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You’ve had a miscarriage or perhaps more than one. Let’s talk about the reasons why miscarriage happens and what can be done to reduce the risk of miscarriage occurring again in future

For those of you that don’t know me, my name is Michelle Cooke, Period & Hormone Naturopath, Natural Fertility Educator & Naturopathic Emotional Release Practitioner. I’m the Founder and Director of Reproductive Wellness, a clinic located in Melbourne. I see patients online and face-to-face.

About Miscarriage

Defined as loss of pregnancy before it is viable. There are different classifications of miscarriage mentioned below.

Biochemical loss is when there was a positive urinary or blood test confirming raised hCG but then a pregnancy loss takes place.

Clinical miscarriage is when an assessment or ultrasound has confirmed that there was a pregnancy.

There are two types:

-Early clinical pregnancy loss – before 12 weeks

-Late clinical pregnancy loss – 12 weeks to 21 weeks (1)

In women trying to conceive around 1/3 of conceptions arise in live birth. Approximately 30% of conceptions are lost prior to implantation and 30% after implantation (3-4 weeks gestation) (1)

Recurrent miscarriage:

There doesn’t seem to be agreement on the number of miscarriages to meet the recurrent miscarriage criteria. However, the European Society of Human Reproduction and Embryology (ESHRE) define it as 3 or more miscarriages occurring prior to 22 weeks (1)

 It’s estimated that 23 million miscarriages occur every year worldwide (44 pregnancy losses each minute)

Causes / contributing factors of miscarriage

There are several reasons why miscarriage can take place, these are some contributing factors / risk factors:

  • Chromosomal abnormalities

This is generally one of the top reasons why it has happened (particularly in the first trimester). If you are 35 years old and over this increases the risk of chromosomal abnormalities.

  • Low progesterone

  • Luteal phase defect

Defective corpus luteum with insufficient progesterone production in duration or amount. This is also associated with an inadequate endometrial maturation (2)

  • Over production of LH

  • Hyperprolactinaemia

Over production of prolactin. This can suppress ovulation too (2)

  • Thrombophilias

Can be acquired or hereditary and is associated both with recurrent and sporadic miscarriage. This is due to the increased risk of blood clots forming in the placental blood vessels leading to an interruption of the blood flow between the placenta and the baby.

Hereditary factors: Present with factor II or factor V leiden gene mutations, hyperhomocysteinemia or deficiency of protein S, protein C or antithrombin

Acquired factors: Hyperhomocysteinemia, Anti-cardiolipin antibodies, lupus anticoagulant or anti-phospholipid antibodies (1)

  • Abnormal HLA-G expression

  • Thyroid autoimmunity

  • PCOS

Mechanism is unclear buy might be associated with the obesity (1)

Potentially associated with high LH and high androgens (androstenedione) (2)

  • NK Cell dysfunction

There is research that shows that NK cells regulate blood vessels in the endometrium and could potentially play a role in implantation and early pregnancy (1)

  • Autoantibodies

Anti-phospholipid, anti-nuclear, anti-thyroid

  • Disrupted Endometrial Selection

  • Sperm DNA fragmentation

Biology 101: DNA holds genetic material and gives your body instructions. Chromosomes carry DNA. We need 23 chromosomes from mum and 23 chromosomes from dad to make a baby. In other words both the man and the woman need to be assessed and treated when it comes to miscarriage. If that is what your family unit looks like (not everyone has a male partner).

It is essentially looking at the degree of sperm DNA damage. A study showed that 85% of recurrent miscarriage couples had a high degree of sperm DNA damage. This is a huge one and one that is commonly missed because it is not part of a standard semen analysis it is a test that you would need to request separately (SCSA – sperm chromatin structure assay).

This doubles the risk of miscarriage

 

  • Abnormal sperm morphology

Sperm morphology relates to the number of normal sperm. If they are abnormal particularly in the head this is related to increased DNA fragmentation and chromosomal abnormalities. Due to poor sperm morphology arising in sperm DNA damage this interferes with the early embryo development.

A study done seemed to confirm that normal sperm morphology began to start gradually declining at the age of 30 (3)

 

  • hCG gene polymorphisms

  • Alcohol consumption

  • Caffeine consumption

  • Cigarette smoking

  • Mum to be in preconception period (time prior to conception) regardless of whether you are a light, moderate or heavy smoker.

  • Father to be in preconception period (time prior to conception) regardless of whether you are a light, moderate or heavy smoker

  • For men it arises in DNA fragmentation – damaged sperm DNA increases risk of miscarriage

  • Illicit Drugs

Contributes to breaks in chromosomes > chromosomal abnormalities > increased miscarriage risk

  • Overweight

  • Uterine Malformations

  • Sexually transmitted infections

A big concern in miscarriage

When a semen or sperm analysis is done the accepted levels by WHO (World Health Organisation) is so poor. Depending on which guide they are following the recent one regards 4% normal morphology as normal. This means that 96% of sperm are abnormal! Whereas the older reference guide suggests 15% is normal. Anything under 4% or 15% is usually when they would do ICSI (Sperm injected into the egg).

Abnormal sperm morphology is when they might have something like abnormally shaped head, tail or neck, two heads, two tails and can’t swim.

The sperm analysis is based on what sperm should be for IVF but it is not normal for natural conception. But regardless of whether you are doing it naturally or through IVF we can do better and should aim to do better than this because if morphology is poor this increases miscarriage risk. Poor quality sperm can impact whether fertilisation takes place or not as well.

 

What can help prevent further miscarriage?

THOROUGH INVESTIGATION

  • Hormones

  • Vitamin and mineral status

  • Sperm analysis

  • Sperm DNA fragmentation

  • Immune / genetic testing (if indicated)

  • Thyroid testing

I am not talking about just TSH (thyroid stimulating hormone) this is just one little part of such a bigger puzzle. It needs to be TSH, fT4, fT3, thyroid antibodies and urinary iodine and if possible rT3 as well. Because TSH could be normal but your actual thyroid hormones T4 and T3 may not be normal, and if you just had TSH tested you wouldn’t know. T4 converts to T3 which is your active thyroid hormone, so we want to know what those levels are like too. We also want to know if you have enough iodine for your thyroid to be working properly.

 

Female

  • The presence of thyroid antibodies increases the risk of early miscarriage at 2-8 weeks 4 x

  • TSH > 2.5 doubles the risk of miscarriage (1)

  • TSH > 2.5 along with TPO thyroid antibodies the miscarriage rates double again

  • Abnormal thyroid hormones or normal thyroid hormones with the presence of thyroid antibodies (1)

Male

Male thyroid function is just as important as checking the female’s thyroid function.

 

Hypothyroidism (thyroid under functioning) or subclinical hypothyroidism it affects:

-Manly hormone production – Arising in low FSH, LH, testosterone and sex hormone binding globulin (SHBG)

-Semen and sperm – poor morphology (amount of normal sperm), reduces sperm motility (ability for the sperm to swim straight up toward the egg), reduces semen volume. Semen is essential because it provides nutrients for the sperm and protects sperm with it being an alkaline pH shielding it from the acidic environment of the vagina.

Hyperthyroidism (over functioning thyroid) or subclinical hyperthyroidism in men affects:

-Manly hormone production – arises in increased testosterone and SHBG, hyper response to LH

-Semen and sperm – impacts motility (ability of sperm to move towards the egg), reduces sperm count

There is so much that can be done that can assist with thyroid function with natural medicine for instance; there is a herb called Rehmannia and a mineral called selenium can protect the thyroid gland from further damage from antibodies. If your thyroid hormones are imbalanced there are herbs, vitamins and minerals that can assist with production and making sure that you are effectively converting T4 to T3.

Likewise with hormone imbalances, sperm analysis and sperm DNA fragmentation there are several herbs, minerals and vitamins that can assist with this.

 

What I would recommend doing moving forward

Don’t accept:

  • Not taking any action until you have had 3 miscarriages. One miscarriage is too many and it signifies that something is wrong that needs addressing now.

  • ‘Normal’ pathology test results – this doesn’t get you pregnant. I will explain more below

  • A male partner who is not investigated – If you have a male partner and his sperm is being used he needs to be investigated too. Over 50% of infertility is due to male factor infertility (i.e. sperm quality issues). Sperm analysis, sperm DNA fragmentation, vitamins, minerals, hormones (including male hormones, thyroid and pancreas) and other general pathology needs to be done

A thorough investigation into why you are experiencing miscarriage whether it be a once off or recurrent will be essential in future prevention. I would highly recommend being referred by your GP to a Gynaecologist if indicated and potentially a Reproductive Immunologist if it is deemed appropriate. I would also recommend booking an appointment with a Naturopath who specialises in periods and hormones. FYI this is what I do.

Naturopaths will take a rather thorough approach looking at your pathology testing in a very different way than a GP or specialist would. The pathology reference range is so broad on a pathology test is so broad. A GP or specialist will only treat you if you are outside that broad pathology range (when the wheels fall off the wagon) because they are trained in treating disease and symptoms. It is no fault of the doctor or specialists they are just trained this way.

Whereas a Naturopath will be making sure that you are within the optimal range for fertility. Because the truth is if you fall outside the optimal range which is a smaller range within the broad range you can still present with symptoms, fertility issues and increased miscarriage risk. Naturopaths will also look at nutrient levels like vitamins and minerals which are crucial to fertility and conception outcomes. Then treatment will be the use of things that support the body like herbal medicine, nutritional medicine, diet and lifestyle advice to improve quality of sperm and eggs, hormone balance etc.

I am also a Naturopathic Emotional Release Practitioner. Naturopathic Emotional Release is a technique which helps to identify underlying emotions / stress or sabotages relating to your irregular periods. This tool uses Muscle testing & Chinese meridian points to identify the emotion & Chinese meridian points & EFT to clear & process the underlying emotion. It taps into the Autonomic Nervous System and works on subconscious beliefs, stress or underlying emotions.

When it comes to fertility and miscarriage particularly there are a myriad of underlying emotions to process in order to clear the way for conception to take place. I commonly hear things like ‘my body is broken’ all these are subconscious blocks preventing you from getting pregnant.

I would love to help you, go ahead and book a FREE 15 min discovery call to find out more about how we would work together and if we are a good fit.

References

 

  1. Larsen EC, Christiansen OB, Kolte AM, & Macklon N. (2013). New insights into mechanisms behind miscarriage. BMC Medicine. 11:154, pp. 1-10. http://www.biomedcentral.com/1741-7015/11/154

 

  1. Regan L, & Rai R. (2000). Epidemiology and the medical causes of miscarriage. Bailliere’s Clinical Obstetrics and Gynaecology. Vol 14. No. 5, pp 839-854. Doi: 10.1053/beog.2000.0123

 

  1. Cao X, Cui Y, Zhang X, Lou J, Zhou J & Wei R. (2017). The correlation of sperm morphology with unexplained recurrent spontaneous abortion: A systematic review and meta analysis. Oncotarget. 8(33), pp 55646-55656

If you have any questions or comments please pop them in the comments box down below 🙂