Recurrent miscarriages: what can be done?

In the New Zealand public health system, an investigation into reasons for miscarriage will only happen after a couple has experienced three consecutive early pregnancy losses. For many, this means forging on in silence for many years without support.

Opening up about recurring pregnancy loss

In some circles, miscarriage can feel like a taboo subject but, for those who have lost a pregnancy, the feelings of anguish and grief are no different to those experienced after the loss of any other family member. If it occurs again, these feelings often compound, added to by anxious thoughts of potential further losses and fear that bringing a pregnancy to full term may not be possible.

Along with reaching out to family, friends, or mental health professionals to open up about such feelings, a medical investigation into possible reasons for recurring early pregnancy loss can help to restore hope. In the place of silence, action can be a great salve for those in grief. From a medical perspective, these actions may also help to prevent further losses.

At what point should an investigation be done?

Around 1 in 50 couples experience two miscarriages in a row, and half of those will suffer from three consecutive early pregnancy losses. Unfortunately, the New Zealand public health system will only investigate potential reasons after three consecutive losses (even though most women’s health organisations around the world recommend investigations occur after two). In private practice, women can opt to have these investigations carried out at any time and will have more robust follow up if an issue is highlighted. For older women wanting to conceive, time may well be of the essence.

"While it is often difficult to ascertain the reasons for a miscarriage, many are predetermined from early in the pregnancy due to factors within the embryo."
- Dr Greg Phillipson

What does an investigation entail?

Your doctor will order blood tests that check for genetic abnormalities and conditions, including testing for parental chromosomes, lupus, anticardiolipin antibodies, and thyroid function. Usually, a 3D ultrasound will be taken to rule out a septum or fibroid, which could be interrupting implantation of the embryo. For many couples, there will be no obvious reason for the losses.

Pre-pregnancy

Because a woman’s health and wellbeing before conception can affect her baby’s health and development, there are lifestyle factors to consider before becoming pregnant. The Planning for Pregnancy guide by RANZCOG walks through some steps for optimising health, to give the best chance of a healthy pregnancy and baby.

Women can also undergo some testing prior to starting their pregnancy journey. This involves testing blood count and groups and checking if vaccinations are up to date, and may include testing for chromosomal and genetic conditions, which in some cases can cause miscarriage. Most women will undergo a check for diabetes during their pregnancy. In some cases altered resistance to blood sugar indicated through these tests can point to an increased risk of miscarriage.

Women who have had problems with excessive bleeding in the past may be at a higher risk of miscarriage, and this can often be determined by blood tests. There are certain illnesses that can carry a risk factor and many of these are treatable, so in these cases miscarriage may be avoided through testing and treatment.

What can cause early pregnancy loss?

“While it is often difficult to ascertain the reasons for a miscarriage, many are predetermined from early in the pregnancy due to factors within the embryo,” says Dr Greg Phillipson, gynaecologist and fertility specialist with Certification in Reproductive Endocrinology and Infertility (CREI). “It’s often to do with genetic makeup of the sperm, or a silent infection that has gone undiagnosed, making implantation difficult.”

Endocrinological testing, which looks into hormonal factors, can help determine if a course of hormone treatment would help a couple to carry a pregnancy through to full term. For those with a risk factor of miscarriage, a course of progesterone can be prescribed to help reduce the risk.

Age can be a factor too, with the risk of miscarriage increasing as couples grow older. Lifestyle factors will sometimes play a part also, such as smoking, alcohol and excessive caffeine consumption. It is worth highlighting though that we do hear those who have experienced a miscarriage blaming it on too much exercise or working too hard. Exercising, playing sports or experiencing stress does not cause miscarriage.

When should you try again?

The short answer is: when you are ready. It is incredibly important to acknowledge the emotional toll of your experiences and to talk about it as much as possible. If you know someone who has experienced a miscarriage, telling them to rest or have a holiday is not helpful. Grief can present as a whole range of feelings, from anger to sadness or hopelessness, and should be given the time and support to work through these emotions. Trying again is as much a head game as it is a physical undertaking, so both partners should feel ready. If there are any health factors, these should also be resolved prior to resuming the pregnancy journey.

If you have experienced miscarriage, and are concerned, a gynaecologist can help. We will be able to rule out possible causes and create a plan to reduce the risk of future losses as much as possible. There are also many options available to people wanting to achieve pregnancy these days – we can walk you through them.