Advice after miscarriage is usually “don’t panic” as most come from one-off chromosomal abnormalities that have little bearing on future pregnancies. Because of this it’s unusual for miscarriages to be investigated until there’ve been two consecutive miscarriages, irrespective of maternal age or fertility problems, however an alternative approach to the situation has been suggested that involves some testing of all miscarriages, and is based on the stage of pregnancy:i
|Stage of loss||Usual causes||Testing|
|Pre-embryonic or embryonic (before 8 weeks)||Chromosomal or immune abnormalities||Karyotype / Immune testing|
|Early fetal (8-12 weeks)||Thrombophilia and antiphospholipid syndrome||Blood testing for clotting and immune issues|
|Late fetal or spontaneous in 2nd trimester||Anatomical abnormalities, Bacterial vaginosis||Hysteroscopy / HSG Bacterial swabbing|
This approach focuses on the usual causes in each stage and gets assessment early; it’s a sort of proactive but conservative way. It’s not surprising that miscarriage rates are higher for women who’ve previously miscarried (compared to women with children or no pregnancies) since chance chromosomal events don’t cause all miscarriages, and some women are more likely to miscarry than others. These women tend to have a higher risk of complications such as pre-eclampsiaii and bleeding early in pregnancy,iii however, it’s important to remember that despite the wide media coverage, only 1% of women suffer recurrent miscarriage.
Age affects the quality and quantity of eggs and sperm, and the combined age of the couple is important as the chances of an unwanted chromosome numbers (aneuploidy) rises with both sexes age. Age also makes eggs and sperm more vulnerable to DNA fragmentation, and in this case the embryo often implants but high fragmentation levels reduce the chances the embryo will be able to repair the DNA breaks and the create a successful pregnancy.
Men are able to dramatically improve their sperm quality in about three months by changing their lifestyle and diet to match the ‘type’ needs, taking supplements and having Chinese medicine and this approach is something women should adopt, and Chinese herbal medicine reduces FSH levels and increases ovarian function.iv
Most women (81-97%)v vi without known fertility problems fall pregnant again, but the age of the mother has a strong influence on fertility generally, and for women over the age of 35 who’ve had a miscarriage their pregnancy rate is 63.5%.vii Having a miscarriage and being older, the natural thing to do is try again as soon as possible to “beat the clock”, however this isn’t the most successful path, and the WHO recommends delaying the next pregnancy for a minimum of six months following a miscarriage to reduce the known increased risks of pre-term birth and small-for-age babies, and we think this is particularly true for older women.viii
People are different, but a miscarriage is emotionally and physically exhausting for anyone, and taking time out to replenish precious energy reserves makes sense. What’s clearly understood in Chinese medicine with it’s personalised view of health is that some ‘fertility types’ are more prone to miscarriage than others, and that different ‘types’ may well have miscarriages from particular causes. As a general rule
iDawood F, Farquharson R, Quenby S: Recurrent miscarriage. Curr. Obstet. Gynaecol.14(4),247–253 (2004)
iiEras JL, Saftlas AF, Triche E, Hsu CD, Risch HA, Bracken MB: Abortion and its effect on risk of preeclampsia and transient hypertension. Epidemiology11(1),36–43 (2000).
iiiKashanian M, Akbarian AR, Baradaran H, Shabandoust SH: Pregnancy outcome following a previous spontaneous abortion (miscarriage). Gynecol. Obstetric Investig.61(3),167–170 (2006).
ivMeasuring the effectiveness of Chinese herbal medicine in improving female fertility. Trevor Wing and Elke Sedmeier. Journal of Chinese Medicine. 80. Feb. 2006. 22-28
vTam WH, Tsui MHY, Lok IH, Yip SK, Yuen PM, Chung TKH: Long-term reproductive outcome subsequent to medical versus surgical treatment for miscarriage. Hum. Reprod.20(12),3355–3359 (2005).
viAdelusi B, Bamgboye EA, Chowdhury N, Al-Nuaim L: Pregnancy trends after abortion. J. Obstet. Gynaecol.18(2),159–163 (1998).
viiSohinee Bhattacharya and Siladitya Bhattacharya“”Effect of miscarriage on future pregnancies”Women’s HealthJanuary 2009 ,Vol. 5, No. 1, Pages 5-8 , DOI 10.2217/17455057.5.1.5
viiiConde-Agudelo A, Beliz ́n JM, Breman R, Brockman SC, Rosas-Bermudez A: Effect of the interpregnancy interval after an abortion on maternal and perinatal health in Latin America. Int. J. Gynecol. Obstetrics89(Suppl. 1),S34–S40 (2005).