By Dr Dean Conrad, fertility specialist at City Fertility Sydney Miranda
The loss of a baby during pregnancy is estimated to impact one in 10 women in their lifetime, but experts say miscarriage needs better diagnosis, investigation and management, according to a three-part report published in medical journal The Lancet.
Miscarriages are more common than many people realise, with up to one in four pregnancies ending in loss. Around 80% of miscarriages occur in the first trimester, often before the 12th week, highlighting the need for early care and support.
Misconceptions About Miscarriage and Its Impact on Women
City Fertility Miranda obstetrician, gynaecologist and fertility specialist, Dr Dean Conrad, usually sees patients after they’ve had two or three miscarriages and anxiety is the result.
“There is a pervasive view in women’s health that ‘common’ is the same as normal,” Dr Conrad said.
“Although miscarriages are common, dismissing them as normal ignores the devastating impact many women experience. Consequently, it is often only at the second or third miscarriage that women are provided with the appropriate care they need.”
Report Findings and Miscarriage Statistics
While estimates suggest an annual miscarriage incidence rate of 15%, recurrent miscarriages affect approximately 2% of women, while three or more miscarriages occur in less than 1% of cases. But these figures may be well underestimated ‘as many miscarriages are managed at home and go unreported or unrecognised’.
The Lancet report recommends that after the first miscarriage, patients should be provided with information about miscarriage and guidance to support future pregnancy.
After two miscarriages it recommends an appointment with a miscarriage clinic (or gynaecologist) for full blood count, thyroid function tests and discussion of risk factors. After three miscarriages, additional tests and treatments are advised under the care of a medical consultant: ‘Genetic testing of pregnancy tissues should be offered’ as well as pelvic ultrasound and, if necessary, parental genetic testing’.
The Need for Early Intervention and Guidance on Miscarriage
Dr Conrad noted that most health organisations in Australia recommend patients seek specialist advice after three miscarriages.
“After the first miscarriage, I agree with the report’s recommendations that patients should be provided with guidance and information and not just told to ‘just try again’ and be sent away.
“But waiting until three miscarriages for specialist advice represents a missed opportunity to have early investigations to exclude preventable causes and avoid the devastating consequences of a miscarriage.”
Diagnostic Testing and Genetic Screening at City Fertility
At City Fertility, the recommended tests include investigation of parental chromosomes (to rule out structural rearrangement) as well as lupus, diabetes, thyroid, antiphospholipid syndrome and a detailed pelvic ultrasound. Identifying male factors, such as sperm quality, through detailed studies is also a crucial part of the evaluation process.
Additionally, for couples experiencing recurrent miscarriages or failed IVF attempts, pre-implantation genetic testing (PGT) may increase IVF conception rates by helping to identify the normal embryos. This method prioritises the embryos for transfer most likely to produce an ongoing pregnancy.
How Common are Miscarriages?
Miscarriages are more common than many of us realise, often occurring in the early weeks of pregnancy. For those who experience loss, care and support are essential. Identifying underlying causes is particularly important in cases of recurrent miscarriages. Seeking advice from a GP, counsellor or fertility specialist can assist in reducing future anxiety.
Essential facts about miscarriages
- Miscarriage affects up to one in 10 women or about 1 in 4 pregnancies[5].
- A loss usually occurs in the first 12 weeks but can take place up to 24 weeks.
- The risk of miscarriage reduces significantly with advancing gestation. Recent research shows that once a pregnancy reaches six weeks’ gestation there is only a 9.4 per cent chance of miscarriage. This reduces to a 0.7 per cent chance by 10 weeks.
- After three or more miscarriages (recurrent miscarriages), tests are done to look for the cause.
- Uterine malformations and parental balanced chromosomal rearrangements are the most commonly recognised risk factors.
- Other risk factors include advancing age; lifestyle (smoking, caffeine, alcohol, drugs and weight); medical conditions (such as uncontrolled diabetes, fibroids and thyroid problems); diagnostic procedures (amniocentesis); and cervical abnormalities.
- Research suggests about 9 out of 10 miscarriages happen because chromosomes in the embryo are abnormal and the pregnancy does not develop properly from the beginning [5].
- Investigating the cause of miscarriage can include looking at lifestyle factors; checking chromosomes; carrying out blood tests to check for diabetes, thyroid and other issues; a hysteroscopy and ultrasound to investigate uterine and cervical problems; and semen tests to check sperm quality.
To find out more about miscarriages and their causes, visit our page on miscarriage.
If you have any questions or would like further information, please contact our friendly team on 1300 354 354 or email: contactus@cityfertility.com.au
FAQs about Miscarriage
Miscarriages most often occur in the first trimester, with the highest likelihood in the first 12 weeks of pregnancy. For up to one in four women who know they are pregnant, miscarriage is a possibility during this time.
It’s advised to wait for at least one normal menstrual cycle before trying to conceive again, allowing your body and mind time to recover. Physical and emotional healing is key after a loss, and post-miscarriage care can help support this journey. Reach out to a City Fertility specialist to discuss your next steps.
Ovulation can occur as early as two weeks after a miscarriage, meaning you may be fertile again before your next period. However, the decision to try again should consider both physical readiness and emotional well-being. For questions or guidance, contact one of our City Fertility specialists.
[1] Miscarriage: ‘The era of telling women to “just try again” is over’ ESHRE Focus on Reproduction, 5 May 2021 https://www.focusonreproduction.eu/article/News-in-Reproduction-Miscarriage-report
[2] Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet 2021; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00682-6/fulltext
[3] Coomarasamy A, Dhillon-Smith RK, Al-Memar M, et al. Sporadic miscarriage: evidence to provide effective care. Lancet 2021; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00683-8/fulltext
[4] 3. Coomarasamy A, Dhillon-Smith RK, Papadopoulou A, et al. Recurrent miscarriage: evidence to accelerate action. Lancet 2021. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00681-4/fulltext
[5] Royal Australia and New Zealand College of Obstetricians and Gynaecologists, Pregnancy Loss, 2019 https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Patient%20information/Pregnancy-Loss_2.pdf?ext=.pdf
