What is recurrent miscarriage?
There is no universally agreed definition of recurrent miscarriage. Conventionally in the UK, recurrent miscarriage has been considered to be the loss of 3 or more pregnancies in the first or second trimester of pregnancy. Most often, this is recurrent pregnancy loss before 12 weeks of gestation
However, there is increasing recognition that you may be at increased risk of miscarriage in future pregnancies after 2 miscarriages. The European Society for Human Reproduction and Embryology define recurrent miscarriage as the loss of 2 or more pregnancies for example
What causes recurrent miscarriage?
There are many reasons why someone may be at increased risk of having a miscarriage. Often it is a cumulative effect of more than one of the below.
Risk factors for miscarriage:
- Being older i.e. over 35 years
- Being overweight, BMI > 30
- Number of previous miscarriages
- Smoking, alcohol, caffeine consumption and taking drugs
- Family history of pregnancy losses
Abnormalities of the womb:
- Uterine septum
- Cervical weakness
- Inflammation of the womb lining
- Antiphospholipid syndrome
- Thrombophilia (sticky blood)
- Balanced translocations (abnormality with parent)
- Aneuploidy (abnormality with fetus)
- Thyroid disorders
- Poorly controlled diabetes
- Auto antibodies
- Increased natural killer (NK) cells
- Anti-nuclear antibodies
- HLA typing
- Coeliac testing
- Th1/Th2 imbalance
Sperm related problems:
- Sperm DNA fragmentation
- Reactive oxygen species
Would I benefit from an appointment at BCRM ?
Losing a pregnancy can be a hugely upsetting and distressing life event. Sadly, miscarriage is not uncommon, but this doesn’t make it any easier to understand or process. You may feel you want to do everything you can to try and understand why you had a miscarriage and to reduce the chance of a miscarriage in future pregnancies.
We know that the risk of miscarriage increases with the number of miscarriages you have had previously. We also know that often the risk of miscarriage in a pregnancy can be the result of many small risk factors and in these situations some simple advice and lifestyle modification can improve your chances in a future pregnancy.
Whether you have had one miscarriage or many more, an appointment at the BCRM recurrent miscarriage clinic will ensure there is no clear reason for your loss and more importantly, provide you with reassurance and guidance in taking the brave step towards your next pregnancy with confidence. This model and approach to miscarriage management is being increasingly encouraged by experts in miscarriage management across the globe.
Furthermore, as the longest serving fertility clinic in Bristol, we have developed experience and expertise in advanced miscarriage and fertility investigations and treatments such as specialist psychological support, 3D ultrasound scanning, leading hysteroscopic procedures, immunomodulation and Pre-implantation genetic screening . As a result, we are able to take a holistic approach to your care ensuring we are able to offer support and treatment for every facet of your care needs
It is for these above reasons, that we would welcome any patient with a history of one or more miscarriages to our clinic, so that we can work together to give you the best chance of the outcome you want from a future pregnancy.
What will happen at my first appointment?
After making an appointment to be seen in the recurrent miscarriage clinic you will be sent a patient introduction pack. This will include the following:
- the Recurrent Miscarriage Patient Information leaflet
- An invitation to the BCRM Patient Portal
- A patient questionnaire specifically for recurrent miscarriage patients
- Charges information
Please ensure that you complete the patient questionnaire prior to your appointment and bring this with you or return by email for upload to your patient record. This is important as it will allow more time during your consultation to focus on your individual circumstances.
You will have a 1-hour appointment with Mr Kamali or a member of the team which will include the following:
- A detailed and comprehensive review of your miscarriage history
- A detailed 2D pelvis ultrasound scan assessing:
- The endometrial lining
- Presence of uterine anomalies and intrauterine adhesions
- Evidence of damaged tubes
- Ovarian reserve in the form of antral follicle count (AFC)
- A recommendation on further testing, investigations or treatments based on your clinical history, blood tests and scan
What happens next?
What happens after your first appointment will depend on your history, scan and initial blood tests. Often, there is not thought to be a reason for your history of miscarriage. In this situation, we may provide reassurance and support for your next pregnancy.
You will also be offered early reassurance scans for any future pregnancy from 6 weeks onwards.
If it is felt that there may be an underlying cause for your miscarriages, possible further testing and investigation will be discussed, offered and agreed with you. In most instances we would then suggest you return for a follow up appointment to review the results before agreeing a final treatment plan
We would also advise that you attend your first appointment with your partner when possible so that we can avoid the need for any unnecessary follow up visits as well as ensuring all relevant information has been considered in providing advice, recommendations and support for you both before your next pregnancy.