Miscarriage clinic – helping you to move forward after loss

Bourn Hall has created a dedicated Miscarriage Clinic to support those that have experienced early pregnancy loss after natural conception or fertility treatment.

The chances of early pregnancy loss are much higher than widely thought, and even though it may never happen again, people often want reasons for their loss.

Our Miscarriage Clinic aims to provide some answers to their questions and recommendations where appropriate.

Bourn Hall Miscarriage Clinic

Why do miscarriages happen?

As many as 25% of clinically diagnosed pregnancies end in miscarriage. However, when combined with pre-clinical losses, where the female partner was unaware she was pregnant, the true incidence may be higher. Most miscarriages are isolated incidents, often due to a chance chromosome error and occur within the first 12 weeks of pregnancy.

Recurrent pregnancy loss (RPL) is a different condition and much rarer. It is estimated that 5% of women experience two consecutive miscarriages and approximately 1-2% suffer three or more.

Being over 35 increases the risk of chromosome errors in the embryo, which is a common cause of early pregnancy loss, however for RPL there are potentially other factors involved.

At the Miscarriage Clinic, you will be asked about your reproductive history (history of all previous pregnancies and their outcomes) and lifestyle factors including smoking, alcohol consumption and exercise. In addition, anatomical causes, genetics, and medical factors (endocrine, haematological, cardiovascular, immunological) will all be analysed carefully as they may be risk factors for some couples.

To discuss and learn more about our miscarriage clinic, please speak to our patient services team on 01954 717210, or complete the form on our contact page here.

Latest research

There is emerging evidence that the lining of the womb plays an important role in determining the success of implantation; this is when the embryo starts to embed itself into the endometrium. It is known, for example, that for a successful pregnancy the endometrium needs to balance accepting good embryos (receptivity) and with rejecting those that have errors (selectivity).

Some RPL patients are ‘super-fertile’ as their lining is overly receptive to embryo implantation but not selective enough at choosing the correct embryos for implantation.

Current research projects being conducted by the Tommy’s Charity include: testing foetal DNA and studying sperm for DNA damage Other large multi-centre observational studies are looking at ways to predict an individual’s risk of miscarriage and the most effective ways to medically treat miscarriage.

Tommy's Early Pregnancy Loss research

The Bourn Hall Miscarriage Clinic

Talking through the experience of miscarriage and undergoing investigations can help couples to move forward after a loss.

The easy-to-access Bourn Hall service is available to all couples who have suffered a miscarriage, whether they had natural or assisted conception, and there is no waiting time or need to have experienced multiple loss to self-refer to the service.

At the Miscarriage Clinic, couples will have investigations that look to provide explanations and treatment for future pregnancies.

In many cases all the tests will come back negative, which is good indicator that future pregnancies will be successful.
In addition to investigations, Bourn Hall offers an early reassurance scan at seven weeks as part of its Miscarriage Clinic and the support of a fertility nurse.

Many of Bourn Hall’s fertility nursing team trained as midwives, and they will have previously supported couples following the loss of pregnancy. They will therefore be able to provide invaluable specialist support and guidance. You will have a named fertility nurse or midwife to support you and that person remains your point of contact even after you have left the clinic.

Shreeya Tewary

Advice and testing you can access at the Bourn Hall Miscarriage Clinic

Bourn Hall consultant Dr Shreeya Tewary has a MD in Recurrent Pregnancy Loss (RPL) and led a research trial looking at potential medical treatments. Here she explains the tests available in the Miscarriage Clinic.

Lifestyle – some lifestyle factors, such as excessive alcohol or caffeine consumption, smoking and having a high or very low BMI, are known to reduce your fertility. Improving your health and the quality of your nutrition are all helpful in increasing your chances of a successful pregnancy. Bourn Hall offers the support of a nutritional therapist.

Medical history – talking through your reproductive and miscarriage history can help to identify possible causes. For example, a loss that occurs early can indicate an issue with implantation, or a loss after 12 weeks a problem with the placenta.

Quality of the endometrium – a healthy endometrium is vital for a healthy pregnancy and the lining is refreshed after each menstrual bleed. A scan can reveal issues such as scarring or adhesions due to previous surgery or infection. It may reveal and unusually thin endometrium. All of these factors would have an impact on successful implantation. For a more detailed investigation it is sometimes recommended to have a biopsy of the endometrium.

Anatomy – an unusually shaped womb has been shown to be associated with loss, and this can be revealed by a scan. Scanning may also identify fibroids, polyps, or cysts, which can also have an impact. For a more detailed examination a hysteroscope may be indicated.

Hormone levels – some underlying health issues such as diabetes, thyroid disorders or an infection may have an influence on the pregnancy. These can be identified with blood tests.

There is also some research that indicates a link between pregnancy loss and low levels of progesterone (which is needed to build the endometrium). Where there has been early bleeding progesterone may be prescribed to help maintain the pregnancy.

Sperm analysis – every sperm sample includes a high proportion of poor-quality sperm, and it is thought that DNA fragmentation may be a cause of some miscarriages. It is important that both partners are checked for fertility issues and providing a sample for semen analysis is quick and non-invasive.

Parental chromosome abnormality – by checking the genome of both partners it is possible to identify if either partner has a genetic condition that may affect the foetus.

Some people carry a balanced translocation. This means they contain all the genetic material necessary for normal growth however a part of one chromosome is attached to another. When that person’s cells divide to create an egg or sperm cell, the chromosomes are not shared equally, and some cells may end up with extra genetic material or missing genetic material.
If the sperm or egg cells have an imbalance of genetic material, then a baby developing from these cells will have an unbalanced translocation (missing or extra genetic material) resulting in the baby not being viable.

Blood clotting – thrombophilia the loss of pregnancy after 12 weeks. Acquired thrombophilia (antiphospholipid syndrome or APS) is found in 5–20% of patients with RPL compared with 2% in the wider population. Aspirin and Heparin in this group of patients has been shown to reduce the risk of future miscarriage.

Reassurance scans – for those who have had previous pregnancy loss, having more frequent scans can provide reassurance that the baby is developing as expected. Support for mental wellbeing is an important part of fertility treatment.

Counselling –Bourn Hall we have independent fertility counsellors that are experienced at working with couples that have experienced miscarriage. The impact on you as an individual and as a couple can be distressing. Having an opportunity to talk through the experience and gain support for coping with the loss or considering next steps can be lifechanging.

There are also a number of charities that provide this type of counselling.

Moving forward

One of our consultants will discuss with you the results from the tests and advise you on the next steps. The aim is to enable you to move forward with natural conception or further fertility treatment.

Alternatively, it could be that the tests reveal acquired thrombophilia or an underlying health condition that can be managed with medication or lifestyle changes.

You may possibly be recommended to have assisted conception to provide additional checks on sperm and embryo health.

Whatever you decide, we aim to make your experience at the Miscarriage Clinic empowering to help you move forward with confidence.

More information

Find out more about Bourn Hall’s Miscarriage Clinic.

Research by Tommy’s charity – more information here.

Charities that can provide support and advice include the Miscarriage Association 

Baby Loss Awareness week provides further support and events.

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