By Dr Devora Lieberman, NSW Medical Director and fertility specialist at City Fertility Sydney CBD
What is a miscarriage?
A miscarriage is the spontaneous loss of a pregnancy in the first 20 weeks. They are distressing and common, affecting about one in five pregnancies. In most cases, when pregnancy fails, it is due to a problem with the embryo (chromosomal) or developmental, or both. Miscarriage is rarely the result of anything a woman did right or wrong.
Interestingly, human beings are very inefficient reproducers. The majority of embryos that we make, whether in nature or the IVF lab, are not normal. Pregnancy is a very strong filter for the abnormal, so most abnormal embryos will fail to implant. More than half of all miscarriages happen because of an irregular number of chromosomes in the embryo, and the pregnancy does not develop properly from the start. The miscarriage risk increases with increasing maternal age as older eggs are more likely to be abnormal.
What are common miscarriage symptoms?
Common miscarriage symptoms include cramping, period-like pain and vaginal bleeding.
Some women are at higher risk due to:
- Age – the risk of miscarriage increases significantly after 35 and more so after 40, mainly due to chromosomal abnormalities with older eggs.
- Some medical conditions, like uncontrolled diabetes, thyroid issues and some autoimmune conditions.
- Uterine abnormalities – some women are born with an unusually shaped uterus, which can increase the chance of a miscarriage.
Things that do not cause miscarriage
The list of things that don’t cause miscarriage is far longer than those that do.
Miscarriages in early pregnancy are not caused by:
- Exercising, working, travelling, having sex, eating the “wrong” food, morning sickness or birth control pills
- Having a few drinks before knowing you’re pregnant
- A fall or a fright
- Stress or worry
- Not wanting the baby
- Having had an abortion
Things that may increase the chances of miscarriage
The risk of miscarriage may be increased in pregnant women who:
- Smoke
- Use illegal drugs like cocaine
- Are exposed to high levels of radiation or toxic agents
What are the odds of having a miscarriage?
After an isolated spontaneous miscarriage, the chance of having a successful pregnancy in the future is quite high.
Every time you get pregnant, you have the same age-based risk of pregnancy loss. In other words, a 32-year-old woman who has a 15% chance of miscarrying in her first pregnancy will have a 15% of 15% chance, or a 2.25% chance of having a second consecutive miscarriage, based on chance alone.
When to seek fertility advice after a miscarriage
While pregnancy loss usually is a one-time occurrence, up to one in 20 couples experience two miscarriages in a row, and one in 100 has three or more. Most women’s health organisations suggest you should have investigations after two consecutive miscarriages, and all agree they should be done after three.
Fertility testing to identify the increased risk of miscarriages
According to the European Society of Human Reproduction and Embryology (ESHRE), these are the tests with supported evidence:
Blood tests for:
- Parental chromosomes to rule out a structural rearrangement
- Lupus
- Anticardiolipin antibodies
- Thyroid function
- A 3D ultrasound to rule out a septum or fibroid that may prevent implantation
Pregnancy care to prevent future miscarriages
Sometimes, the cause of the miscarriages can be treated. Surgery may help some uterine problems. Hormone or anti-clotting treatment may also help. And some medical conditions can be treated with drugs.
If chromosomal problems are found, your doctor may suggest genetic counselling. A counsellor can help you learn what risks they may pose for future pregnancies.
In the past, couples had to wait until the pregnancy was established before the foetus could be tested for chromosomal problems by amniocentesis or chorionic villus sampling. It is now possible to undergo an IVF cycle and test the embryos before they are implanted.
FAQs about Miscarriage
Bleeding in a desired pregnancy is never welcome, especially when it is accompanied by pain. Bleeding can range from spotting to heavy bleeding with clots. Immediate management ranges widely. At either extreme, the differential diagnosis can include ectopic pregnancy.
Everyone deals with miscarriage differently. While the medical focus may be on treating the physical causes of miscarriage, it’s just as important to take care of your emotional well–being. City Fertility has a team of counsellors and other staff trained in miscarriage support who can help you manage the stress and emotions involved.
It’s not uncommon for a woman to have some bleeding after a miscarriage. If you’re uncertain about how your body is reacting, please contact our specialist team at City Fertility.
It’s usually like a period and lasts for two weeks or less. Most women pass the tissue during this time, but it can take longer. Cramping should subside quickly, but you may experience some spotting for up to a month.
We advise that you rest for a couple of days, but you can resume normal activities once you feel ready. For miscarriage support, please contact City Fertility.
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