The only type of miscarriage that can be treated successfully during pregnancy is a threatened miscarriage, as inevitable, missed or incomplete miscarriages can’t be saved. If a miscarriage is suspected, seek medical advice at the local “early pregnancy unit”, and the signs of threatened miscarriage are usually:
- Mild bleeding
- Cramping and pain in the lower abdomen
- The cervix remains closed
- Scans show “hypo-echogenic” areas behind the gestational sac
However, do bear in mind that light bleeding in the first 12 weeks of pregnancy is quite common. If there is a miscarriage, it’s crucial to reduce the chances of further miscarriage, and knowing the causes and treatment options is a core part of this. Preserving some of the tissue lost (in contact lens solution) for chromosomal testing can rule out the main cause.
10 Causes of miscarriage and their treatments
The risk of a miscarriage varies with age, lifestyle, health history and immune state:
- Chromosomal abnormalities
- Placental problems
- Immune issues
- Antibiotic use
- Anomalies of the uterus or cervix
- Hormonal abnormalities
- Lifestyle choices (cigarettes, alcohol, coffee, drugs)
- Bacterial infections
- Polycystic ovary syndrome (PCOS)
1. Chromosomal abnormalities
These cause around 60% of miscarriages, usually have little bearing on future pregnancies and can be due to two factors:
- Extra or missing chromosomes create a condition called ‘aneuploidy’. Aneuploidy is random errors that occur when eggs and sperm form, and we all produce a percentage of these cells. Any foetus with an abnormal number of chromosomes has such significant problems there’s usually a miscarriage. However, some aneuploidy variations, especially Downs Syndrome (three of chromosome 21), survive.
Testing is on the embryo’s DNA, and most IVF clinics offer pre-implantation tests to exclude this problem.
- DNA fragmentation is when bits of chromosomes get broken off and misplaced and happens to DNA in all eggs and sperm. However, the more damage, the more difficult it becomes to repair the missing material. Implantation is usually fine, but as cell numbers increase, the pregnancy becomes less viable. DNA fragmentation rates rise with age and exposure to toxins.
Standard chromosome testing doesn’t detect DNA fragmentation, but there are tests for sperm. The best way to reduce DNA Fragmentation is by reducing exposure to toxins and improving health. Morefertile Support packages for the Fertility Profiles provide personalised advice, testing and products that suit individual needs. Save lost tissue in contact lens solution for testing to reveal possible causes.
2. The placenta
There are potential problems with the site of implantation and how it develops that can cause miscarriage. The placenta also has a crucial role in progesterone production that starts towards the end of the first trimester. A poorly timed or incomplete shift in progesterone from the corpus luteum is a relatively common cause of miscarriage.
It’s not possible to provide any treatment options for poorly placed implantation sites. However, it’s possible to support progesterone, and the conventional treatment is to supplement with progesterone. An alternative approach is to give personalised support that will increase progesterone from the corpus luteum and improve the health of the uterus and placenta. Of the six PFPs, Cold and Energy are the most likely to experience this problem.
Thrombophilia is an increased tendency for the blood to clot, which is a significant issue in pregnancy as the mother’s blood gets thicker in pregnancy anyway. Any clots around the placenta will reduce the blood supply to the baby, making the pregnancy unviable. Between 10-20% of women with early pregnancy loss have blood clotting issues.
Conventional treatment is with blood thinners like Aspirin or Heparin. Herbal combinations that promote circulation are effective for about 88% of Anti-Phospholipid Antibodies. Flow PFP women are at most risk of this problem.
4. Immune issues
Immune balance is crucial for health, and accommodating a pregnancy is a significant challenge. Imbalances of the immune system significantly increase the risk of miscarriage. Immune imbalances that are known to cause miscarriage include raised natural killer cells, raised antinuclear antibodies, reduced levels of leukocyte antibodies, systemic lupus erythematosus and anti-phospholipid antibodies.
Subclinical infection and inflammation of the uterus stimulate high levels of cytokines that encourage further immune activity. iv
The usual treatment of immune conditions is immune-suppressing drugs. However, there are immune-modulating herbal products effective at rebalancing the immune system. They should be taken alongside the morefertile PFP advice.
5. Anatomy of the uterus
Abnormal structures to the uterus or cervix make pregnancy more complex and cause 10% of miscarriage cases. Of the women who’ve had recurrent pregnancy losses, about 15% of them have an anatomical problem, with three main issues:
- A septum dividing the uterus is the usual issue as it affects the womb’s ability to accommodate pregnancy.
- A weak or incompetent cervix can also make retaining a baby in the womb difficult from the second trimester.
- Fibroids and polyps cause problems with blood flow and general uterine health for some women. v
Treatment depends on the issue involved:
- Surgery is the preferred option to correct a septum dividing the womb.
- When the cervix cannot hold the pregnancy in place, the option is “cerclage”, where the cervix is stitched shut until the end of the pregnancy. The success rates are usually about 85% and fall to around 50% when the operation is an emergency.
- Fibroids vary in their position and in how much they affect a pregnancy. They can be surgically removed before IVF if needed. Fibroids respond to estrogen, and some grow in the first trimester, while others shrink after pregnancy!
Prescriptions of antibiotics are common in pregnancy, especially for urinary tract infections (UTIs), but they can significantly increase the chances of miscarriage, especially when taken in the first trimester. If antibiotics are needed, it’s crucial to choose ones that are safe during pregnancy, and the following increase the risk of miscarriage:
- Macrolides (except erythromycin)
Penicillins, cephalosporins or no antibiotics are much less risky. vi and alternative treatment for UTIs is D-Mannose, which usually works well, especially for E. coli infections.
7. Hormonal issues
Hormones play a crucial role in maintaining a healthy pregnancy. The three main conditions are:
- Progesterone must be maintained at a high level throughout pregnancy to avoid miscarriage. For women with a known issue with progesterone deficiency (and those undergoing IVF), progesterone supplementation is essential.
- Thyroid hormones need to rise during pregnancy, and many women struggle to conceive because their T3 and T4 levels are low. The same issue increases the chances of miscarriage, especially in early pregnancy.vi The recommendation to all women trying to conceive and with hypothyroidism is to have their thyroxin dose adjusted as soon as possible. viii
- Diabetes affects fertility and pregnancy and significantly increases the risk of miscarriage or stillbirth (2.5x). The average medical cost for managing the pregnancy of a diabetic woman is almost double other women.ix The PFPs have excellent lifestyle information, and diet and exercise are crucial elements in diabetic care, and blood sugar levels (BSL) need monitoring carefully. We advise all women with hyperinsulinemia or diabetes to invest in a BSL monitor like Freestyle Libre.
Lifestyle choices make a significant difference to conception and miscarriage rates, and it’s important to avoid:
- Environmental toxins
- Hormone disrupting chemicals
Engage in moderate exercise and rest as much as possible during the first trimester to improve the chances of a healthy pregnancy.
9. Bacterial infections
Infections and imbalances of the womb microbiome increase the chances of miscarriage as they inflame the womb lining and interfere with the placenta. Bacteria are an essential part of the womb environment, but abnormal communities alter the health of the womb.
Testing can assess the health of the vaginal microbiome, and antibiotics or probiotics can remove infections and rebalance the community.
PCOS increases the risk of miscarriage and premature birth due to an increased risk of cervical incompetence. PCOS is also associated with the hormonal conditions of Type II diabetes and metabolic syndrome. xi
There is a wide range of natural treatments for PCOS that are effective at reversing the condition, and continuing these during pregnancy helps to reduce the risk of miscarriage.
ii Tang OS, Ho PC. The use of misoprostol for early pregnancy failure. Curr Opin Obstet Gynecol. 2006;18:581-586
iii Hassan MAM, Killick SR: Is previous aberrant reproductive outcome predictive of subsequently reduced fecundity? Hum. Reprod.20(3),657–664 (2005).
iv Joining the Immunological Dots in Recurrent Miscarriage Bansal, A. S. (2010), American Journal of Reproductive Immunology
v Propst AM, Hill JA (2000). “Anatomic factors associated with recurrent pregnancy loss”. Semin. Reprod. Med.18 (4): 341–50. doi:10.1055/s-2000-13723. PMID11355792.
vi “Use of antibiotics during pregnancy and risk of spontaneous abortion” Flory T. Muanda, MD, Odile Sheehy, MSc, Anick Bérard, PhD. CMAJ May 1, 2017 vol. 189 no. 17 E625-E633
vii Maternal Subclinical Hypothyroidism and Thyroid Autoimmunity in Early Gestation Are Associated with Increased Risk of Miscarriage. Pearce Elizabeth N. Clinical Thyroidology. September 2014, 26(9): 235-237. doi:10.1089/ct.2014;26.235-237.
viii Levothyroxine-Treated Women in Their Reproductive Years Should Have their Serum TSH Adjusted Before Conception to Prevent Hypothyroidism in the First Trimester. Mestman Jorge H. Clinical Thyroidology. October 2014, 26(10): 254-257. doi:10.1089/ct.2014;26.254-257.
ix Jovanovič, L., Liang, Y., Weng, W., Hamilton, M., Chen, L., and Wintfeld, N. (2015) “Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy”. Diabetes Metab Res Rev, 31: 707–716. doi: 10.1002/dmrr.2656.
x Bacterial vaginosis and infertility: cause or association?” Magdy AM. J Obstet Gynecol Reprod Biol. 2013
xi “Co-morbidity of cervical incompetence with polycystic ovarian syndrome (PCOS) negatively impacts prognosis: A retrospective analysis of 178 patients” Yongqing Wang Et al. BMC Pregnancy and Childbirth201616:308. DOI: 10.1186/s12884-016-1094-6