Treatments

Here at the BCRM recurrent miscarriage clinic, we are able to offer advanced, cutting edge treatment options to cover a wide spectrum of causes of repeated pregnancy loss

The suggested treatment will be individualised and based on your medical history as well as the initial test results. Some of the treatment options we may discuss and advise for you include the following:

• Serial early pregnancy reassurance scans
  • The first 12 weeks of a pregnancy can be a hugely distressing time for couples who have experienced previous pregnancy loss. It is well known, that for patient with recurrent pregnancy loss, having access to regular early ‘reassurance’ scans not only reduces the psychological and emotional burden for these couples, but critically there is some evidence to suggest it may be associated with a reduced risk of miscarriage in that pregnancy
• Supplementary Progesterone
  • Progesterone is essential for the establishment and maintenance of a pregnancy and low levels of progesterone in the early stages of pregnancy is associated with an increased risk of miscarriage. You may therefore be advised to take additional progesterone in future pregnancies to reduce the risk of a subsequent miscarriage

• Low molecular weight Heparin
• • This blood thinning medication helps to reduce the risk of miscarriage if there is suspicion or confirmation of a condition that causes ‘sticky blood’. It may also be beneficial for some couples in whom there is no other cause for miscarriage found as it also has an anti-inflammatory affect
• Immunotherapy
  • There is increasing evidence and understanding that the immune system plays a big part in the very early stage of a pregnancy. As half of the genetic material of an embryo has come from the male partner, it is important that the mothers immune system is welcoming of a new embryo rather than considering it to be hostile, which may provide an explanation for some early pregnancy loss. Here at the BCRM recurrent miscarriage clinic, we are able to offer a variety of advanced and cutting-edge treatment options if there is thought to be an immune basis for your miscarriages. The following are some of the immunotherapy options that are available and can be discussed in more detail at your consultation:
• Prednisolone
  • Prednisolone is a steroid based medication. It works by acting as an immunosuppressant (dampening down your immune system) as well having a strong anti-inflammatory (reducing inflammation) effect. It may be used therefore in patient with an underlying inflammatory condition but can also reduce your risk of miscarriage if there is thought to be an immune cause such as high natural killer cells
• Anti-TNF drugs
  • This treatment is with biological medicine and are already used commonly for many conditions, mostly rheumatological conditions, for their anti-inflammatory affect through suppression of the immune system. Evidence suggests treatment with these medications in patients with a history of subfertility or recurrent miscarriage who have hight TNF levels (see tests) can improve the chance of an ongoing pregnancy.

• Intravenous Immunoglobulin (IVIG)
  • Immunoglobulins are antibodies which are made by the immune system. IVIG treatment works by preventing the body from attacking itself i.e dampening the immune systems response to pregnancy. Studies have shown that immunoglobulins can reduce the Th1/Th2 ratio in patients with recurrent miscarriage as well as reducing the levels of peripheral natural killer cells. As such, immunoglobulins can be used to reduce the risk of miscarriage in patients with recurrent miscarriage
• Intralipid
  • Intralipids are a fat emulsion sometimes used as a nutrional supplement. In the context of recurrent miscarriage, intralipids can be used in patients with abnormal natural killer cell activity and is a potential treatment option in recurrent miscarriage
• G-CSF
  • G-CSF is a molecule that is involved in the production of certain immune cells in the body. Studies have suggested that G-CSF plays a role in preventing miscarriage. It has been found to be in lower levels in the pregnancy tissue of patients with recurrent miscarriage and low levels are associated with a reduction in implantation. G-CSF has been found to reduce the risk of miscarriage in patients with recurrent pregnancy loss in whom there is no other cause of pregnancy loss
• Endometrial scratch
  • In some patients with recurrent miscarriage, it is possible that the lining of the womb (endometrium) is not receptive or welcoming for a new embryo. Endometrial scratch is a test whereby a small tube is used to gently scrape the endometrium through the neck of your womb (cervix). Studies have shown that this can stimulate the endometrium to become more receptive to an embryo, resulting in a reduced risk of miscarriage
• IVF with PICSI
  • PICSI is Physiological Intracytoplasmic Sperm Injection, an advanced form of IVF. This new and advanced treatment technique can reduce the risk of miscarriage in couples where there is evidence of a high rate of sperm DNA damage. See https://www.fertilitybristol.com/is-picsi-a-new-hope/ for more information
• IVF with PGS
  • Link to BCRM PGS page https://www.fertilitybristol.com/pgs/
• Hysteroscopy
  • This is a camera test whereby a small camera passes through the neck of your womb to look more closely at the lining of your womb. We are able to offer this at the BCRM recurrent miscarriage clinic if we suspect that there may be a reason for your miscarriages relating to the womb lining, such as scar tissue or polyps in the womb lining