Dr Weng Chan | 14th Oct 2016
Miscarriages are a lot more common than most people think, with one in six pregnancies ending before week 20.
For women and couples experiencing miscarriage, it’s important to remember that they are not alone. October 15 is Pregnancy Loss Remembrance Day, raising awareness in the general community about the burden of miscarriage and help to reduce the stigma associated with it.
Along with the emotional toll a miscarriage can take on couples, a major source of frustration is being left with a myriad of unanswered questions. Unfortunately even in cases of recurrent miscarriages, investigations will pinpoint a cause in fewer than 50% of cases. Whilst this adds to the frustration it can also mean you are more likely to achieve a healthy pregnancy in the future.
Following are the most common questions people ask about miscarriage:
How do I know I’m having a miscarriage?
Miscarriages can present in many ways, with some women experiencing a period like pain and bleeding. For others, there may be no symptoms and the miscarriage is picked up incidentally on a routine ultrasound. In some cases, an ultrasound can pick up features that the pregnancy may not be optimal and further testing or follow-up may be required by their fertility specialist. To confirm a viable pregnancy an early dating scan is recommended. If this is confirmed, then the chance of a miscarriage occurring is greatly reduced.
My mum/sister experienced recurrent miscarriage, does that mean I will too?
As miscarriages are common, it is not unexpected that other family members may have suffered one or more miscarriages. There are numerous causes of miscarriages, depending on the individual’s and family’s medical history, the timing of conception and when the miscarriages occurred. Some of which can run in the family, sometimes it may be co-incidental.
What are the main causes of miscarriage?
The majority of miscarriages occur as a result of genetically abnormal embryos. Conditions that are also known to lead to recurrent miscarriage are blood clotting disorders; endocrine disorders; submucosal fibroids; and other structural abnormalities in the womb; as well as hormonal issues commonly seen with polycystic ovaries. In a small percentage of people, a genetic abnormality can be passed down resulting in miscarriages.
How does the woman’s age increase the risk of miscarriage?
Because women are born with a finite amount of eggs and these eggs age as we do, women over 35 face an increased risk of miscarriage as the quality of the eggs decline. By the time a woman has turned 43, there is a 50% chance a pregnancy will miscarry. With aging, there can be an increased amount of exposure to oxidative stresses which affects the DNA which makes up the important genetic material of a woman’s eggs. This affects the health and quality of the eggs and ultimately the quality of the embryo and its risk of miscarrying. It’s important to remember that no matter how healthy you are or how young you feel, this will not prevent the quality of your eggs declining with time and the risk of chromosomally abnormal pregnancies increase with age.
Does a man’s age increase the risk of miscarriage?
While a man’s age does not have the same impact on his fertility compared with women, the quality of sperm does decreases with age, especially after the age of 40 which may increase the risk of miscarriage and also infertility. In the same way that aging increase’s a woman’s eggs exposure to oxidative stresses, affecting the DNA of genetic material, so too does it affect a male’s sperm, and ultimately the quality of the embryo. The risk of miscarriage is twice as high for women whose male partner is aged over 45 than for those whose partners are under 25.
Does stress increase my chance of miscarriage?
The causes of pregnancy loss are complex and are usually due to chromosomal abnormality in the embryo, and not increased with personal or work stress, excessive exercise or travel.
How soon after a miscarriage can we try to conceive again?
Doctors generally advise giving your body the chance to have 1 or 2 periods before trying again to fall pregnant. This is also useful for dating the pregnancy. However, it is important you wait until both partners feel ready both physically and emotionally to try again. One should consult their treating doctor with regards to this depending of the circumstances leading to the miscarriage and the treatment.
What can we do to prevent miscarriage?
While there is no way to prevent a miscarriage happening, there are some controllable lifestyle factors such as smoking, drug use and obesity which are known to increase the potential for miscarriage. This also optimises one’s health from a fertility and pregnancy point of view.
There are a small percentage of people that carry a genetic abnormality, or what is known as parental chromosome abnormalities such as translocations. Embryos with unbalanced translocations usually result in a miscarriage; Pre-implantation Genetic Screening (PGS) can help improve their chances of having a healthy baby in these circumstances.
What treatments are available to avoid miscarriage occurring?
Unfortunately the management of miscarriages can be complex and the care will need to be individualised with the fertility specialist and the couple.
There are various advanced tests available to help detect the likelihood of another miscarriage and to prevent it from occurring in the future. The most common one is Preimplantation Genetic Screening (PGS) which can be included as part of an IVF cycle. PGS allows for screening of all chromosomes in a developing embryo so only the embryo/s with normal chromosomes are selected for implantation, decreasing the risk of miscarriage from an abnormal embryo.
If a submucosal fibroid or uterine septum is diagnosed as the cause of miscarriage, the removal of these may improve the chances of implantation.
What should we do if we experience multiple miscarriages?
A small percentage of couples may experience more than one consecutive miscarriage. Three or more consecutive or ‘recurrent’ miscarriages affect around 1% of couples trying to have a baby.
Couples that have experienced recurrent miscarriages should consider seeing a fertility specialist to discuss their unique situation, undergo an assessment and have a treatment plan tailored for them.
Based on individual cases, the fertility specialist may offer testing as well as early monitoring of a pregnancy with blood tests and ultrasounds. If the need arises, then early diagnosis and treatment of any issues can be expedited.
Fertility specialists with their links to specialised fertility clinics can also offer additional support for patients from experienced nurses to counsellors, whom are experienced in the care of women in the early stages of their pregnancy.