be happy to discuss your circumstances and possible reasons first before arranging any tests. Please see the Price-list (LINK TO PRICE LIST - TBD) for the consultation fees and individual test costs.

At JIVA Fertility, we are committed to providing expert medical care, emotional support, and tailored treatment plans to help you achieve successful pregnancy.

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OLD VERSION To Be Deleted

JIVA Fertility is not just for individuals or couples experiencing difficulty conceiving. Our consultants have clinical and research expertise in Recurrent Miscarriage and will help you understand the possible reasons for your miscarriages. More importantly, we provide guidance and reassurance, supporting you in taking the next step toward pregnancy with confidence.

1. What is a miscarriage?

A miscarriage is the spontaneous loss of a pregnancy before 24 weeks. If this occurs in the first 12 weeks, it is referred to as an early miscarriage. Other types of pregnancy loss include ectopic pregnancy and molar pregnancy, which also happen before 24 weeks. Sadly, one in four pregnancies result in miscarriage.

2. What is a recurrent miscarriage?

• According to the Royal College of Obstetricians and Gynaecologists (RCOG), recurrent miscarriage affects 1 in 100 women and is defined as three or more early miscarriages, which do not have to occur consecutively—you may have healthy pregnancies in between.

• The European Society of Human Reproduction and Embryology (ESHRE) suggests that recurrent pregnancy loss could be diagnosed after two or more pregnancy losses.

3. What are the possible causes of recurrent miscarriage?

Many factors can contribute to recurrent miscarriage. Often, it is a combination of factors, and in some cases, the cause remains unknown.

General:

• Women over 35 years, with risk significantly increasing after 40 years
• Being overweight, obese, or underweight
• Previous miscarriages
• Smoking, excessive alcohol, or caffeine consumption
• Use of recreational drugs
• Family history of pregnancy losses
• Chronic stress (linked to miscarriage but not a direct cause)

Conditions affecting the uterus (womb) or pelvis:

• Fibroids (can distort the womb cavity and impact implantation)
• Endometriosis & Adenomyosis
• Uterine septum or other congenital uterine anomalies such as heart-shaped womb
• Intrauterine adhesions (Asherman’s syndrome) – scar tissue inside the womb cavity
• Cervical weakness (incompetent cervix)
• Endometritis (chronic inflammation of the womb lining)

Clotting disorders & immune system issues

• Antiphospholipid Syndrome (APS) (linked to abnormal blood clotting, affecting placental function)
• Inherited Thrombophilia (causes increased blood clotting risks)
• Increased Natural Killer (NK) cells (controversial, but some studies suggest they may play a role)
• Autoimmune disorders (anti-nuclear antibodies, Th1/Th2 imbalance)

Genetic factors:

• Chromosomal abnormalities (aneuploidy) in the embryo – a leading cause of early miscarriage
• Parental chromosomal abnormalities (Balanced translocations)

Hormonal & Metabolic disorders

• Thyroid disorders (hypothyroidism, hyperthyroidism)
• Polycystic Ovary Syndrome (PCOS)
• Poorly controlled diabetes
• Vitamin D deficiency
• Anaemia
• High Prolactin levels

Sperm related causes

• High sperm DNA fragmentation – Associated with a higher risk of miscarriage, even with normal sperm count and motility

For more in-depth details on the causes of miscarriage, visit: Tommy’s Research on Recurrent Miscarriage.

4. What tests are recommended after recurrent miscarriage?

At JIVA Fertility, we offer comprehensive investigations to identify any underlying causes.

Diagnostic Tests for Recurrent Miscarriage

• Blood Tests – To assess clotting disorders (APS, thrombophilia), hormonal imbalances, immune factors, and genetic abnormalities.
• Genetic Testing (Karyotyping) – In some circumstances, checks for chromosomal abnormalities in both partners.
• Pelvic Ultrasound (including 3D assessment) – To evaluate womb and pelvic health
• Hysteroscopy – A detailed camera examination of the womb to check for fibroids, intrauterine adhesions, or endometrial polyps.
• Semen analysis with DNA fragmentation test – To assess sperm quality and its role in miscarriage.
• In over half of the couple, no cause is found (unexplained infertility) – about 70 % of couples still go on to have a successful pregnancy in the future with supportive care.

5. What treatment options are available for recurrent miscarriage?

Lifestyle Modifications

• Achieve a healthy BMI – Weight optimization can improve pregnancy outcomes.
• Quit smoking, limit alcohol and caffeine – Reduces miscarriage risk.
• Stress management – Relaxation techniques like yoga and mindfulness may help.

Medical Treatments

• Antiphospholipid Syndrome (APS) – medical treatment with low molecular weight Heparin injections & Aspirin tablets  
• Thyroid & Diabetes Management.
• Progesterone Support – For women with a history of early pregnancy loss and early pregnancy bleeding

Surgical Interventions

• Hysteroscopic Surgery – Removal of fibroids, polyps, uterine septum, or adhesions.
• Cervical Cerclage – A stitch placed in the cervix to prevent late miscarriage in women with cervical weakness.

For a personalised approach, our JIVA Fertility team will tailor treatment options based on your test results and pregnancy history and you will receive appropriate advise as some treatments are not available through our clinic.

6. What happens at my first appointment at JIVA Fertility?

After booking your appointment at the JIVA Fertility Recurrent Miscarriage Clinic, you will receive a patient introduction pack, which includes:

• A detailed patient questionnaire – Helps focus the consultation on your specific concerns.
• Recurrent Miscarriage Patient Information Leaflet
• Information on consultation fees

We encourage both partners to attend the consultation, as this helps us evaluate all potential contributing factors.

Your 60-minute consultation includes:

• Comprehensive Medical History Review – Discussing previous miscarriages, lifestyle, and previous tests.
• Detailed Pelvic Ultrasound Scan, including:
• 3D assessment of the uterus
• Endometrial lining evaluation
• Detection of uterine anomalies or adhesions
• Fallopian tube assessment (hydrosalpinx detection)
• Ovarian reserve evaluation via Antral Follicle Count (AFC)
• Discussion of further investigations and treatment options
• Follow-up appointment for reviewing test results and finalizing treatment plans

7. What happens next?

• If no specific cause for miscarriage is identified, we provide reassurance and guidance on future pregnancy success rates, using prediction models to support decision-making
• We offer early reassurance scans from 6 weeks onwards for future pregnancies.
• If investigations reveal an underlying cause, we will discuss further testing or treatment options tailored to your needs.

For additional information on miscarriage and recurrent pregnancy loss, visit Tommy’s Research on Recurrent Miscarriage.

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At JIVA Fertility, we are committed to providing expert medical care, emotional support, and tailored treatment plans to help you achieve a successful pregnancy.