For just under 5% of couples trying to conceive in Australia, multiple pregnancy losses is a reality. The general recommendation is to come under the care of a fertility specialist with expertise in recurrent miscarriage management if you have experienced two or more pregnancy losses. A thorough investigation into your fertility situation and targeted treatment of underlying causes can increase your chances of a healthy pregnancy.
Accurately identifying the underlying cause of a pregnancy loss helps us to decide on treatment strategies and plot our way forward. Although a reason can’t be determined in every single case, we now have a better understanding of recurrent miscarriage causes than we used to.
An abnormal number of chromosomes in the embryo can be implicated in about half of all recurrent pregnancy losses. This includes cases where you or your partner may carry a balanced chromosomal anomaly, which means you have the normal number of chromosomes but in an abnormal arrangement. While this abnormality has no impact on your own health, it can increase the risk of a genetic defect passing through your egg or sperm.
Through genetic tests such as karyotyping of you and your partner, we can identify whether chromosomal abnormalities are a cause for your recurrent pregnancy losses. If this is found to be the case, Dr Reyftmann will have a discussion about your options, which include IVF and preimplantation genetic testing (PGT), natural conception with invasive genetic testing of the pregnancy, or egg/sperm donation.
There are a number of anatomical abnormalities in women that have been associated with recurrent miscarriage. Uterine fibroids are a common finding among women but not all interfere with pregnancy. Studies suggest that certain types of fibroids (intramural and submucosal fibroids) may increase rates of miscarriage. Other abnormalities of the womb, such as a septate uterus (when your uterus is divided by a membrane into two sections, either partially or completely) and uterine adhesions (abnormal bands of scar tissue joining separate walls of the uterus together) are also thought to increase the risk of pregnancy loss.
We can diagnose these anatomical problems through advanced imaging techniques, such as two- or three-dimensional ultrasound with sonohysterography. If Dr Reyftmann establishes that surgery to correct these issues can improve your chances of a live birth, he can perform these advanced techniques himself, including hysteroscopy, laparoscopy, and robot-assisted surgery.
Antiphospholipid syndrome is a blood clotting disorder, also known as an acquired thrombophilia. If you’re a woman with this disorder, it may be difficult to carry a pregnancy to term as the proper function of your placenta will be impacted by abnormal blood clotting. The placenta is vital for the health of your foetus, providing crucial oxygen and nutrients, and removing toxic waste products.
Testing for antiphospholipid syndrome is through a series of blood tests, which measure certain antibodies that are associated with the disorder. If we get two conclusive positive test results, we can treat you with anticoagulant medications, including heparin and aspirin. The combination of these two anticoagulants can significantly reduce the risk of miscarriage due to antiphospholipid syndrome.
Hormones play a big part in reproduction. An undiagnosed or untreated endocrine (hormone) condition, even if not directly related to fertility, can still be enough to upset a pregnancy in its early stages. Hypothyroidism (an underactive thyroid) and poorly managed diabetes are both considered to be risk factors for recurrent pregnancy loss.
Managing any endocrinological disorders is important not only for your fertility but also your overall health. We can assess your hormones through blood tests and manage any imbalanced levels with medications or lifestyle changes. Dr Reyftmann may also work with your endocrinologist to help you optimise the management of any of these conditions.
Similar to the factors Dr Reyftmann discusses in lifestyle therapies for fertility treatment, certain environmental and lifestyle factors can increase your risk of recurrent miscarriage. Tobacco smoking (including passive or secondhand smoke), alcohol consumption, and caffeine intake can increase the risk of miscarriage, as can recreational drug use. Obesity while pregnant is also linked to a higher risk of pregnancy loss.
Minimising your risk of miscarriage from environment and lifestyle factors involves abstaining from smoking, alcohol, and illicit drug use while pregnant. The risk of pregnancy loss from caffeine is dose-dependent, meaning the risk increases with a higher intake of caffeine. The commonly accepted guidelines recommend limiting coffee to two cups a day. Meanwhile, maintaining a healthy body weight not only reduces your risk of pregnancy loss but can also lower the likelihood of other pregnancy complications.
