A discussion on recurrent miscarriage: part 2
Written in association with:
Obstetrician - gynaecologist
Published: 20/03/2024
Edited by: Aoife Maguire
In the second article of two-part series, leading consultant gynaecologist Mr Laxmikant Chaudhari discusses the link between age and recurrent miscarriage, and treatment options which may help those suffering from recurrent miscarriage.
How does age impact the likelihood of recurrent miscarriage, and are there interventions to improve outcomes for older women?
Age can significantly impact the likelihood of recurrent miscarriage, with advanced maternal age being associated with an increased risk. The risk of miscarriage tends to rise as a woman gets older, and this is attributed to a variety of factors. Here's how age influences the likelihood of recurrent miscarriage:
Chromosomal abnormalities
As women age, the likelihood of chromosomal abnormalities in eggs (oocytes) increases. These abnormalities can lead to failed fertilisation, implantation issues, or early miscarriages.
Decreased egg quality
Advanced maternal age is associated with declining egg quality. This can affect both the success of fertilisation and the ability of the embryo to implant and develop properly.
Increased risk of underlying health conditions
Older women may have a higher prevalence of certain medical conditions that can contribute to recurrent miscarriage, such as diabetes, hypertension, or autoimmune disorders.
Uterine factors
Age can also impact the condition of the uterus. Fibroids, polyps, or other structural abnormalities may become more prevalent with age, contributing to recurrent miscarriage.
While age itself is a significant factor, there are interventions and strategies that can be considered to improve outcomes for older women:
Preconception counselling
Seeking preconception counselling with a healthcare provider can help identify any potential risk factors and provide guidance on optimising health before attempting to conceive.
Genetic counselling
Older women may opt for genetic counselling to assess the risk of chromosomal abnormalities and to discuss options such as preimplantation genetic testing (PGT) or prenatal screening.
Fertility treatments
In some cases, assisted reproductive technologies (ART), such as in vitro fertilisation (IVF), may be recommended to address age-related fertility challenges.
Regular prenatal care
Close monitoring and early prenatal care are essential for women of advanced maternal age. This allows for timely detection and management of any potential complications.
Lifestyle modifications
Adopting a healthy lifestyle, including maintaining a balanced diet, regular exercise, avoiding smoking and excessive alcohol consumption, and managing stress, can positively impact reproductive outcomes.
Older women should collaborate with healthcare providers, including fertility specialists if necessary, to address their unique situation and explore suitable interventions. Although age poses challenges, advancements in reproductive medicine offer opportunities for successful pregnancies in later years. However, success rates may vary, influenced by individual factors.
What lifestyle factors or habits might contribute to recurrent miscarriage, and how can they be modified to reduce the risk?
Here are some lifestyle factors that might contribute to recurrent miscarriage and suggestions on how they could be modified to reduce the risk:
Advanced Maternal Age
While age itself is not modifiable, women trying to conceive at an older age should consider seeking medical advice early and possibly explore assisted reproductive technologies.
Nutritional Factors
Maintaining a healthy and balanced diet, ensuring an adequate intake of essential nutrients such as folic acid, iron, and vitamin D. Consult with a healthcare provider for personalised nutritional advice.
Weight and BMI
It is important to achieve and maintain a healthy weight before conception. Both underweight and overweight conditions can contribute to fertility issues and increase the risk of miscarriage.
Smoking
You must quit smoking, as it has been linked to an increased risk of miscarriage.
Alcohol and Substance Use
You should avoid or limit alcohol consumption, and refrain from using recreational drugs. Substance abuse can negatively impact fertility and increase the risk of miscarriage.
Stress
It is important to implement stress management techniques such as yoga, meditation, or counselling. Chronic stress may contribute to fertility issues and increase the risk of miscarriage.
Chronic medical conditions
It is crucial to manage chronic conditions like diabetes, thyroid disorders, or autoimmune diseases under the guidance of healthcare professionals. Well-controlled medical conditions can reduce the risk of recurrent miscarriage.
Infections
You must practice safe sex to reduce the risk of sexually transmitted infections (STIs). Ensure vaccinations are up-to-date to prevent certain infections that may impact pregnancy.
Uterine abnormalities
Some structural abnormalities of the uterus may contribute to recurrent miscarriage. Surgical interventions or other medical approaches may be considered based on individual cases.
Genetic factors
Genetic counselling may be beneficial for couples experiencing recurrent miscarriage to identify any underlying genetic issues.
It's important for individuals experiencing recurrent miscarriage to consult with a healthcare professional, preferably a reproductive endocrinologist or a specialist in recurrent pregnancy loss. They can conduct a thorough evaluation, identify potential causes, and provide personalised guidance on how to address specific risk factors.
Are there new or emerging treatments or technologies that offer hope for individuals experiencing recurrent miscarriage?
Some areas of research and potential treatments that were being explored include:
Immunotherapy
Researchers have been investigating the role of the immune system in recurrent miscarriages and exploring immunotherapy approaches to modulate immune responses.
Genetic testing and screening
Advances in genetic testing techniques have been providing more insights into potential genetic factors contributing to recurrent miscarriage. This information could help tailor treatments or interventions.
Hormonal therapies
Hormonal imbalances are being studied, and hormone-based interventions were being explored to address potential issues.
Personalised medicine
There has been a growing focus on personalised approaches, considering the unique factors and medical history of each individual to tailor treatments more effectively.
Endometrial Receptivity Analysis (ERA)
Some studies are being condicted to investigate the timing of embryo implantation and the receptivity of the endometrium. ERA involves analysing the best timing for embryo transfer in the context of the woman's menstrual cycle.
It is crucial to note that the effectiveness of these treatments and technologies can vary from person to person, and individualised medical advice based on a thorough assessment is essential. If you or someone you know is experiencing recurrent miscarriage, it's recommended to consult with a reproductive specialist or a healthcare professional who can provide the most up-to-date information and guidance tailored to specific circumstances.
*Disclaimer: This information is based on the doctor's personal opinion.
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