Despite being a relatively common experience, miscarriages can have a devastating physical and emotional effect on those involved. Dealing with the loss of a wanted pregnancy is difficult enough, but even more so when no one can explain why it has happened.
Dr Amin Gorgy, Fertility Consultant at The Fertility & Gynaecology Academy, describes the most frequent causes of miscarriage and explains what can be done to help women who are experiencing multiple miscarriages.
What is a miscarriage and how often does it occur?
Miscarriage (the loss of pregnancy before completing 24 weeks of gestation) is the commonest complication of pregnancy and it’s a heart-breaking experience.
Around 25 to 50% of women will have experienced one or more miscarriages in their reproductive life, but the risk is very much underestimated as many miscarriages are not reported. Furthermore, early pregnancy losses (before the clinical confirmation by scan or examination) are not accounted for in the above figures.
Recurrent miscarriage is an even more devastating experience for the family. In Europe, the diagnosis is usually made after 3 consecutive miscarriages.
What are the causes of miscarriage?
Age: The risk of miscarriage increases significantly with the mother’s age. Advancing maternal age is associated with a decline in both the number and the quality of the remaining eggs and hence reduced chance of conception and increased risk of miscarriage. The risk of miscarriage increases from 9% at the age of 20-24 to 75% at the age of 45. It rises steeply after the age of 35.
Previous pregnancy outcome: The risk of miscarriage increases after each miscarriage; from 15% to about 25% after two miscarriages and to 45% after three consecutive miscarriages.
History of subfertility is associated with an increased risk of miscarriage. There is high prevalence of subfertility in women with recurrent spontaneous miscarriage. This probably means that both conditions might share background pathology.
a) Maternal cigarette smoking has an adverse effect on the trophoblast (the layer of cells that nourishes the embryo) and is associated with the risk of miscarriage dependent on its frequency.
b) Caffeine consumption is associated with dose dependant risk of miscarriage particularly when the intake exceeds three cups a day.
c) Heavy alcohol consumption is toxic to the embryos and the foetus. Even moderate consumption of five units a week increases the risk of miscarriage.
d) Obesity increases the risk of sporadic and recurrent miscarriage.
Medical causes of miscarriage:
Medical causes of miscarriage include genetic abnormalities (Chromosomes), structural abnormalities of the uterus, blood clotting abnormalities (thrombophilia), endocrine abnormalities, immune system imbalance, male and psychological factors.
What are the effects of miscarriage on the body
Pregnancy is a challenge to the mother’s immune system. If the immune system does not do what is required to achieve a successful pregnancy, miscarriage might result. Miscarriage and particularly recurrent miscarriage can further upset the immune system, making it even more dysfunctional and increasing the risk of further miscarriage. That is why the risk of miscarriage increases with each further miscarriage and it becomes more difficult to achieve a successful pregnancy.
Miscarriage and particularly recurrent miscarriage increase the level of anxiety, stress and even depression. Psychological problems in turn cause more immune system dysfunction. The latter might cause further miscarriages. We need to break this vicious circuit by providing immune therapy and psychological support.
What can you do about it?
- Consult a clinic like The Fertility & Gynaecology Academy which specialises in “Recurrent Miscarriage” with a comprehensive program to cover all aspects of the problem, not just one side of it.
- Have tests that cover different causes of “Recurrent Miscarriage”, not only just one cause. As you might have noticed the different causes are inter-related particularly endocrine disorders, thrombophilia and immune system dysfunction.
- You should start the treatment, particularly the immune therapy, before you get pregnant to get the healthiest environment ready for the implantation and placenta formation. Most of the problems that will result in reproductive failure or complications start very early on in pregnancy. Many studies show that immune supportive therapy is more effective if started before pregnancy as by the time pregnancy is diagnosed the damage might have already happened.
- Learn relaxation techniques to keep your stress levels down. Discuss your worries with your doctor and a counsellor. Acupuncture could help to keep your stress level down.
About the author: Dr Amin Gorgy has been practising in the field of Fertility and Assisted Conception since 1994. He founded The Fertility & Gynaecology Academy with Dr Eskander in 2004 and is now its co-director.