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JIVA Fertility

Recurrent Miscarriage

Compassionate Care for Early Pregnancy Losses or Miscarriages

JIVA Fertility is not just for individuals/couples with difficulty conceiving or infertility. Mr Harish Bhandari has clinical and research interests in Recurrent Miscarriage and will help you understand the possible reasons for your miscarriages and more importantly, provide you with the guidance and reassurance in taking the brave step towards your next pregnancy with confidence.

What is a Miscarriage or Early Pregnancy Loss?

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 and after 12 weeks as a late miscarriage. Sadly, one in four pregnancies result in miscarriage.

Other types of early pregnancy loss include ectopic pregnancy and molar pregnancy, which also happen before 24 weeks.

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.

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

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.

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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)

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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)

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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)

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Genetic factors

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

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Hormonal & Metabolic disorders

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

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Sperm related causes

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

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

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How can JIVA Fertility help?

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 tests:

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Medical Evaluation:

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

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Preconception Care:

‍We discuss optimising maternal health before further pregnancy to help reduce the risk of miscarriage and improve pregnancy outcomes.

We offer preconception counselling

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Diagnostic Tests

Based on 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

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What treatment options are available for recurrent miscarriage?

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

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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.

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Medical Treatment

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

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

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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.

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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.

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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.

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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.

What happens when I book my initial appointment at JIVA Fertility?

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

If you have opted for the Recurrent Miscarriage Assessment Package, we will arrange all the tests as highlighted in the package in preparation for your appointment. Please note that some blood tests will ideally have to be done three months after your previous miscarriage.

What happens at my Recurrent Miscarriage Assessment Package 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 Recurrent Miscarriage 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 investigation results undertaken so far
Arrange further tests as appropriate
Discuss various treatment options
Keep a plan in place for future pregnancies
A letter summarising your consultation, test results and treatment options will be sent to you

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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 have a specialist Fertility Counsellor
We encourage and support lifestyle modifications - We have a Dietician-Nutritionist to guide and support you
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 infertility) – about 70 % of couples still 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.

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Can I 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 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.

Come & Visit Us

New York, NY 10001

123 Main Street

Apt 4B

Contact: +123 456-7890

Los Angeles, CA 90012

456 Elm Avenue

Suite 300

Contact: +122 555-1212

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This site is for information purposes only and is not a substitute for medical consultation, diagnosis, or treatment. We suggest arranging a suitable specialist appointment if you wish to discuss your medical issues.