The loss of a pregnancy can be devastating, leaving many questions. To help those impacted move on from their loss, Bourn Hall has appointed Dr Shreeya Tewary, formerly a Research Fellow and then Clinical Lecturer at the Tommy’s Centre for Miscarriage Research, to support the development of a new Miscarriage Clinic, which is open to both couples and individuals even after a single miscarriage following natural or assisted conception.
Dr Tewary comments: “1 in 4 women will suffer a miscarriage at some point in their life. For 80% of these losses it will be a chance event due to a chromosomal error in that particular pregnancy. However, recurrent pregnancy loss 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 and these are increasingly likely to be genetically normal embryos with each loss so we need to look for other causes.”
Led medical trial
Dr Tewary completed an MD in Recurrent Pregnancy Loss (RPL). She took two years out of her Obstetrics and Gynaecology training to work under the supervision of world-renowned Professors Quenby and Brosens at the Tommy’s National Centre for Miscarriage Research, University Hospital Coventry and Warwickshire. During this time she led a trial looking at the role of a medical treatment for patients with recurrent pregnancy loss.
Endometrium has important role
“There is emerging evidence that the human endometrium (lining of the womb) plays an important role in determining the success of implantation,” she continues.
Dr Tewary explains that the human endometrium is one of the most dynamic human tissues, undergoing regeneration every single month following a menstrual period during a woman’s reproductive years.
Work by researchers at The University of Warwick has given insights into the cyclical changes and mechanisms within the endometrium that govern embryo implantation. This has revealed that some women have fewer stem cells in their endometrium and this might influence its receptivity to embryos and selectivity of quality. It is thought that an imbalance may result in it rejecting healthy embryos.
Dr Tewary conducted the SIMPLANT trial to investigate if the medication Sitagliptin improves the stem cell count at the lining of the womb to be then potentially considered in the future as a pre-conception treatment to improve the environment for implantation*. The research was funded by Tommy’s and sponsored by University Hospitals Coventry and Warwickshire NHS Trust.
The aim of the study was to improve the quality of the endometrium and its ability to support implantation and pregnancy.
The pilot study had promising results but Dr Tewary observes: “A much larger trial is needed to assess the effectiveness of sitagliptin in increasing the stem cell density of the endometrium.”
Medical investigation and intervention is just one element of helping patients with recurrent pregnancy loss.
“Recurrent pregnancy loss is debilitating and associated with considerable psychological distress. It has been shown that compassionate care and recognition of this significant life event has a beneficial effect on outcomes,” Dr Tewary continues. “Having a Miscarriage Clinic that is open to anyone on request will make this specialist support more accessible and I am delighted to be part of this pioneering approach at Bourn Hall.”
Bourn Hall’s Miscarriage Clinic
The Miscarriage Clinic aims to support those who have experienced a loss from either a natural or assisted conception. The team includes experienced fertility midwives and consultant gynaecologists and obstetricians each with different specialisms.
Bourn Hall’s Miscarriage Clinic is open to couples who have experienced one or more miscarriages. The process of investigation, concluding with a consultation to discuss results and next steps, takes approximately eight weeks.
The Miscarriage Clinic can be accessed through the Bourn Hall Clinics at Cambridge, Norwich, Wickford and Colchester. It will offer consultation and clinical advice, a carefully researched panel of tests, nutritional therapy, reassurance scans and dedicated fertility nurse and midwife specialists with experience of supporting those who have experienced loss of a pregnancy.
Research project: Can sitagliptin help increase stem cells in the wombs of women who have suffered recurrent miscarriages? Scientists funded by Tommy’s have found how a drug used for diabetes could help women who have experienced several miscarriages.
Research conducted by Warwick Medical School in collaboration with Tommy’s National Centre for Miscarriage Research and Juntendo University and published in EbioMedicine investigated the impact of the diabetes medication sitagliptin on stem cell formation in the endometrium. Research led by Professors Brosens and Quenby had previously found that patients who had experienced multiple miscarriages had very low levels of stem cells at the lining of the womb and it is suggested that this might be associated with poor implantation. Further funding would be required for a larger trial.