Mischance of Miscarriage
The journey of fertility is a long and winding road which brings about much anxiety and stress for many couples trying to conceive. Fertility has its challenges with trying to conceive in the first place along with maintaining pregnancy. It is fair to say that for most couples that once pregnancy has been achieved, stress and anxiety continues to increase, particularly in the first trimester.
Sadly, the probability of pregnancies ending in miscarriage in the UK is estimated around 1 in 4, with most miscarriages happening in the first trimester. In this trimester, it is considered that around 80% of miscarriages are usually caused by chromosomal abnormalities, which understandably causes emotional devastation when you have been trying to conceive, no matter how long it has taken to fall pregnant.
With a high rate of 1 in 4 women suffering a miscarriage at some time in their lives, it is encouraging to know that most couples who experience this loss go on to having successful pregnancies thereafter, but what can you do to prevent miscarriage? or what are your chances of maintaining pregnancy if have been diagnosed with recurrent miscarriage? I see many couples with this condition and know only to well the mental and physical affects that miscarriages can bring with their need to understand why this has happened.
Although very difficult to take a rational approach of understanding after a miscarriage due to the emotions associated, I think it is important to have some clarity to the reasons and causes of miscarriage and most of all what you can do to prevent miscarriage prior to becoming pregnant.
Most common reasons for miscarriage
Once a miscarriage has happened, many ask themselves what could have been done to stop the miscarriage during its process, but the truth of the matter is that once a miscarriage starts there is nothing anyone can do to prevent it, as its nature’s way indicating something is wrong with the developing pregnancy and baby.
Our body provides nutrients to the developing baby during pregnancy to help with its normal development, and one of the main causes of miscarriage during the first trimester is that there is an abnormal development.
Half of miscarriages usually occur because of chromosome issues. Chromosomes carry the DNA and genetic code for cells to function which errors can occur randomly during the rapid division of foetal cells and as a result of damaged sperm or egg cells. At the time, most early miscarriages cannot always be explained in depth and unless a biopsy is taken it is difficult to the know the reason, which is why embryo testing can help. Pre-implantation genetic screening (PGS) or pre-implantation genetic diagnosis testing can be carried out to identify embryos that have chromosome issues or known genetic disorders for the prevention of miscarriage particularly for those with recurrent miscarriages or whom are carriers of specific chromosome and genetic illnesses.
However, some miscarriages can be identified and termed with the following causes,
Molar pregnancy happens when the father provides both sets of chromosomes, but there is no development of a foetus. Instead, there is an abnormal growth of the placenta.
Partial molar pregnancy is when the chromosomes from the mother remain; but the father also provides two sets of chromosomes. It is associated with placental abnormalities and growth of an abnormal foetus.
The intrauterine demise of the fetus is a formation of the embryo but it stops developing before there is a development of any symptoms of miscarriage.
Blighted ovum is where there is no formation of an embryo. This is one of the reasons for early miscarriage.
Although a miscarriage cannot be predicted there are several factors that may increase the likelihood of miscarriage in women.
Long Term Health Conditions
The health of the mother to be able to carry and nurture for 9 months is an important factor to ensure of a continuous and healthy developing baby. Unfortunately miscarries that happen around 20 weeks of pregnancy are usually due to long-term health conditions, which is why the health of you as a mother is so important and that you do as much as you can to be healthy prior to starting to conceive. Health conditions such as diabetes, thyroid disease, heart disease, high blood pressure, antiphospholipid syndrome (sticky blood) as well as kidney disease all put you at a higher risk of miscarriage. But, managing your long-term health prior to becoming pregnant can decrease your risk of miscarriage.
One of the other main causes of miscarriage during the second trimester of pregnancy is a weakened cervix also known as the incompetent cervix or cervical incompetence. In this condition, the cervical muscles are weaker and are not able to hold the fetus. It may occur as a result of a previous injury to the cervix such as after a surgery. Due to the weakness of muscles, the cervix may open too early often during the second trimester of pregnancy resulting in miscarriage. However, there are procedures that can help that sews the cervix closed. This procedure is called a cerclage and is usually performed between week 14-16 of pregnancy and stitches are removed between 36-38 weeks to prevent any problems when you go into labour.
Unfortunately, not only does PCOS make it difficult for you to get pregnant, it also makes it difficult to have a viable pregnancy.
Recent studies have shown that having PCOS increases your risk of having a miscarriage. Originally the miscarriage rate for women with PCOS was reported to be as high as 30 to 50 percent, but studies now say that rate might be higher. The exact reason is unclear, but it is suggested that the hormone imbalance plays a big part such as elevated insulin levels, elevated testosterone, LH levels and obesity. It is also suggested that if you have PCOS and are undergoing assisted reproductive therapy such as IVF, you are twice more likely to have a miscarriage.
However, we see many patients with PCOS and through a combination of medically researched complementary therapies and lifestyle changes we have seen many pregnancy and birth outcomes.
Many infections in the mother may result in a miscarriage, particularly those associated with the reproductive system or sexual transmitted diseases such as chlamydia, gonorrhoea, syphilis and AIDS, but equally infections such as German measles, malaria and the all known Zika virus affect the developing baby.
Taking the necessary precautions to reduce sexual transmitted diseases and acting upon travel advice of countries where health issues put you at risk is important.
IVF assisted procedures
It's true that there is some research showing pregnancies conceived via assisted procedures such as IVF and ICSI carry a slightly increased risk of miscarriage and stillbirth compared to natural pregnancies. The exact level of the increased risk varies by studies. It is not clear if the reason for the increased risk of miscarriage relates to the IVF procedure itself or underlying reasons for assisted fertility treatment which further information and research is required.
We are all aware that women 35 years of age or older are likely to have an increased risk of miscarriage in comparison to younger women. This is largely down to the degeneration of egg quality. The risk of having a miscarriage is about 20 percent when you are 35 years old, however, the risk increases to 40 percent at age 40 and to 80 percent when you are 45 years old.
In clinic our mean age of patients is 41years of age, but despite age, we have a high success rate of 80% of natural pregnancies and 74% of assisted pregnancies for all those who follow our treatment and lifestyle program to enhance their egg and sperm quality that contribute towards pregnancy and live birth outcomes.
Being overweight has its many health problems and obesity which is defined as a body mass index over 30 has shown to be associated with as much as a 67 percent increased risk of pregnancy complications, including miscarriage and recurrent miscarriage. This is one of the main reasons you are asked by your consultant to lose weight when undergoing assisted procedures or trying naturally.
Smoking especially during pregnancy increases your risk of miscarriage. For years, doctors have known that women who smoke while pregnant have almost double the risk of having a low-birthweight baby and an increased risk of giving birth prematurely and therefor miscarriage. There are many NHS and private support groups to