Recurrent miscarriage treatment: reducing and preventing recurrent miscarriages
In this blog post, we provide a thorough explanation of what the potential causes of recurrent miscarriages often are, as well as guidance on the treatments available.
What is recurrent miscarriage?
Recurrent miscarriage has no agreed definition but in the UK, it is generally considered to be a loss of three or more pregnancies in your first or second trimester. Often in recurrent miscarriage, a pregnancy loss occurs in the first 12 weeks.
Going through recurrent miscarriages can be emotionally and physically distressing, often leaving you confused as to why it keeps happening.
In some cases, testing can uncover an underlying reason for recurrent miscarriage. However, there are times when no underlying cause can be found.
Why do recurrent miscarriages happen?
There are several reasons why you might experience recurrent miscarriages. Here are some of the main factors that can influence your risk:
Your age – the older you are, the higher your risk of having a miscarriage.
Being overweight – having a body mass index of more than 30 can raise your risk of a recurrent miscarriage.
Past miscarriages – if you have had miscarriages previously, you could have a higher risk of having another in the future.
Embryo abnormalities – abnormalities can be caused due to genetic or chromosomal issues within the embryo, increasing your risk of miscarriage. This may be the most common cause of singular miscarriages but it is a less common cause of recurrent miscarriages.
Immunity abnormalities – an autoimmune disorder called antiphospholipid syndrome (APS) causes an increased risk of blood clots, leading to pregnancy complications and recurrent miscarriages.
Around 15 in every 100 women who have recurrent miscarriages have APS in their blood, compared to less than 2 in every 100 women in a full-term pregnancy. APS is thought to cause your immune system to behave abnormally towards an embryo (an alloimmune reaction) and cause a miscarriage.
Weakened cervix – the entrance to your uterus (cervix) can open too early in pregnancy, leading to a miscarriage.
Polycystic ovary syndrome (PCOS) – thought to be caused by a hormonal imbalance, PCOS is a condition where your ovaries become slightly enlarged and develop more small follicles (the eggs that develop in the ovaries) than normal. While not a direct cause of recurrent miscarriage, many women with polycystic ovaries have higher levels of male hormones in their bodies which could contribute to an increased risk of miscarriage.
Uncontrolled diabetes or thyroid disorders – these conditions can increase your risk of recurrent miscarriage if left untreated and unmanaged.
It's important to remember that even if you have one of these risk factors, that does not necessarily mean it's the underlying cause of your recurrent miscarriage or will impact your likelihood of a successful pregnancy.
Treatments for recurrent miscarriage
Treating recurrent miscarriages can reduce and prevent further miscarriages. However, this treatment will need to be tailored to your specific circumstances and take your health into consideration.
Factors that need to be considered before undergoing recurrent miscarriage treatment include:
Your previous miscarriages
Results of any fertility testing you have undergone
Your medical and family history
There is not one treatment that works for all women and there is no guarantee that treatment will work. However, new research suggests that a combination of different treatments can be effective.
Folic acid is a synthetic version of folate (a vitamin also known as B9). Folate promotes the production of healthy red blood cells and is essential during pregnancy. Folic acid supplements can help your baby's brain, skull and spinal cord develop properly and prevent developmental conditions such as spina bifida from occurring.
Taking folic acid a day three months before conception and until your 12th week of pregnancy could reduce your chances of miscarriage. One study found that an increased intake of folate from supplements reduced the risk of miscarriage by 50% – 60%.
Progesterone (cyclogest pessaries)
Progesterone is a hormone that supports your menstrual cycle and the early stages of pregnancy. Produced in your ovaries, progesterone causes the lining of your womb to grow, supports the implantation of a fertilised egg and may help reduce your risk of miscarriage.
The PRISM study was a clinical trial carried out in 48 hospitals across the UK. Over 4,000 women who bled during early pregnancy took part and researchers found that taking 400mg progesterone pessaries (a tablet which you can insert into your vagina) reduced the number of miscarriages. However, it seemed to be more effective in women who had already experienced miscarriages.
If you are experiencing recurrent miscarriages, progesterone pessaries may be recommended when you become pregnant to lower your risk. Cyclogest vaginal pessaries are a type of progesterone supplement used to reduce the risk of recurrent miscarriage. This treatment is provided until your 12th week of pregnancy.
Prednisolone is a type of steroid that is often used to manage conditions including allergies, skin conditions, inflammation and infections.
Prednisolone works as an immunosuppressant (a medication that stops your immune system from attacking healthy cells by mistake) so it can be useful in women experiencing recurrent miscarriage caused by an alloimmune reaction. You will typically begin taking prednisolone once you have a positive pregnancy test and will stop at 12 weeks.
Clexane (blood thinner)
Clexane is an anticoagulant (blood thinner) that can be used to treat recurrent miscarriage. If there is a high risk that your blood can become too thick, clots can form in the embryo or placenta, increasing your risk of miscarriage. Taking Clexane can help reduce this risk as it thins your blood and prevents clotting.
You will need to continue taking Clexane until you're told to stop.
Low doses of aspirin could help recurrent miscarriage caused by APS. This treatment could increase your chances of a live birth from 1 in 10 to 7 in 10. However, you will need to be carefully monitored during pregnancy due to being at a potentially higher risk of pre-eclampsia (a condition that causes high blood pressure and liver and kidney problems) and premature birth.
Do not take aspirin unless it has been prescribed to you as it may increase your risk of miscarriage.
Get in touch with the Bristol Centre for Reproductive Medicine
As one of the longest-serving fertility clinics in Bristol, we understand the complexities of recurrent miscarriages and the impact they have. Our expertise can provide you with the support you need during this challenging time.
If you're trying to overcome recurrent miscarriages, get in touch with our supportive team today. We can work together to offer support from the very beginning and give you the best chance of a successful pregnancy.