Miscarriage Is Still A Mysterious Problem, But Solution To It Could Be Surprisingly Simple

Infertility is one of the biggest neuroses of the 21st century woman. In reality, however, getting pregnant is the easy part. Staying pregnant is much harder. While one in ten couples has problems conceiving, at least one in six pregnancies will end in miscarriage. The rate rises to 25% - one in four – when a woman passes the age of 40.

Any couple who has suffered a miscarriage will be assured by everyone around them that it is a one-off tragedy, and it probably is. However recurrent miscarriages are devastating. The truth is that a woman whose first pregnancy ends in miscarriage has a 20% risk of a second. After two miscarriages, the risk of a third is 24%. After three, the chance of a fourth rises to 43%.

Despite this, miscarriage remains one of the most mysterious, unexplored issues in the baby business. Specialist units are few and doctors are often slow to refer sufferers.

Miscarriage is the poor relation of infertility. If you’re infertile, there is information, resources and research. If you miscarry, you’re told ‘better luck next time’, but it can be devastating.

Surveys find that 45% of women who miscarry do not feel well informed about what is happening, and 90% receive no aftercare. Women are usually never offered any treatment, tests, advice or explanations. The first time is a big shock, for most women. They want to know what had happened, but the doctors fall back on the old rule that it’s likely that the baby wasn’t formed properly. It’s probably correct in most cases, but it’s also an easy answer.

The miscarriage clinic at St. Mary’s hospital, London, is the largest referral unit in the world. The clinic admits about a thousand new women each year, all of whom have had at least three miscarriages – and 80% will leave with a baby.

Women who are referred will be given a chromosomal analysis (from their blood and possibly from fetal tissue). Blood will also be tested for certain antibodies and hormone levels. The clinic may take a vaginal swab to test for infection and scan the shape of the womb while checking for fibroids.

As many as one in five referrals are found to have the autoimmune disorder antiphospholipid antibodies (APA). Little is known about APA, except that it somehow affects the blood supply to the placenta. Treatment is a daily aspirin and injections of the anticoagulant heparin, which has been found to increase the chance of a live birth from 10% to 70%.

Uterine and vaginal infections are also increasingly believed to be a cause, particularly of late miscarriage. Chlamydia is one culprit – it is detected by a swab and treated with antibiotics. Streptococcus B is another. This bacterium is present in the vaginas of one in ten women, but women with a history of late miscarriage appear to be chronic carriers. It is treated with penicillin.

A further 20 % of the women at St. Mary’s who miscarry late have the vaginal infection called bacterial vaginosis (BV). Not a lot is known about BV, except that it is more common in smokers, Afro-Caribbean women and those who use antiseptics while bathing. It can also be treated with antibiotics.

Hormonal imbalances are harder to treat, but they also play a significant part. It is believed that a high level of luteinizing hormone (LH) causes the egg to mature too early, making it less likely to be fertilized. LH is also linked to polycystic ovary syndrome, which is found in 60% of those who suffer recurrent miscarriages.

Another factor is a weak cervix, which causes the cervical canal to open at about 20 weeks. This can be due to a congenital abnormality or a previous difficult vaginal delivery. Luckily, the cervix can be strengthened with a stich that helps to keep it closed.

All of the above can be detected and corrected at specialist clinics with varying degrees of success. The study of miscarriage is still in its infancy, and although these conditions can be identified, their exact role in miscarriage is still little understood. The vast majority of women who attend such clinics will never know for sure exactly why they miscarried. It is estimated that half of all miscarriages are caused by sheer bad luck – a chance chromosome abnormality in the fertilized egg.

Most couples hope that tests will identify a problem, because they think problems, equals treatment equals cure. So, specialty clinics spend a lot of time saying the opposite. They say “we can’t find an underlying problem, so that’s good news. You’ve had bad luck, but we’re going to support you through the next pregnancy.”

Specialty clinics offer a range of acre and counselling services, and pregnant women are invited back to be scanned and monitored periodically. They can see that the bay is alive, safe and growing. This makes the crucial difference. It has been observed that those who choose to come back each week for monitoring do significantly better. Two independent studies have found the same result.

This suggests that miscarriage could somehow be stress-related. Most women too believe this to be the case. One woman suffered four miscarriages while she was in a deeply unhappy marriage. As she confesses, “I was ambivalent, underhandedly trying for a family, and finally abandoned it, hoping that I would have a child at another stage in my life.” In her second marriage, this woman became pregnant easily, and had a son with no problem at all. She believes that there is a big psychosomatic context.

Women who have suffered three recurrent miscarriages must seek specialists help. You have to be assertive and know that things are changing. We no longer just have to go home and try again.