Prashanth Fertility Research Centre offers support for couples that have experienced one or more miscarriages. Our experienced counsellors are always there to listen to your concerns in a supportive environment. If you would like to make an appointment to see one of our counsellors please contact Prashanth Fertility Research Centre reception. Genetic Screening is provided to all couples who need the service particularly those with recurrent pregnancy loss, IVF failure, low or absent sperm counts and women with amenorrhoea.
The most common reasons for miscarriage include:
- Genetic abnormalities
- Uterine abnormalities
- Cervical abnormalities
- Hormonal abnormalities
- The immune system
- Maternal illness
- Lifestyle and environmental factors
In some cases, eggs or sperms are produced that have the wrong number of chromosomes (ie: missing or extra chromosomes). As a result of this chromosome imbalance, the resulting embryo cannot develop normally and will either fail to implant, miscarry, or gives rise to the birth of an affected child. The risk of miscarriage due to a chromosomal abnormality increases with maternal age. For example, a 40-year-old woman is almost twice as likely to miscarry as a 20-year-old woman. This is because women are born with their life supply of eggs and the quality of these eggs deteriorates over time. In order to determine whether there is a genetic cause for repeated pregnancy loss, physicians may order a chromosome analysis (called a karyotype) on the fetal tissue. The physician may also request that a karyotype is done on a blood sample taken from each parent. In approximately 96% of cases, both parents will have a normal karyotype (ie: a normal set of chromosomes). In these cases it is likely that the genetic abnormality in the fetus was a chance event. In the remaining 4% of cases, one parent will be identified as having a chromosomal abnormality, such as a translocation. A translocation is a rearrangement of chromosome segments between two different chromosomes. Carriers of these translocations are considered “balanced” because all their genetic information is present. However, they are at risk of producing sperm or eggs with an “unbalanced” form of their translocation. This may result in difficulty to conceive, recurrent miscarriages or the birth of a child with developmental abnormalities. If a translocation is identified, the couple should undergo genetic counselling to discuss their reproductive options. Options may include using IVF coupled with Preimplantation Genetic Diagnosis (PGD) to screen out genetically unbalanced embryos.
The main procedure used to examine the uterine cavity (inside of the uterus) is called hysteroscopy. A narrow telescope like instrument called a hysteroscope is inserted through the cervix into the uterus so that the physician can view the uterine cavity. This procedure is usually performed as a daycare procedure with general anaesthesia or along with a laparoscopy. Once identified, some uterine abnormalities can be surgically corrected, thereby increasing the chance of a successful pregnancy.
The second category of immune disorders involves an alteration in the immunologic response of the mother towards the fetus. In a normal immune response, cells called “NK” cells protect us from attack from foreign material such as bacteria, viruses and organ transplants (people who have had an organ transplant are therefore prescribed immuno-suppressive drugs to prevent their body rejecting the organ). During pregnancy, the fetus contains “foreign” genetic material from the father. However, it is able to survive in the mother’s uterus because of a special protective response from the mother’s immune system. For certain couples this protective response does not occur. As a result, the maternal immune system is activated to reject the father’s foreign material in the fetus, resulting in miscarriage.
At this time, other therapies including various types of immunisation to prevent the maternal immune system from rejecting the fetus are experimental and unavailable at most centres.
Couples who are interested in making lifestyle changes can join the Lifestyle Program at PFRC hospital. The Lifestyle Program is a free service that aims to provide couples with up-to-date information on lifestyle factors that may impact on conception, pregnancy and IVF outcomes. The ultimate goal of the Lifestyle Program is to equip you with the knowledge and resources to assist you in your IVF journey. If you are interested in joining the lifestyle program please contact PFRC hospital.
Tests can include:
- Blood tests to check for chromosome abnormalities in both parents.
- Testing tissue from the miscarriage for chromosomal abnormalities (if tissue is available).
- Blood tests to check for hormonal or immune system disorders in the mother.
- Ultrasound examination of the uterus.
- Hysterosalphingography (an X-ray of the uterus).
- Hysteroscopy (viewing the uterus through a special microscope inserted through the cervix).
- Endometrial biopsy (suctioning a small piece of uterine lining).
If a cause for recurrent miscarriage is identified, treatment can often resolve the problem. However, it is important that couples are aware that having these tests does not guarantee that a cause for recurrent miscarriage will be identified. In fact, a cause for recurrent miscarriage is typically only found for about 50% of couples. If a cause for recurrent miscarriage is not identified,couples should not lose hope. Even without treatment, approximately 60-70% of couples that have experienced repeated miscarriages go on to have a successful pregnancy.
To aid in healing, a woman should eat a balanced diet that includes protein, vegetables, fruit and whole grains. Engaging in physical activity every day is very therapeutic, even if the activity is just a short walk around the block. Getting adequate rest is also important and encourages the healing process. Some couples need to symbolically acknowledge their loss by having a memorial service, giving a donation to a favourite charity or planting a special tree.