Miscarriage

There is a common understanding among women that when they are pregnant they should not tell anyone until after the first trimester.  This news is kept secret so that in the event of a miscarriage, no one has to know about it.  Although this approach that will help avoid explaining repeatedly when a pregnancy is lost, it certainly makes women experiencing a miscarriage feel alone, and often surprised that the pregnancy is not going to result in a baby.

Truth be told, miscarriages are very common.  Probably more common than you could ever imagine.  Most miscarriages are a random event.  Mother Nature makes many mistakes during the process of egg and sperm development, fertilization and early growth of the embryo.  Chromosomes can break or be lost.  The result is an embryo that will implant and start to grow, but then stop.  Researchers that have studied causes of miscarriage have found that this is by far the most common explanation, and occurs in roughly 70% of pregnancies that stop developing.  From the graph below, you can see that the chance of miscarriage increases with age.  This is because women are born with all of the eggs they will ever have, and over time they are susceptible to damage.

There is a subset of women that will experience more than one miscarriage.  If this happens, it is valuable to have an evaluation to ensure that there is not an underlying reason.  The term “recurrent pregnancy loss” is a diagnosis for women who have experienced three consecutive miscarriages, and in approximately 50% of couples with this diagnosis, there will be a cause found.  Even after two miscarriages it is reasonable to have testing done.  Causes of recurrent miscarriage may include thyroid dysfunction, cervical infections, uterine pathology (i.e. something growing within the cavity of the uterus), a predisposition to form blood clots that interfere with pregnancy (known as a “thrombophilia”), or a genetic disorder.

Many women wonder if they have done something to cause their miscarriage.  The short answer is no.  It is very difficult to cause a miscarriage.  If you think about it, women are having babies all over the world, including areas of famine and drought.  However, there are a few things that can be done to help improve the chances of success.  Avoid of smoking and caffeine.  Do not take any medications, be it prescription, over-the-counter, or herbal unless you have spoken to a pharmacist and have been informed that it is safe in pregnancy.  There is no  evidence to show that bed rest will improve chances of pregnancy success.  Likewise, having sex has never been shown to be a cause of miscarriage.  Many women also wonder about the impact of stress.  Unfortunately, this is a very difficult thing to measure.  Researchers have shown that women receiving ultrasounds every week during the first trimester for reassurance that the pregnancy is progressing normally will have a higher chance of a live birth.  So maybe there is something to be said about stress.

The good news is that even after three miscarriages in a row, the next pregnancy is more likely to result in a baby than another pregnancy loss.  Persistence is the key!  That is easy to say, and hard to do, but it is the truth.   So keep trying.  Eventually it will work.

35 thoughts on “Miscarriage

  1. Hi Dr. Jackson,

    What tests would you recommend to determine the cause of recurrent pregnancy loss? I have had 5 IUIs now and 3 have resulted in chemical pregnancies (two consecutive). Of the 5 IUIs, 4 of them were natural and 1 was with Clomid 25mg (which shortened my cycle but still only produced one follicle). All 3 chemicals ended very early, just after I got a positive – for this last one, I had a positive beta at 14dpiui but it had already halved by 16 dpiui.

    I am just starting my 6th IUI cycle now and I have read online that adding viatamin B6 and baby aspirin can help prevent early pregnancy loss. Is this true? Is there anything else I can do to improve my odds? We’re trying 50mg of Clomid this time to see if maybe I’ll make more than one follicle.

    Thank you!

    • Testing that I usually complete for those with recurrent pregnancy loss include:

      1. Thyroid function testing (TSH)
      2. Cervical swab for mycoplasma/ureaplasma organisms
      3. Saline ultrasound to confirm that there are no growths such as fibroids or polpys in the uterus
      4. A “thrombophilia screen” which is a series of blood tests to determine if there is a blood clotting disorder
      5. Karyotype testing on both partners to determine if there is a genetic explanation

      In terms of preventing future losses, determining if there is an underlying cause is the best first step. In about 50% of cases a cause will be identified, and some of those causes are treatable. You mentioned Aspririn, and this has only been found to be effective for those with a specific clotting disorder and would not otherwise be of benefit. Vitamin B6 is not something I have heard of before as a preventative measure. As long as you are not taking doses outside the range of what is recommended, I can’t see it causing any harm.

      Good luck with your future treatments!

  2. Hello,
    I recently had three miscarriages following two successful pregnancies (no treatment etc). I have done all the tests and the only thing that comes up is my TSH at 4.81. Although this is still in the normal range, I would like to know whether the clinic treats women with TSH at this level.
    Thanks.

    • Chris: I am sorry for your losses. They must have been difficult. Although your current TSH is in the normal range for general good health, we like the TSH to be below or at 2.5 for our infertility patients and especially for women who suffer from miscarriages. To do this you could take thyroid hormone tablets by mouth once daily. Thyroid hormones work with your follicle stimulating hormones (FSH) to give you the best egg and embryo quality. Your doctor will usually check your TSH after you start oral thyroid tablets and adjust your dose accordingly to bring it into the preferred range. You will need to continue the thyroid hormone tablets while you are pregnant. Hope that this works for you!

  3. Hi,
    I have been diagnosed with both factor V Leiden and antiphospholipid and have had 4 miscarriages and one successful pregnancy. I have just lost the 4th at 16 weeks as was taking a low dose aspirin. I am wondering what the chances are of successful pregnancy after this many losses if I take Fragmin or Heparin as I am 37 and feel like I am running out of time and energy to try again. I also had a septated uterus and had the septum removed before the most recent miscarriage.
    Thanks

  4. Hi, I have just had 3rd miscarriage (this time missed miscarriage) and waiting to hear when I will be going for D&C. What is the next step? I will be asking for referral to have testing done.
    How long till we can start testing and do you have to wait to start ttc again during testing period. Devastated by this loss as saw heart beat at 6 weeks.
    Thank you

    • Sorry for your loss. It is a miserable time for you. I just went through it around the same time you were (for me, it was my fourth).

    • Hi Cassandra,

      I would like to apologize for the delay in responding to your post. We have upgraded our website and the blog section had some kinks in the system that needed to be ironed out.

      I am very sorry to hear about the difficulties you are having. Miscarriages are more common than most people think, but that doesn’t help with the sense of loss.

      I would suggest a referral to the Ottawa Fertility Centre as there are some specific tests we can order to investigate the potential causes of your miscarriages. We are able to see patients within 4 weeks so you could obtain a referral from either your OB or family doctor. Most of the tests we order will need to be completed after some time has passed since your post-miscarriage so even if you see us sooner, we may still have to wait for tests to be ordered.

      We have a very good reproductive health psychologist on site, Dr Pat Gervaize, whom you may wish to speak with as you struggle with this loss. Her consultations are usually covered, if you have group health insurance. If you wish to contact her, she can be reached at pgervaize@conceive.ca

      I hope that helps answer some of your questions.

      • Hello Dr.Aaron Jackson,
        I had a miscarriage in Feb 2013 and still awaiting follow-up treatment – Actually, it was a in-nest abortion in 1 month and I miscarried only in the 3rd month – No D&C or surgery was done as I lost my fetus in bleeding itself – We have been trying to conceive from May 2013 and so far no luck – In my last ultrasound, they have detected a 12.5cm fibroid inside my uterus – I wish to remove it surgically to improve my chances of pregnancy – Pl. email me your fax number so that I can send my referal thru my family doctor. My no.is 6138534347
        Thanking you,
        Yours sincerely,
        Gowri

  5. Sorry, Cassandra, for your loss. Did you get a response from this blog? Why is there no support in Ottawa for women/couples who have miscarriages? I’m at four now, and it would be nice to have someone to talk to who has been through it. Thanks.

    • Hi EC,
      Sorry about the delay, took some time off. Sadly tried again just to have 4th miscarriage. Don’t even know what to think.

  6. Dear Dr.Jackson,

    I have had 2 misscarriages and have been told that i had hypothyroid. I am now at the right level but I have gotten my second miscarriage again. My doctor refuse to let me see an endocrynologist and I feel like Im never gonna have a baby and this is tearing me up… why cant I become pregnant and how come that my sister who delivered a healthy baby then ended up with Hyperthyroidism (she was at level) then had a misscarriage?

    • Sorry to hear about your losses. There are many reasons for recurrent miscarriages, with thyroid being only one possible cause. After two losses in a row, it is reasonable to see a fertility specialist to be assessed. If your family doctor is not willing to refer you, I would suggest you go to a walk-in clinic to have a referral. Good luck.

  7. Just had 4th miscarriage (5 weeks, got positive and then numbers dropped right away). My OB is faxing a referral to ottawa fertility clinic today. Can we start trying this cycle or would you advise waiting till after first visit with doctor at clinic?
    It’s hard to wait as been trying for a year and a half and feel like it will keep hurting till we have a viable pregnancy but also don’t want to mess things up if suppose to wait until after 1st visit and end up having to wait longer ?

    • Hi Cassandra,
      I know it’s hard to wait, but sometimes there are test results that lead to treatments that will reduce your chance of another miscarriage. If you can wait for a complete work-up before trying again, it may lead to success sooner even though it feels like you have stopped trying. However, every couple is different, and some prefer to keep trying while the testing is being done. You have to do what is right for you. Good luck.

  8. Dear Dr. Jackson,
    Could you pls. help me to have a second opinion suggestion? I am 36 yr and have been trying to get pregnant with donor sperm at MUHC McGill reproductive center from dec. 2012 till now. my blood test result from Dec.2012 are AFC13, FSH10.2, E2 114, TSH 2.17, PRL 7.7, LH 5.6, Prog 19.5, all ultrasound results are normal.
    During the total four rounds of natural cycle IUI with donor sperm of the past 15 months, I had once miscarriage within 6 weeks and once ectopic pregnancy with one side Fallopian tube removed and found out with endometriosis state two behind uterus, surgery remove one side Fallopian tube and dye test the other side Fallopian tube is OK.
    then I did the fourth natural cycle IUI and changed donor sperm last month in March 2014 and again a chemical pregnancy, miscarriage.
    With all respect to my doctor at McGill, I am thinking to get a second opinion. Do you think there are any more test I need to do before try the next time? Would you suggest me maybe to try FSH injection controlled ovarian hyper stimulation now?
    Thanks for any comments,
    Lauren

    • Hi Lauren,

      It sounds like you’ve had a very challenging year and a half. I can tell you that with a history of ectopic pregnancy and tubal disease, IUI is less effective. Many will move on to IVF when there are issues with the fallopian tubes, as this treatment would avoid the tubes all together. Perhaps you should talk with your doctor about whether or not they feel it is reasonable to move on to IVF as a next step.

  9. Hello Dr. Jackson.

    I recently stumbled on this blog and thought i’d write and ask your opinion. My wife recently had an ovarian ectopic pregnancy in January 2014; this follows a partial molar pregnancy in late 2012. Recently an ultrasound report indicated that she may have developed a supernumerary ovary as an outcome of the ovarian ectopic.

    Our specialist hasn’t got back to us (it’s been 4 weeks) and our GP didn’t know what to make of the situation. Will this impact future fertility? Should we be getting a referral to your clinic, or are these two pregnancy losses not technically miscarriages and not warrant concern?

    Thank you for any help you can provide,
    Tyler

  10. Hi Dr. Jackson,
    I am 42 old. 7 years ago I had a miscarriage at about 6 weeks. Then from this Feb., I started trying ICSI but the miscarriage happened at about 7 weeks (Gestastional Age by date 6w6d, Mean GS 5.1 mm, Age 5w2d, no CRL, no Yolk Sac). My question for you is if I need to do any further tests to identify the causes before I go on next cycle of ICSI? My specialist told me my case is a typical one caused by abnormal chromosome, but I still want to be certain. Thanks for any comments.

    Lucy

    • Hi Lucy,

      The most common cause for a miscarriage is that the embryo is not genetically normal and stops growing. This happens more commonly as a women’s age increases. From the information you have provided, I do not see the need for further testing. It is important to know however, that at the age of 42, the miscarriage rate is very high. 40-50% of pregnancies will end in miscarriage. I wish you the best of luck with your next cycle.

  11. hi Dr. Jackson,

    I am 28 and healthy. I had three miscarriages in a row. After some testing my anti-cardiolipine Igm where positif. I was then put on a low dose of asa daily. I then gave birth to a healthy daughter in december 2011. On sunday i had another miscarriage at 7 weeks. i was wondering if i should consult your clinique or if you have any advise.

    thank you

    julie

    • Hi Julie,
      If you were on ASA again when you had your recent miscarriage, your loss may not have been related to your anti-cardiolipin antibody necessarily. Sometimes pregnancies are destined to result in miscarriage because they are not genetically normal. If you would like more information before trying again, it would be reasonable to request a consult. However, you could also just try again and see what happens. There is no right answer, it is what you feel comfortable with.

  12. Hi. Just looking for a quick second opinion. I have had one child (no problems), 3 miscarriages (18 weeks, 5 weeks, 5 weeks) another child (no problems) followed by 2 more miscarriages at 14 weeks and 10 weeks. None of the doctors seem to know what to do with me as all the tests have come back negative. Bad luck or something more? Thanks

    • Hi Ann,
      Sorry to hear about your difficulties. It is hard to answer your question. It could just be bad luck, but without having all of your information it is hard to say for sure. However, with a history of recurrent pregnancy loss, a complete set of tests will only find a diagnosis in 50% of patients. The other half will remain “unexplained”. Perhaps we do not fully understand all of the causes of recurrent loss yet, but it does leave many patients frustrated when there are no explanations. I wish you the best of luck.

  13. Hello,

    I have just suffered a miscarriage, although I do suspect there may have been more in the last 9 months. I have just been referred which has filled me with relief. I am 34 and healthy but my last ultrasound brought up a possible septated uterus, I had a previous ultrasound in 2012 which brought up a similar finding with a question mark. is this something that contributes to miscarriages and is this something easily corrected.

    • I’m sorry for your recent loss. A uterine septum is something that is associated with miscarriage. The reason for this is that a septum does not have the same normal blood supply as the lining of the uterus (the endometrium). If an embryo implants itself on the septum rather than on normal endometrium, it cannot grow properly because of this altered blood supply. A septum can be diagnosed with 3D ultrasound or MRI. If present, it can be removed surgically by inserting a camera into the uterus through the vagina – this is called a hysteroscopy. This is a fairly minor procedure, usually done as a day surgery (you go home the same day). I wish you the best of luck with your upcoming appointment, and future pregnancies.

  14. Hi!

    After having my daughter (now 3 year old), I got very sick with Lyme Disease. I’ve been going through treatments for 2 years now and was finally given the green light to have a second child. I had ANA 1:80 before my first pregnancy but after it went up to 1:640 and did not change since. I have read terrible stories/miscarriages complications related to positive ANA and I was wondering if you have anything to say about it? I did series of auto-immune tests and inflammation markers and everything else is good expect for TGF Beta one being elevated. Also have 1 copy of the C677T (MTHFR). Are you aware of any issues related to this and should I be seen by a fertility specialist to manage the risks related if any?

    • Thank you for your questions. You have a complicated medical history, so it is difficult to comment on your risks. I would definitely suggest you see a fertility specialist. You may also want to consider seeing a High Risk Obstetrician BEFORE getting pregnant for “pre-conception counseling” to better understand what risks you might have once you are pregnant, and to get an idea of what the plan of care would be for you.

  15. Hi Dr Jackson,

    My wife just had egg retrieval in the part of IVF process but the egg didn’t fertilize. In that case, it doesn’t have embryo available for transfer.

    Based on the instruction from OFC for day 0 of egg retrieval, we shouldn’t have intercourse for 4 weeks. Since the embryo transfer was called off and we still want to try naturally, do we still need to follow that instruction? And why we need to wait for 4 weeks?

    • I’m sorry to hear that you did not have success with your IVF cycle.. The instructions for abstinence are to protect the ovaries. After IVF, the ovaries remain enlarged for a few weeks, and activity including exercise and intercourse have a risk of causing something called torsion where the ovary can spin around and cut off it’s blood supply.

  16. Hi Dr. Jackson
    I have a strange problem and i am unsure of how to go about it or who to see. I have had an irregular period since past august where i keep getting my period with a 4 day to a week break between each period. I saw a doctor and after blood tests my thyroids seemed to be fine. He determined that it is a low progesterone issue and treated it as such. After the use of medication and one round of clomid i finally ovulated and got pregnant. Unfortunately the baby stopped growth at 6 weeks and i had a miscarriage. After the operation i bled for three weeks and got my first period a week and a half later. But i am back to my previous problem of recurrent periods. My question is was my progesterone low during the pregnancy is that why i lost the baby. I am not ovulating since. I keep getting my period as well as it is so irregular instead of a 7 day cycle it is lasting up to 10. Do i need to be referred to your clinic. What should i do i am worried that if i get pregnant again i will have another miscarriage. I am 31 and i have one 2 year old toddler. My hormones seem all over the place and i am in constant mood swings to deep depression at time.
    Sorry for the long message but i do not know what to do.

    • I’m sorry you are struggling with having another child. It never hurts to have a consult with a fertility specialist to get more information and to learn what your options are for treatment. Try asking your family doctor if they think a referral is a reasonable next step. Best of luck.

  17. Hi Dr. Jackson, I just had IVF and the two week wait was torture. I did my beta testing today and was told that my progesterone had dropped and that another drop when I return later in the week would signify that my pregnancy is not going well. Is there anything I can do to prevent miscarriage, given my history of miscarriages in the past?

    • As difficult as it is to wait and see what happens, the unfortunate truth is that there is nothing that can be done to prevent a miscarriage. A low progesterone is a sign that the pregnancy is not normal. Some people have tried adding supplemental progesterone but this has not been shown to be effective. If you’ve had more than one miscarriage, there are tests that can be done to be sure there isn’t an underlying cause for your losses. Sometimes there are things that can be modified to improve your chances of success for next time. Ask your doctor if there is any testing that should be done for you. Hope this helps.

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