A first time miscarriage can be a very upsetting experience, but when that situation is repeated a second, third, or even fourth time, it can push a woman to the brink of despair.
One of the most frustrating aspects of recurrent miscarriage is not knowing what’s causing them. Being told to ‘just try again’ might be acceptable after a first time miscarriage, but once you've had two, three or more miscarriages, proper investigations should definitely be considered.
Here are some of the more common reasons for miscarriage:
Chromosomal abnormalities
This is widely acknowledged as the most common reason for miscarriage (up to 60 per cent of cases) and it's because of this that so many women are told to keep going. However, if you go on to have a second or indeed third miscarriage, the odds that each of the miscarriages were due to chromosomal abnormalities drop significantly. It is more likely that something else is going on, which is why any woman experiencing recurrent miscarriage needs to ensure that her case is being investigated thoroughly and that nothing has been left out.
What can be done about it?
Age is a factor for both men and women. If a woman is over 40, her miscarriage risk is about 33 per cent, which increases to 50 per cent over 45 years old. Men over 40 are at greater risk of fragmented DNA within the sperm, so this should be checked if you have had three miscarriages and nothing untoward shows up in your blood-work. You can’t do anything about your age, but you can improve your diet and lifestyle to ensure that the developing egg follicles have the best chance of proper development.
Cardiovascular problems
‘Sticky’ blood is a known cause of miscarriage as it can lead to blood clots that impede circulation to the placenta embryo. This may be screened for via blood tests to check for various blood clotting markers such as anti-phospholipid antibodies, fibrinogen, c-reactive protein or homocysteine. Genetic variants can also be implicated in blood clotting disorders. If you have a family history of stroke, migraines, dizziness or palpitations then it may be worth checking for potential cardiovascular problems in the initial round of miscarriage investigations.
What can be done about it?
You will likely be prescribed blood thinning medications such as aspirin or low dose heparin once you discover you are pregnant to prevent blood clots that could affect blood flow to the placenta. Opting for a diet high in omega 3 fats (fish oils) and anti-inflammatory foods (garlic and onion) may be helpful, but always tell your doctor if you are taking fish oil supplements as they may be contraindicated with any blood thinning medications you are taking.
Physical issues
Anatomical problems are one of the first areas to be ruled out. There are a number of different ways the physical environment around or within your womb may be affecting your chances of carrying a pregnancy to term:
- You may have had previous abdominal surgeries (C-section for a previous delivery or other surgery) that has led to adhesions or scar tissue, that could affect proper implantation of the embryo.
- You may have a congenital malformation within the uterus where it's divided (uterine septum) or a more advanced version of this (bicornuate uterus), which may be corrected with surgery.
- You may have fibroids growing within or around the uterus that could have a negative effect on carrying a pregnancy to term, as fibroids are known to grow in the presence of increased female hormone levels, especially during stimulated IVF cycles.
- For some women the cervix is more inclined to open up, instead of staying clamped shut for the duration of pregnancy, this is known as an ‘incompetent cervix’. This may sound scary, but is easily addressed with a cervical stitch in early pregnancy. It's removed when you are due to give birth.
What can be done about it?
Anatomical issues are generally treated with surgical methods. Proper recovery after surgery is imperative, so a healthy diet and lifestyle is advisable. Take time off work if necessary, ensure you get plenty sleep and keep stress to a minimum so your body has the best chance to heal and repair.
Hormonal imbalance
You could be experiencing declining oestrogen or progesterone levels, which are a common cause of early term miscarriage. Other hormonal issues to rule out would be hypothyroidism (an under active thyroid gland), insulin resistance (due to PCOS, type 2 diabetes, obesity) or adrenal hormone imbalance (DHEA and Cortisol). Blood testing is commonly recommended to assess FSH, oestradiol and progesterone levels but there are other testing methods that utilise tissue samples, such as saliva, which may be useful to detect sub-clinical hormone imbalances that don’t show up in blood tests.
What can be done about it?
You may be offered hormonal support to take throughout the first trimester to reduce the chances of miscarriage. Diet and lifestyle choices are known to impact hormonal balance, so these factors should also be addressed.
Vitamin D deficiency
This ‘wonder’ nutrient has an enormous impact on the body’s immune system and the inflammatory process, which is considered to be one of the factors that may predispose a woman to miscarriage. Ideally, get your levels tested prior to conception or as soon as you discover you are pregnant.
What can be done about it?
Vitamin D deficiency is not something that can be addressed properly through diet or even sun exposure. Supplementation is really the only way to improve blood serum levels in a short amount of time.
Sub-clinical infections
Most women will have had a smear test that screens for the common STI’s such as Chlamydia, however, few have heard of mycoplasma or ureaplasma, which are lesser known infections that can create an equally hostile environment in the uterus making it difficult for the embryo to thrive. These infections may be screened for with a cervical swab and a blood test to check whether you have made antibodies to the infections.
What can be done about it?
A course of antibiotics will be recommended for you and your partner should you test positive, to avoid any cross-contamination. Probiotic supplementation would be recommended as a follow-up to antibiotic treatment.
Immune issues
This is one of the more controversial factors thought to cause miscarriage, given the research in this area has been mixed. A specialised and expensive test known as the ‘Chicago bloods’ may be recommended to assess a woman’s natural killer cells and numerous other immune markers within the body that are suspected to increase the risk of miscarriages.
What can be done about it?
Common immunosuppressant medications such as steroids may be recommended. Other medications that may be suggested include Intralipids, which have mixed reviews but appear to have a good safety record, except for those with egg or soy allergies.
How to move on
It's so important not to lose hope in the face of repeated losses. While it may seem like all angles have been explored and ticked off the list, if you still have not been given a satisfactory explanation for why you are miscarrying then find someone who is willing to go the extra mile on your behalf.
It may turn out to be a problem that is very tricky to fix, or the solution may be quite straightforward. Either way, it’s better to know why you are miscarrying than to be left in the dark.
With almost a decade of experience in the field, Jessica Bourke has gained a reputation for helping women conceive where everything else has failed. For more from Jessica, visit jessicabourke.com.
