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Recurrent Miscarriage FAQ

RM FAQ

What is a recurrent miscarriage?


When a miscarriage happens three or more times in a row, it is called recurrent miscarriage. Recurrent miscarriage affects 1 in 100 (1%) couples trying to have a baby.




What service do you offer at P4 fertility for recurrent miscarriages? What can you do for recurrent miscarriage?


This service is for private patients or eligible insured patients. You may refer yourself to our dedicated recurrent miscarriage clinic, or your doctor can refer to using the above link (Link). Please comment recurrent miscarriage clinic on referral and bring all your test results for the consultation. P4 consultant will personalise the plan for further tests and management. New research has highlighted various causes for multiple miscarriages. At P4 fertility, we analyse tests and arrange the treatment plan for the next pregnancy, including a tailor-made plan for medications and ultrasound scanning schedule. When you find yourself pregnant, we will offer you early pregnancy scans and an ongoing program of appointments. We have a unique approach to managing recurrent pregnancy loss with personalised care for the patient along with counselling support where necessary by our dedicated team. Recurrent Miscarriage clinic is not designed to handle gynaecological emergencies. Your care within NHS will be routine, and our service is additional support with tailor-made treatment for you.




What is a miscarriage? What week is the highest risk of miscarriage?


If you lose a baby before 24 weeks of pregnancy, it is called a miscarriage. If this happens in the first three months of pregnancy, it is known as an early miscarriage. Unfortunately, early miscarriages are common, with 10–20 in 100 (10–20%) pregnancies ending this way. Late miscarriages, after three months of pregnancy but before 24 weeks, are less common: 1–2 in 100 (1–2%) pregnancies end in a late miscarriage. Miscarriages could be broken down into two categories. The first, sometimes called "sporadic" or "spontaneous" miscarriage, refers to when women lose one or two pregnancies in a row and the second category is a recurrent miscarriage.




What causes miscarriage?


The majority of sporadic or one-off miscarriages are due to unpreventable chromosomal abnormalities. Chromosomes are building blocks of cells. In many cases, a new embryo will have more or fewer than the 23 chromosome pairs it’s meant to have. It's nature's mechanism to miscarry those embryos, which are not destined to develop into a healthy foetus. The risk for chromosomal abnormalities goes up as woman age. The quality of a man's semen also seems to play a role. Many other medical factors can cause miscarriage. Sometimes it is not possible to find out the cause for a miscarriage.




What could be the cause of repeated miscarriages? What causes multiple miscarriages? Why does recurrent miscarriage happen? Why do I have repeated miscarriages?


Sometimes there is a reason found for recurrent and late miscarriage. In other cases, any underlying problem is not found. Most couples are likely to have a successful pregnancy in the future, mainly if test results are normal. Several factors may play a part in causing recurrent and late miscarriage: • Age: The older you are, the higher your risk of having a miscarriage. If the woman age is over 40, more than 1 in 2 pregnancies end in a miscarriage. Miscarriages may also be more common if the father is older. • Antiphospholipid syndrome (APS): APS (a syndrome that makes your blood more likely to clot) is uncommon but is a cause of recurrent miscarriage and late miscarriage. • Thrombophilia: Thrombophilia is an inherited condition in which your blood is more likely to clot. It may cause recurrent miscarriage and late miscarriages. • Genetic factors: In about 2–5 in 100 couples (2–5%) with recurrent miscarriage, one partner will have an abnormality on one of their chromosomes. Chromosomes are the genetic structures within our cells. Although this may not affect the parent, it can sometimes cause a miscarriage. • Weak cervix: Weakness of the cervix is known to be a cause of miscarriage from 14 to 23 weeks of pregnancy which can be challenging to diagnose when you are not pregnant. It may be suspected if in a previous pregnancy, your waters broke early, or if the neck of the womb opened without any pain. • Developmental problems of the baby: Some abnormalities of the baby may lead to a miscarriage but are unlikely to be the cause of recurrent miscarriage. • Infection: Any infection that makes you very unwell can cause a miscarriage. Milder diseases that affect the baby can also create a miscarriage. The role of infections in recurrent miscarriage is unclear. • The shape of the uterus: It is not clear how much an abnormally shaped uterus contributes to recurrent miscarriage or late miscarriages. However, minor variations do not appear to cause miscarriage. • Diabetes and thyroid problems: Diabetes or thyroid disorders can be factors in miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control. • Immune factors: It has been suggested that some women miscarry because their immune system does not respond to the baby in the usual way. It is known as an alloimmune reaction. There is no clear evidence to support this theory at present. Further research is needed.




Does caffeine consumption or coffee cause miscarriage?


There's no reason to think a cup or two of coffee could trigger a miscarriage. A little caffeine is safe. It's more challenging to know if pounding cup after cup of coffee all day long could be harmful. But even then, caffeine's links to miscarriage are uncertain. Excessive alcohol, smoking and obesity are risk factors for miscarriages.




Does stress cause miscarriage?


Stress: a very significant emotional trauma such as suffering the loss of a parent or loved one could add to the risk of miscarriage. But run-of-the-mill stresses from work or busy home life are not going to lead to a lost pregnancy.




Can the wrong sperm cause a miscarriage?


The quality of a man's semen may play a role. Poor sperm quality can be the cause of miscarriage in about 6% of couples.




Why are investigations helpful? What studies do you advise?


Finding out whether there is a cause for your recurrent miscarriage or late miscarriage is essential. We will be able to give you an idea about your likelihood of having a successful pregnancy. There may be treatment available to help you. At P4 fertility Recurrent Miscarriage service, we extensively investigate for all possible causes for recurrent miscarriages and tailor the treatment for you. We collect the previous investigations results from you; we have structure history sheet to pay attention to every clinical detail. Following your assessment, we recommend a personalised investigation plan for you. It includes blood tests, scans or camera tests where necessary.




How can I prevent recurrent miscarriages? How can I stop a recurring miscarriage? What if you do not find a cause? Can I have a healthy pregnancy after two miscarriages?


If we find a cause, we offer possible treatment options along with p4 fertility recurrent miscarriage support package to improve your chance of a successful pregnancy. There is currently no evidence that heparin and aspirin treatment reduces the possibility of a further miscarriage. Women who have supportive care from during early pregnancy assessment unit from the beginning of pregnancy have a better chance of a successful birth. For couples where no cause for recurrent miscarriage has been found, 75 in 100 (75%) will have a successful pregnancy with this care. It is worth remembering that most couples will have a successful pregnancy the next time even after three miscarriages in a row.




Can folic acid prevent miscarriage?


Folic acid is a vitamin (B9). It is present in certain foods, and you can take it as tablets. If you're planning to have a baby, you must take folic acid tablets for three months before you conceive. It protects your future baby against conditions called neural tube defects, such as spina bifida. Few women may need a higher dose of folic acid.




What is the role of folic acid to prevent recurrent miscarriages? Does MTFTR mutation cause recurrent miscarriage?


Recurrent miscarriages and neural tube defects are potentially associated with MTHFR. The Genetic and Rare Diseases Information Centre says studies suggest that women who have two C677T variants are at an increased risk of having a child with a neural tube defect. Though there's little evidence to support it, some doctors suggest taking blood clotting medications. We may recommend extra folate supplementation. At P4 fertility, we plan personalised care with the support of the latest available research. To discuss your condition, please book an appointment. Read more about MTFTR at the link (FAQ).





MTFTR FAQ

What is MTHFR?


The abbreviation “MTHFR” stands for methylenetetrahydrofolate reductase. A genetic mutation may lead to high levels of homocysteine in the blood and low levels of folate and other vitamins. There’s been a concern that certain health issues are associated with MTHFR mutations.




What are the types of MTFTR mutation?


You can have either one or two mutations — or neither — on the MTHFR gene. These mutations are often called variants. A variant is a part of a gene’s DNA that’s commonly different, or varies, from person to person. There are two variants, or forms, of mutations that can occur on the MTHFR gene. Having one variant is called heterozygous which is less likely to contribute to health issues. Some people believe having two mutations called homozygous which may lead to more serious problems.




Which are the conditions proposed to be associated with MTHFR?


Conditions that have been proposed to be associated with MTHFR include: Recurrent miscarriages in women of child-bearing age Pregnancies with neural tube defects, like spina bifida and anencephaly Cardiovascular and thromboembolic diseases (specifically blood clots, stroke, embolism, and heart attacks) Depression, anxiety, bipolar disorder, schizophrenia. Colon cancer, acute leukaemia, chronic pain and fatigue, nerve pain and migraines.




Is testing for MTHFR mutations advised?


Royal College of Obstetricians and Gynaecologists UK and American College don’t recommend testing for variants unless a person also has very high homocysteine levels or other health indications.




Recurrent miscarriages and MTFTR mutation?


Recurrent miscarriages and neural tube defects are potentially associated with MTHFR. The Genetic and Rare Diseases Information Centre says studies suggest that women who have two C677T variants are at an increased risk of having a child with a neural tube defect. Though there’s little evidence to support it, some doctors suggest taking blood clotting medications. Extra folate supplementation may also be recommended. At P4 fertility, we plan personalised care with the support of the latest available research. To discuss your condition please book an appointment.





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