If you lose a baby before 24 weeks of pregnancy, it is called a miscarriage. If this happens in the first 3 months of pregnancy, it is known as an early miscarriage. Unfortunately, early miscarriages are common, with 10 20 in 100 (10 20%) pregnancies ending this way. Late miscarriages, after 3 months of pregnancy but before 24 weeks, are less common: 1 2 in 100 (1 2%) pregnancies end in a late miscarriage. When a miscarriage happens three or more times in a row, it is called recurrent miscarriage. Recurrent miscarriage affects 1 in 100 (1%) couples trying to have a baby.

Why does recurrent miscarriage and late miscarriage happen?

Sometimes there is a reason found for recurrent and late miscarriage. In other cases, no underlying problem can be found. Most couples are likely to have a successful pregnancy in the future, particularly if test results are normal.

There are a number of factors that may play a part in causing recurrent and late miscarriage:

Age, the older you are, the greater your risk of having a miscarriage. If the woman is aged over 40, more than 1 in 2 pregnancies end in a miscarriage. Miscarriages may also be more common if the father is older.
Antiphospholipid syndrome (APS- a syndrome that makes your blood more likely to clot) is uncommon but is a cause of recurrent miscarriage and late miscarriage.
Thrombophilia (an inherited condition that means that your blood may be more likely to clot) may cause recurrent miscarriage and in particular late miscarriages.
Genetic factors, about 2 5 in 100 couples (2 5%) with recurrent miscarriage, one partner will have an abnormality on one of their chromosomes (the genetic structures within our cells that contain our DNA and the features we inherit from our parents). Although this may not affect the parent, it can sometimes cause a miscarriage
Weak cervix is known to be a cause of miscarriage from 14 to 23 weeks of pregnancy. This can be difficult to diagnose when you are not pregnant. It may be suspected if in a previous pregnancy your waters broke early, or if the neck of the womb opened without any pain.
Developmental problems of the baby may lead to a miscarriage but are unlikely to be the cause of recurrent miscarriage.
Infection that makes you very unwell can cause a miscarriage. Milder infections that affect the baby can also cause a miscarriage. The role of infections in recurrent miscarriage is unclear.
An abnormally shaped uterus may contributes to recurrent miscarriage or late miscarriages. However, minor variations do not appear to cause miscarriage.
Diabetes and thyroid problems can be factors in miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control.
It has been suggested that some women miscarry because their immune system does not respond to the baby in the usual way. This is known as an alloimmune reaction. There is no clear evidence to support this theory at present. Further research is needed.
Are there any other risk factors?

Being overweight increases the risk of miscarriage. Smoking and too much caffeine may also increase the risk. Excessive alcohol is known to be harmful to a developing baby and drinking five or more units a week may increase the risk of miscarriage.

The chance of a further miscarriage increases slightly with each miscarriage. Women with three miscarriages in a row have a 4 in 10 chance of having another one. This means that 6 out of 10 women (60%) in this situation will go on to have a baby next time. 

Why are investigations helpful?

Finding out whether there is a cause for your recurrent miscarriage or late miscarriage is important as your doctor will be able to give you an idea about your likelihood of having a successful pregnancy. In a small number of cases there may be treatment available to help you.

What investigations might be offered?

Blood tests:

For APS- APS is diagnosed if you test positive on two occasions 12 weeks apart, before you become pregnant again.
For thrombophilia- If you have had a late miscarriage you should be offered blood tests for certain inherited thrombophilias.
To check you and your partner s chromosomes for abnormalities. You may be offered this test if your baby has been shown to have abnormal chromosome
Tests for abnormalities in the baby You should be offered tests to check for abnormalities in your baby s chromosomes. This is not always possible but may help to determine your chance of miscarrying again. If you have had a late miscarriage you may also be offered a postmortem examination of your baby. This will not happen without your consent and you will have the opportunity to discuss this with your health team beforehand.

Tests for abnormalities in the shape of your uterus. You should be offered a pelvic ultrasound scan to check for any abnormalities in the shape of your uterus. If an abnormality is suspected, further investigations may include a hysteroscopy (a procedure to examine the uterus through a small telescope which is passed through the vagina and cervix) or a laparoscopy (a procedure in which a surgeon uses a fine telescope to look inside the abdomen and pelvis).

Tests for infection. If you have had a late miscarriage, tests such as blood samples and vaginal swabs may be taken at the time to look for any source of infection.




What are my treatment options?

Treatment for APS

If you have APS and have had recurrent miscarriage or a late miscarriage, treatment with low-dose aspirin tablets and heparin injections in pregnancy increases your chance of having a baby. Aspirin and heparin make your blood less likely to clot and are safe to take in pregnancy.

Having APS means you are at increased risk of complications during pregnancy such as pre-eclampsia, problems with your baby s growth and premature birth. You should be carefully monitored so that you can be offered treatment for any problems that arise.

Treatment for thrombophilia

If you have an inherited tendency to blood clotting (thrombophilia) and have had a miscarriage between 12 and 24 weeks of pregnancy, you should be offered treatment with heparin. At present there is not enough evidence to say whether heparin will reduce your chance of miscarriage if you have had early miscarriages (up to 12 weeks of pregnancy). However, you may be still offered the treatment to reduce the risk of a blood clot during pregnancy.

Your doctor will discuss what would be recommended in your particular case.

Referral for genetic counselling

If either you or your partner has a chromosome abnormality, you should be offered the chance to see a specialist called a clinical geneticist. They will discuss with you what your chances are for future pregnancies and will explain what your choices are. This is known as genetic counselling.

Monitoring and treatment for a weak cervix

If you have had a miscarriage between 14 and 24 weeks and have a diagnosis of a weak cervix, you may be offered an operation to put a stitch in your cervix. This is usually done through the vagina at 13 or 14 weeks of pregnancy under a general or spinal anaesthetic. Your doctor should discuss the surgery with you.

If it is unclear whether your late miscarriage was caused by a weak cervix, you may be offered vaginal ultrasound scans during your pregnancy to measure the length of your cervix. This may give information on how likely you are to miscarry. If your cervix is shorter than it should be before 24 weeks of pregnancy, you may be offered an operation to put a stitch in your cervix.

Surgery to the uterus

If an abnormality is found in your uterus, you may be offered an operation to correct this.

Hormone treatment

Taking progesterone or human chorionic gonadotrophin hormones early in pregnancy has been tried to prevent recurrent miscarriage. More evidence is needed to show whether this works.

Immunotherapy

Treatment to prevent or change the response of the immune system (known as immunotherapy) is not recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and may carry serious risks (including transfusion reaction, allergic shock and hepatitis).

What if no cause is found?

Where there does not appear to be a cause for recurrent miscarriage or late miscarriage, there is currently no evidence that heparin and aspirin treatment reduces the chance of a further miscarriage. For that reason this treatment is not recommended in these circumstances.

What does this mean for us in the future?

You and your partner should be seen together by a specialist health professional. Your doctor will talk to you both about your particular situation and your likelihood of having a further miscarriage and a successful pregnancy. If a cause has been found, possible treatment options will be offered to you to improve your chance of a successful pregnancy.

For couples where no cause for recurrent miscarriage has been found, 75 in 100 (75%) will have a successful pregnancy with this care. It is worth remembering that the majority of couples will have a successful pregnancy the next time even after three miscarriages in a row.

Recurrent And Late Miscarriage - Tests & Treatment For Couples!

Top 5 signs you're ready to have a baby

Most couples dream of holding their first-born in their arms. But there are others who also dread the prospect of taking such a responsibility. Some are not sure and some cannot wait. It's important to know the fact that life certainly changes forever the moment a small bundle of joy enters your life. And there are many factors involved.

If you wish to know if you and your partner are ready to have a baby, check for these points:

1. You're excited

The first sign that you need to look out for, and which points out that you're ready to start a family of your own is you're eager and excited to welcome the newest addition. Reading baby books and blogs, thinking of ideas on how to decorate the room for your baby, or keeping yourself up-to-date on the latest parenting news may be certain signs that indicate your eagerness to have a baby of your own.

2. You're financially ready

Another indication that you may be ready to welcome a baby in your family is when you have every financial aspect sorted out, including investments and savings. The ideal financial plan should be such that you're able to add to your savings as well as build up a retirement corpus while still being able to sustain the lifestyle that you and your partner would like. Most importantly, sticking to the financial plan is as important as coming up with one.

3. You can empathise

A quality that every would-be parent needs to have is empathy. The ability to put yourself in another person's shoes is vital before you can bring another human being into the world. You and your partner may have different empathy levels, which you need to know beforehand as parenting also involves empathising with your child's pain fears, needs, and worries and so on. 

4. You're ready to make a professional sacrifice

Having a baby also calls for making a professional sacrifice as looking after a baby is not an easy task. You or your partner may have to take a long break from work. It's, therefore, vital to see where you and your partner stand in your careers.

5. You have support

Having experienced people around you or people you can trust can help ease the days that usually follow on the arrival of this newest visitor. Your support could be in the form of your parents or in-laws who can look after your child while you go for work or take rest. Other support systems that you can consider are day care. 

Above all, you need to be the best version of yourself before taking on this additional responsibility.

If you would like to consult with me privately, please click on 'consult'.

Related Tip: Title: 4 Worst Foods Ever To Feed Your Baby! #ParentingBlunders

Assessment for Young Couples: Top 5 Signs You're Ready to Have a Baby

How to improve your vaginal health?

There is very little awareness or action to ensure vaginal health for women. There aren't many public discussions to be witnessed and women basically survive on whatever little they know and experience. 

Here are a few things you can do to improve your vaginal health, naturally:

1. Drink lots of water - our body is 70% water. And water alone is the cure to a lot of our basic health problems. To have a healthy vagina too, you should drink a lot of water. The science behind this is that mucous vaginal membranes need a lot of water.

2. Go nuts - almonds, flaxseeds, walnuts, hazelnuts, sunflower seeds, and such nuts should be eaten in plenty. The essential minerals in them regulate your monthly cycle and also ensure that you do not face dryness, itchiness, etc.

3. Have garlic - we all know that garlic has anti-fungal and anti-microbial properties. Eating them raw helps cure infections. Wrapping a clove of fresh garlic into gauze and making a sort of a tampon, inserting it into your vagina and leaving it overnight would actually cure itchiness, dryness and infections.

4. Try cranberry juice - cranberries (the pure form, and not the bottled ones) are known to be beneficial for the bladder. They also acidify the urine and balance the ph in your vagina.

5. Less sugar is good - sugars, wheat and alcohols should be avoided when trying to heal an infection. It is advisable to consume these products as less as possible. The sweetness from all these foods disbalance the ph level of the vagina. If you want your vagina to be healthy, avoid rich, processed and sugary foods, and eat a balanced diet with a lot of fresh fruits and vegetables.

If you would like to consult with me privately, please click on consult.

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5 Foods That Care For Your Vagina

In the course of their life, women have to go through a lot of changes and challenges that make them wiser and better at handling the circumstances that they faced. Women go through physical as well as emotional changes when they reach puberty. Also, after the menstrual cycle begins the lady has to struggle through different pre-menstrual symptoms each month. It is because of the menstrual cycle that women are able to conceive and give birth to life, which means that it can be safely said that the source of all human life is owed to the menstrual cycle of women.

It is however, seen that when the menstrual cycle comes to an end in the form of menopause and the uterus takes a retirement, the women going through menopause end up experiencing difficult times and health issues. A lot of women complain of severe mood swings, depression, increased fatigue, hot flashes, dryness in the vaginal region and even problems like osteoporosis in a lot of cases. While these may sound like deadly challenges and a lot of women may lead unhealthy lives by accepting the changes, it should be realized that the problem is treatable.

Hormone replacement therapy:
When the menstrual cycle works regularly, it ensures that the level of hormones in the body are regularised and the body does not face discomfort, but when menopause strikes the body stops making the important hormones and throws the system out of order. In order to make sure that the body remains healthy and the problems related to menopause are kept at bay, it may be important to replenish the body with the hormones and this is how the hormone replacement therapy works.

HRT or hormone replacement therapy is found to be a common medication and type of treatment in the modern times, but this does not mean that the patients may be safe by getting their treatment from just any doctor. It is particularly essential to make sure that the best gynaecologist in the field is chosen and the therapy is started only with the right expertise. The administering of the hormones may be a tricky treatment and if the patient is not in the right hands, they may fall prey to problems such as inadequate or excessive hormones, which may in turn be a source of more health issues.

Choosing your expert:
Running a simple search on the internet about how the treatment for hormone replacement should be taken and the doctors who specialize in the course of treatment may lead you to a number of reliable names. With the help of the search and a thorough study about the background and experience of the specialists so that you are able to put yourself in safe and able hands only.

Menopause - Can Hormone Replacement Therapy Help?

Frozen Embryo Transfer or FET is an extremely effective method to conceive a pregnancy. Recent studies have proved that there is a increased chance for pregnancy when the embryos, which get used are frozen and get placed inside the uterus at a time right after the ovaries are stimulated. Still, certain issues can arise with the transfer of frozen embryo, such as:

A Thin Lining of the Uterus
Research has shown that there are not many women who get pregnant if the lining in their uterine does not tend to thicken enough. It is not clear exactly why this problem occurs in most women and moreover there is no sure shot treatment to make the lining of the uterine thick. The experts on fertility would try out different methods like increasing the amount of estrogen or change the way how estrogen is given. There are other instances when women might be given supplemental medicines, while for some, the problem will continue to exist.

What Should Be Done In Case The Problem Persists?

In case the problem continues for some women, then there are certain approaches which experts might look to adopt. The first one is to cancel the transfer of embryo and try once again at any later stage, that too with a different treatment method.
The second option which they could think of is to go ahead with the transfer, wherein they might feel that a thin lining does not necessarily mean that it is impossible for a woman to get pregnant but definitely the efficiency would be reduced.
One last option is to make use of the opportunity for undergoing additional tests which would help them to assess the ability of the uterus to allow implantation of the embryos.
Unexpected Ovulation
For enabling the embryos to get implanted into uterus, placing them very precisely and at the appropriate time is important. This is regarded as the window of implantation. The time taken, is based on the time frame since progesterone reaches the lining of the uterine.

Doctor knows the exact time to place the embryos, right from the time he or she instructs a woman to start having progesterone supplements. In case a woman was to ovulate, the production of progesterone would begin earlier than the normal time and would lead to the shift of the window of implantation. As identifying the correct time of ovulation is almost impossible, so that would lead to some sort of uncertainty into the timing.

Due to this reason, there are doctors who would use medication in order to prevent unexpected ovulation from occurring. Generally an injection called Lupron is usually used as medication.

Timing for the Embryo Transfer is Inappropriate
This is a problem related to early ovulation. There are case when the implantation window is shifted, still the timing of the transfer becomes accurate. Recent studies have shown that quite a nominal percentage of women might have a window of implantation, which could be either earlier or later than normal time. A test called the Endometrial Receptivity Array can help determine at what time is the window of implantation open.

Frozen Embryo Transfer - Complications Associated With It!

Intracytoplasmic Sperm Injection i.e. ICSI is different from conventional IVF i.e. In Vitro Fertilization because a single sperm is selected by the embryologist to be injected by a needle into the egg rather than a dish with many sperms placed near the egg so that the fastest swimming sperm enters it. Once the sperm is injected directly into the egg, it fertilizes, after which the embryo is transferred into the womb or uterus. 

Your doctor might recommend ICSI treatment for you if you have an extremely low sperm count resulting in infertility or other medical sperm conditions such as poor motility or poor morphology. It may also be suggested if prior attempts at IVF procedures have failed in fertilizing the egg or the fertilization rate is extremely low. You must also consider ICSI treatment if you resort to embryo testing or if the sperm needs to be collected from the epididymis or testicles surgically. 

However, you must keep in mind that if your partner has a genetic problem resulting in low sperm count, it could be passed on to your child, if you decide to use your husband's sperm for this process.

Success Rates of ICSI:
The success rate of ICSI treatment depends on your age and your fertility problem. Your eggs are healthier when you are young and as you age, chances are that they will become less healthy.
1. 35 per cent if you are under 35 years of age
2. 29 per cent if you are between 35 to 37 years of age
3. 21 per cent if you are between 38 to 39 years of age
4. 14 per cent if you are between 40 to 42 years of age
5. 6 per cent if you are between 43 to 44 years of age
6. 5 per cent if you are above 44 years of age

Advantages of ICSI Treatment:
Intracytoplasmic Sperm Injection gives you a chance to conceive a child genetically when most other options are exhausted. Males may be unable to ejaculate on the day the eggs are collected due to anxiety. ICSI proves to be advantageous because sperm may also be surgically extracted for this process. It is extremely helpful for those couples who suffer from unexplained infertility. However, one of the most important factors is that ICSI treatment does not affect your child's physical or mental health.

Intracytoplasmic Sperm Injection (ICSI)

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