Repeated (Recurrent) Miscarriages and Further Investigation

Repeated Miscarriages are one of the most disappointing experiences a couple can have when trying for a baby. In most cases, especially if the miscarriages occur during a natural pregnancy, patients may believe that this is a normal phenomenon and they should keep trying. We have treated many patients who had experienced more than 10 miscarriages when trying for a baby without receiving proper support or information from their health care provider.

Repeated miscarriages can be labeled as such if the patient has had three or more consecutive miscarriages. Having had only one miscarriage will not call for additional testing and investigation as that is something a large number of women experience at one point during their lifetime and it has been shown that women who have a single miscarriage will go on to have a healthy full-term pregnancy afterwards. However, if the patient keeps having miscarriages one after another, there is usually a medical condition behind it which needs to be investigated.

One of the first things that needs to be established is when the patient is experiencing her miscarriages. Certain times of gestation may point to different underlying causes behind the patient's miscarriages. If the patient has experienced her pregnancy losses after 12 weeks of gestation, then there is a high likelihood of cervical incompetence as the underlying cause. Cervical incompetence can be diagnosed through testing when the patient is not pregnant or via close monitoring during pregnancy.

When the patient experiences her miscarriages earlier on, during the first trimester, then other possible problems are accentuated. For instance, genetic problems with gametes (sex cells) could be one problem. Also, the couple may have chromosomal problems that show no symptoms but cause problems during reproduction (such as reciprocal translocations). Alternatively, thrombophilic defects that cause clotting problems are one of the main factors behind first trimester pregnancy losses.

A number of precautionary measures can be taken prior to or during your pregnancy in order to minimize the risk of yet another miscarriage. However, the underlying reasons must be well investigated and understood so that appropriate measures can be taken. For more information, please visit our website.

Repeated IVF Failures & Further Investigation

Without a doubt, IVF failures are one of the most frustrating occasions for a couple throughout their IVF path. Especially when they aren't fully informed about the reasons behind a number of failed IVF attempts, it may even lead to depression.
North Cyprus IVF pays extreme attention on this issue. In case of a failed trial, our patients are subject to
go through a complete analysis before their next IVF attempt in order to rule out some known possibilities. Additionally, if consequent results are not satisfying enough, some other factors are considered and observed in detail.

Some of the exigent factors that cause for IVF implantation failure can be cited as follows;

Uterine Infection

It is highly believed that infection of the uterine cavity with bacteria may result in an inhospitable environment and therefore may cause a failure of embryos to implant. Similarly, some other infectious diseases such as; CMV, IgG, Chlamydia etc. should be examined within this framework. Generally, antibiotics are used for infection treatments.

Immune factors

In some circumstances, the immune system is suspected to perceive the embryo as a foreign entity. Hence, it rejects the implantation of embryos.

Thrombophilias

Based on large scale investigations and researches, the existence of thrombophilias in women is associated with the risk of miscarriage. Furthermore, some researches even indicate the relation between thrombophilias and implant failures.

Although these factors can not be presented as a complete list of causes behind IVF failures, they are accepted as main contributors. However, for a much better personal assessment some specific analysis are needed to be performed with all aspects and conditions included.


If you have any specific questions or answers regarding the type of procedure you are interested in, please, do not forget to check our "Frequently Asked Questions" section. And please, do not hesitate to use our contact form for any more information.

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Quick Review

Some more great news from our patients! 


Dear Ahmet & team

I am delighted to inform you that I am pregnant.  I have just had my 12 week scan and all is good.  I wanted to wait until i did the 12 week scan so that we can be sure of the good news.

Thank you very much for all your help.

I will keep in touch and hopefully be able to give you further good news in another 6 months.

With best wishes,


S.C - United Kingdom


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MISCARRIAGE INVESTIGATION

Miscarriage is defined as pregnancy loss before 24 completed weeks of pregnancy. The occurrence of a miscarriage is a tragic loss for a couple trying to have a child and can be associated with significant psychological problems for the woman, their partner and family. Miscarriage is usually a single occurrence, and often followed by successful pregnancy. Recurrent miscarriage is defined as the loss of three or more consecutive pregnancies. Even after 3 consecutive losses, the chance of a successful pregnancy is over 60%. Most miscarriage occurs within the first 14 weeks of pregnancies. Maternal age and previous number of miscarriages are independent risk factors for a further miscarriage. There could be several reasons for repeated - recurrent miscarriages.

Causes of miscarriage
There are several causes of miscarriage that have been identified. These include chromosomal abnormalities, gene defects, hormonal problems, infection, immunological, uterine abnormalities, chronic maternal illness and environmental hazards.

Blood clotting (thrombophilic) disorders Inherited thrombophilias include Factor V Leiden, Factor II(prothrombin gene) mutations in the gene that codes for MTHFR, an enzyme involved in folate metabolism.
If blood clots occur in the blood vessels of the placenta, the blood flow to the baby is decreased and this can lead to either second trimester miscarriage or, if the pregnancy proceeds, to the birth of a baby that is smaller than he or she ought to be. Women with these disorders are also at risk of developing high blood pressure later in pregnancy

Chromosomal abnormalities One-off pregnancy losses can occur when the cells of the placenta and the fetus contain an abnormal number of chromosomes. Mostly the extra chromosome or the deficient chromosome is not present in the parents: instead the abnormality occurs as mature eggs or (less often) sperm cells are formed just before they are released
The miscarriage happens by chance. In most cases, there is nothing wrong with the mother or father's health and miscarriage is not likely to occur again in a later pregnancy.

The uterus and miscarriage Several abnormalities of the uterus are commonly linked to repeated pregnancy loss. Most of them can be treated with surgery.

They include:

• Congenital abnormalities. These are defects present from birth. For instance, a woman may have a uterus that is divided into two sections by a wall of tissue (septate uterus).

• Uterine fibroids (leiomyomata). Uterine fibroids are benign growths (not cancer) made up of uterine muscle tissue.

• Incompetent cervix. An incompetent cervix is one that begins to widen and open too early, in the middle of pregnancy, without any sign of pain or labor. Incompetent cervix is not a cause for recurrent first trimester losses.

Hormonal disorders

1. Progesterone
Low levels of progesterone hormone are frequently found in women whose pregnancies are miscarrying.

However, low progesterone levels in early pregnancy reflect the fact that the pregnancy has not implanted successfully in the womb lining, rather than because the developing placenta is not producing enough progesterone to maintain the pregnancy. This is an important point - low progesterone is the effect not the cause of the miscarriage. This explains why giving women progesterone and/or hCG hormone injections in early pregnancy does not improve pregnancy outcome.

The exception to this is when we take advantage of the immunosuppressant effects of progesterone in women who are found to have immune problems.

2. Follicle Stimulating Hormone
Follicle stimulating hormone (FSH) drives the ovary to start growing follicles. Unfortunately, some women with a history of pregnancy loss are also found to have high FSH levels because their ovaries have become prematurely menopausal. Although rare, this is obviously a very important problem to identify. If FSH levels are high, the appropriate next step is referral to a fertility specialist.

3. The uterine lining (the endometrium)
At the present time the only way of determining the response of the endometrium at the time of implantation is to sample it and look at the histological (microscopic) evidence of the state of the tissues. An endometrial biopsy can be performed towards the end of your cycle (approximately day 26). This biopsy is no more uncomfortable than undergoing a cervical smear test. However, in order to be able to obtain the most useful information from the biopsy, it is important to know exactly the time of ovulation.

4. Polycystic ovarian syndrome
A pelvic ultrasound scan shows that many women with recurrent miscarriage have polycystic ovaries (PCO). This is a common condition, found in 25% of all women, in which there are multiple small cysts within the ovary. These cysts are not dangerous and cannot be removed as they are within the ovary.
Polycystic ovaries can sometimes be associated with a number of hormonal imbalances such as increased production of LH and testosterone. A number of carefully designed studies have shown that neither PCO nor high LH levels are a cause for recurrent miscarriages.

Infections The role that vaginal infections may play in recurrent pregnancy loss is the subject of a new field of research.

Infection may well play a role in causing late pregnancy losses (14 weeks gestation) in a small number of women but it is unlikely to be important in causing early miscarriages.

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