Investigating recurrent miscarriage in London

The loss of a pregnancy before 24 weeks is known as a miscarriage, and if it happens in the first 3 months it’s defined as an early miscarriage. Unfortunately, early miscarriages are extremely common with 10-20% of pregnancies ending in this way. 

If you experience two or more miscarriages in the first 12 weeks of pregnancy, it’s defined as recurrent miscarriage. Sadly, they are not uncommon, and affect around 1 in 100 women. Recurrent miscarriages can be hard to process, so it’s important to get as much support as you can at this time, and explore all the necessary investigations to try and establish a cause.

There are many different factors that can cause or increase the risk of recurrent miscarriage. They may include:  

• Chromosomal abnormalities: These are responsible for more than 50% of early pregnancy loss. Chromosomes are clusters of DNA, containing instructions for the development of the embryo. If there are too few or too many chromosomes as the embryo divides and grows, or if there are structural abnormalities, it can lead to miscarriage.
• Blood clotting disorders: These are rare, but conditions such as antiphospholipid syndrome or systemic lupus make your blood more likely to clot and can be a cause of recurrent miscarriage.
• Hormonal imbalances: Having too many or not enough of certain hormones in your body may make recurrent miscarriage more likely. Diabetes, thyroid problems and PCOS have been linked to this, therefore it’s important that they are diagnosed and properly managed.
• Shape of your uterus: An abnormally shaped uterus can be a risk factor for recurrent miscarriage. We can diagnose this with an advanced 3D ultrasound. 
• Immune system: During your pregnancy your immune system changes to help protect the baby. However, recurrent miscarriage has been linked to problems with the way in which the immune system responds. However, this is a relatively under-researched area at the moment.
• Chronic endometritis: This is a long-term inflammation of the lining of the womb, and can be a risk factor in recurrent miscarriage. Luckily, once identified, it can usually be treated with a course of antibiotics.
• Sperm DNA fragmentation: Men with a high percentage of sperm with broken DNA can increase the risk of miscarriage. A DNA fragmentation test with a sperm sample is used to determine if this is the case.

Unfortunately there may be no obvious cause of your recurrent miscarriages, and it’s possible that each loss had a different reason. Testing doesn’t always provide the answers, and 50% of all recurrent miscarriages have no given cause. 

It can be hard to accept the loss from unexplained recurrent miscarriages. However it might be helpful to know that there are changes you can make yourself to reduce the chances of it happening again. Sometimes, with fertility treatment and guidance from your specialist, it is possible to continue your journey towards parenthood. 

Some factors are linked to a greater risk of miscarriage, but they are not definitive causes. Many women who have an elevated risk will go on to have a successful pregnancy.

Risk factors include: 

• Smoking
• Excessive alcohol or caffeine intake 
• A previous miscarriage: This slightly increases your risk of having another. However, if you’ve had a baby after a miscarriage this decreases your risk of another miscarriage.
• Age of both parents: The risk of recurrent miscarriage increases as the biological parents get older. The number and quality of the eggs decrease as women get older and there are more problems with the chromosomes in sperm as men age.
• A poor diet

It’s important to note, however, that many older parents or those who have experienced past miscarriages go on to have children. Our team of specialists can work with you on any treatments or lifestyle changes you might need to give you the best foundation possible for a future pregnancy.

Our private London clinic offers comprehensive testing to try and identify the cause of your recurrent miscarriage. This includes detailed 3D and 4D pelvic ultrasound and HyCoSy scans to assess: 

• Endometrial lining 
• Presence of any uterine anomalies and adhesions
• Ovarian reserve 

We provide comprehensive blood tests which check the following: 

• Hormone levels after your most recent miscarriage
• Thyroid function
• The presence of any clotting disorders 

Other tests we offer, depending on the results of the standard tests we carry out can include:

• Sperm DNA fragmentation tests 
• Microbiome testing of the lining of the womb

It’s natural to feel like you want to do everything you can to understand the reasons for your recurrent miscarriages. Having the full range of tests will help you gain as much accurate information as possible, and we can work alongside you to create a plan to ensure the safest pregnancy possible in the future.

After a full investigation of the potential causes of your recurrent miscarriage, there may be a range of further tests, fertility treatments or lifestyle options that could enhance your chances of having a baby. These can include: 

• Specific lifestyle changes: This includes tailored advice for men and women. For example, increasing the amount of fruit and vegetables is known to be particularly important. For men, there is evidence that taking protein supplements can decrease sperm quality, so eliminating these can be a good idea.
• Supplements: Folic acid, vitamin D, zinc and selenium for men can increase chances of a healthy pregnancy. 
• Treatment for hormonal imbalances: Getting any underlying conditions such as diabetes or thyroid issues under control with medication can significantly help.
• Progesterone pessaries: These can help support early pregnancy.
• IVF with genetic testing (PGT-A): Pre-implantation genetic testing for aneuploidy (PGT-A) involves screening your embryos before implantation and ruling out those with chromosomal abnormalities. This may help reduce the risk of miscarriage. 

The best way to feel empowered and enhance your fertility is to work closely with our fertility specialist, who can provide expert advice around investigations and the most appropriate approach to increase your chances of a healthy pregnancy.

Whether you have had one or more miscarriages, we are here to offer you support and expertise. We have huge experience in investigating recurrent miscarriage and in advanced fertility investigations. 

You will be seen by our fertility specialist, Mr Venkatesh Subramanian, Senior Consultant in reproductive medicine at King's College NHS Hospital, and one of the UK’s leading experts in infertility investigation, assisted reproduction, and the use of advanced ultrasound technology. 

We provide the following services as part of a comprehensive investigation and follow-up for recurrent miscarriage: 

• A detailed consultation, with plenty of time for a review of your full medical and miscarriage history
• Advanced 3D transvaginal pelvic ultrasound 
• Comprehensive blood tests
• Further specialist investigations if needed
• A bespoke and holistic treatment plan

You will also be offered early ultrasound scans for any future pregnancies to screen for any abnormalities and provide reassurance from 6 weeks onwards.