The advice after miscarriage is usually “don’t panic”, and most miscarriages are due to one-off chromosomal abnormalities that have little bearing on future pregnancies. This is why miscarriages aren’t routinely investigated unless they are consecutive, irrespective of maternal age or fertility problems. However, an alternative approach has been suggested, where all miscarriages are tested, based on the stage of pregnancy and the most likely causes in each step: i
|Stage of loss
|Pre-embryonic or embryonic (before eight 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 is both proactive and conservative, and it focuses on the usual causes in each stage, and an assessment arrives early. Knowing what caused a miscarriage makes a huge difference to the people involved and enables treatment if needed.
Some couples experience three or more miscarriages in a row, which is incredibly distressing. In some ways, it’s not surprising that the risk of miscarriage rises for women who’ve already had a miscarriage when the odds are relative to women with children or no pregnancies. Chance chromosomal events don’t cause all miscarriages, and some women are more likely to miscarry than others. These women also tend to have a higher risk of complications such as pre-eclampsia ii and bleeding early in pregnancy, iii, so pregnancy isn’t that easy for them. The different Fertility Profiles are more prone to different causes of miscarriage, and following the advice for your FPP reduces the chances of repeats.
Age and miscarriage
Age affects the quality and quantity of both eggs and sperm, and the couple’s combined age is as important as the age of one partner.
- The chances of a fetus with abnormal chromosome numbers (aneuploidy) rise with the age of either sex
- Age also increases the chances of eggs and sperm having higher DNA fragmentation rates. This may not rule out pregnancy in the way aneuploidy does, but high fragmentation levels reduce the likelihood of a successful pregnancy
Most women (81-97%)iv v without known fertility problems fall pregnant again. However, maternal age is crucial for fertility generally, and subsequent pregnancy rates for women over 35 who’ve had a miscarriage is 63.5%.vi
The natural thing to do after a miscarriage is to try again as soon as possible. There’s a need to fill the space and often to “beat the clock”; however, this isn’t the most successful path to take. The WHO recommends delaying the subsequent pregnancy for a minimum of six months after a miscarriage to reduce the known increased risks of pre-term birth and small-for-age babies. Despite the age issue, we think this advice is particularly true for older women. vii
People may well be different, but a miscarriage is emotionally and physically exhausting for anyone, and taking time out to replenish precious energy reserves makes sense. The morefertile Fertility Profiles give clear and personalised advice on raising fertility and reducing the chances of miscarriage for each group. Some Fertility Profiles are more prone to miscarriage than others, and different FPs tend to have miscarriages from particular causes. As a general rule, miscarriages that are unconnected to chromosomal abnormalities are due to either:
- Blood clotting
- Abnormal immune responses
- The mother is depleted in some way
|Most likely problem
|Bleeding early in pregnancy / “early fetal” miscarriage
|“Early fetal” miscarriage / hypothyroidism / diabetes
|Pre-term birth / “small-for-age” babies
|Chromosomal abnormalities / pre-term birth / “small-for-age” babies / diabetes
|Complications with diabetes and pre-eclampsia
|Thrombophilia / antiphospholipid syndrome or other immune issues
It’s essential for all FPs to take time to recover from such an exhausting experience to enable hormones and the immune system to calm down and re-balance. Building up energy reserves are crucial for the next attempt as the fetus relies on energy stored in the womb walls before conception for nourishment in the first trimester. viii
The adage “prepare the seedbed for strong germination, growth and harvest” applies even more than usual now because:
- The more miscarriages, the greater the risk of an immune response to pregnancy developing
- Miscarriages drain vital energy reserves essential for fertility and starting a pregnancy while exhausted raises the chances of problems ahead
- Abnormal immune responses are more likely when energy reserves are low
We strongly suggest that couples consider taking some time out after a miscarriage to focus on the lifestyle and diet for their Fertility Profile. It’s a positive response and will help improve immune and energy balance before trying for a baby again from a stronger position.
Men can usually dramatically improve their sperm quality in about three months by changing their lifestyle and diet to match the needs of their FP and taking supplements. It may be that herbal medicine or seeing a nutritionist is appropriate for both partners. There’s strong evidence that herbal medicine improves the function of the ovaries and uterus and reduces FSH levels. ix
While it is understandable that women feel the loss of a miscarriage deepest (and tend to take “the blame” for it happening), please remember that miscarriage is linked to multiple male factors. By making changes to their lifestyle and health, men can significantly reduce the chances of their partners having a miscarriage.
ii Eras JL, Saftlas AF, Triche E, Hsu CD, Risch HA, Bracken MB: Abortion and its effect on risk of pre-eclampsia and transient hypertension. Epidemiology11(1),36–43 (2000).
iii Kashanian M, Akbarian AR, Baradaran H, Shabandoust SH: Pregnancy outcome following a previous spontaneous abortion (miscarriage). Gynecol. Obstetric Investig.61(3),167–170 (2006).
iv Tam 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).
v Adelusi B, Bamgboye EA, Chowdhury N, Al-Nuaim L: Pregnancy trends after abortion. J. Obstet. Gynaecol.18(2),159–163 (1998).
vi Sohinee Bhattacharya and Siladitya Bhattacharya “” Effect of miscarriage on future pregnancies” Women’s Health January 2009, Vol. 5, No. 1, Pages 5-8 , DOI 10.2217/17455057.5.1.5
vii Conde-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).
viii’ Tracking nutrient transfer at the human maternofetal interface from 4 weeks to term’ C.J.P. Jones, R.H. Choudhury, J.D. Aplin. Placenta April 2015 Vol 36, Issue 4, Pages 372–380
ix Measuring the effectiveness of Chinese herbal medicine in improving female fertility. Trevor Wing and Elke Sedmeier. Journal of Chinese Medicine. 80. Feb. 2006. 22-28
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