was successfully added to your cart.
Category

Prevent Miscarriage

How the Right Diagnosis Can Prevent Miscarriage: The Top 10 Causes

By | Natural Fertility Support, Prevent Miscarriage | No Comments

If I had to choose an area of fertility medicine that is most near and dear to me, it’s working with pregnancy loss. I’m fascinated by each of my unique patients, the vast possibilities, and the ever-changing research. There’s just so much that we don’t know about what it takes to carry a baby to term. If you’re working with a fertility clinic you’ll notice there’s a whole lot of observation during the first two weeks of your cycle, and once you’ve ovulated (or post embryo transfer) there’s not much monitoring after that! Rest assured, this article isn’t about what we don’t know but rather what we can. Fifty percent of miscarriages may not have an identifiable cause, but that means 50% of them do.

Let’s go over the stats here for a moment.

Recurrent miscarriage is considered two or more consecutive miscarriages, however diagnosis and treatment is often not suggested until three consecutive miscarriages have occurred. Not because you should have to suffer, or because your doctor doesn’t care, but because there’s a 15-25% chance of any pregnancy ending in miscarriage. The most common cause of miscarriage is fetal chromosome abnormality, which is about 60% of the time. While we’re going over the terminology, a “chemical pregnancy” is considered a miscarriage before 5 weeks, however it’s still a miscarriage to me.

Factors to consider in miscarriage:

  1. Did you have an early loss in the first trimester, or a late loss in the second or even third? Different diagnoses are more likely in late pregnancy versus early pregnancy.
  2. Do you already have a child, and in trying to conceive again have a miscarriage? Having a baby already can rule out some causes of miscarriage.
  3. Do you have a family history of autoimmune, hormonal, or blood disorders? That makes some of the diagnoses more likely.

Factors NOT to consider in miscarriage:

  1. You haven’t “stressed” yourself to the point of miscarriage. I promise!
  2. Exercise is always healthy! You don’t need to avoid physical activity
  3. Progesterone, in any form, is not always the answer. A 2008 Cochrane review found prophylactic progesterone to have no effect on preventing miscarriage, more on this soon.

In my practice I don’t wait the “3-loss” rule to begin treatment and diagnosis, if you’ve experienced a loss and you want support, you deserve that support right away.

Now let’s get into my Top 10 Most Common Causes of Miscarriage. The majority of the list can be diagnosed with blood work or imaging. The entirety of the list can be treated!

  1. Anti-phospholipid syndrome (and other causes of poor placental perfusion)

    This is a syndrome where antibodies attack components of your blood vessels. Anti-phospholipid antibodies include: lupus anticoagulant, anticardiolipin antibody, and anti-B2 glycoprotein. These antibodies interfere with uterine blood flow, more specifically the development of the trophoblast, which are the cells that form the placenta.

    .

  2. PCOS

    The foundation of PCOS is insulin resistance, which interferes with ovulation, follicle maturation, and maintaining a pregnancy. Insulin resistance, and the corresponding hormonal imbalances, cause poor egg quality, pelvic inflammation, and progesterone deficiency – all which contribute to miscarriage. I will add that metformin has not been found to be beneficial in preventing miscarriage in PCOS, but there are many naturopathic therapies that have!

    .

  3. Chromosome translocation (it’s not all about the woman!)

    This genetic condition can occur in men or women. If you have a chromosome translocation you won’t have any signs or symptoms, but some of the gametes you produce (i.e. egg or sperm) will also have the translocation. Unfortunately, if you’re conceiving naturally it’s a game of chance as to whether or not you will produce a viable embryo. IVF with PGS (pre-implantation genetic screening) can determine whether your embryo has a viable number of chromosomes.

    .

  4. Hypothyroidism & thyroid antibodies

    TSH greater than 4.0 during pregnancy is associated with miscarriage, preterm birth, premature rupture of membranes, and placental detachment. Thyroid peroxidase antibody, found in Hashimoto’s thyroiditis, causes similar outcomes.

    .

  5. Anatomical causes: fibroids, polyps, uterine malformations, cervix incompetence

    Anatomical issues are more commonly at play during second trimester losses, and the outcome depends greatly on the location of the finding. I won’t go into the details here as they are easily diagnosed, and quite obvious, through imaging and pelvic exam.

    .

  6. Poor quality sperm (it’s not all about the woman!)

    The best test for measuring sperm quality is called sperm DNA fragmentation. Greater than 25% fragmented DNA indicates poor quality. In my experience, beyond lifestyle factors like diet and recreational drug use, medications are the most common culprit of increased DNA fragmentation. Anti-depressant medication, specifically SSRIs, cause statistically significant increases in DNA fragmentation as well as miscarriage.

    .

  7. Poor quality egg

    If only we had a test for egg quality like we do sperm quality! Age is the number one predictor for egg quality, steadily declining after age 35 – lucky us! But don’t worry, there’s lots that can be done!

    .

  8. Vitamin D deficiency

    One prospective cohort study identified vitamin D deficiency as a risk factor for miscarriage, preterm birth, and low birth weight. Adequate vitamin D levels, hard to come by in gloomy Canada, are extremely important when it comes to reproductive health. 1 nmol increase in serum vitamin D levels decreases miscarriage rate by 1%. Testing is clearly imperative!

    .

  9. Inflammation & oxidative stress

    Conditions like PCOS, listed above, and endometriosis cause increased uterine inflammation and oxidative stress. Inflammation can also be elevated in the presence of other autoimmune diseases during pregnancy. However, there is significant research on specific anti-inflammatories and antioxidants increasing live birth rate and preventing miscarriage in these scenarios!

    .

  10. Progesterone deficiency & hyperprolactinemia

    As I’ve already suggested in this article, progesterone supplementation only appears to be helpful when there is a progesterone deficiency. High dose progesterone supplementation is all too common and I often see the extremely uncomfortable side effects in my patients. It may be indicated in cases of recurrent miscarriage. I’ll also mention hyperprolactinemia here as elevated prolactin levels can suppress progesterone production and lead to deficiency.

Honorable mentions:

  1. MTHFR deficiency & elevated homocysteine

    MTHFR deficiency refers to a mutation in the gene “MTHFR”, responsible for metabolizing folate (a vitamin found in your prenatal supplement to prevent spina bifida). When folate is not metabolized properly, a build up of an amino acid called homocysteine results. Elevated homocysteine can cause blood clotting and inhibit uterine and placental blood flow.

    .

  2. Immunological cause

    I’m going to throw out some pretty fancy terms here: HLA incompatibility, anti-paternal antibodies, and natural killer cells. They’re all terms for potential immunological conditions that cause miscarriage, meaning the woman’s immune system is attacking the embryo. Currently there’s insignificant research to suggest any of the above cause miscarriage, and the treatment is theoretical as well.

    .

  3. Vaginal infection

    I’ve noticed many fertility clinics test for ureaplasma and mycoplasma, and treat both partners with antibiotics if present. There is no clear data that these infections cause miscarriage. I have mixed feelings about the results, as there are often comorbidities present in my patients who have been treated for these infections. However, untreated bacterial vaginosis can indeed cause early miscarriage.

As I mentioned previously, I wouldn’t provide you with this information if there were not ways to diagnose and treat the possibilities. You have options! Just book an appointment with me and let’s get started.

References
Iqbal, S., Ghani, F., & Qureshi, R. (2016). Frequency of Thyroid Peroxidase Antibody and its Association with Miscarriages Among Pregnant Women. Journal of the College of Physicians and Surgeons Pakistan26(10), 831-834.
Sundermann, A. C., Edwards, D. R. V., Bray, M. J., Jones, S. H., Latham, S. M., & Hartmann, K. E. (2017). Leiomyomas in pregnancy and spontaneous abortion: A systematic review and meta-analysis. Obstetrics & Gynecology130(5), 1065-1072.
Bärebring, L., Bullarbo, M., Glantz, A., Hulthén, L., Ellis, J., Jagner, Å., … & Augustin, H. (2018). Trajectory of vitamin D status during pregnancy in relation to neonatal birth size and fetal survival: a prospective cohort study. BMC pregnancy and childbirth18(1), 51.
Loss, E. P. PRACTICE BULLETIN.
EVALUATE, W. (2012). Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertility and Sterility98(5).
El Hachem, H., Crepaux, V., May-Panloup, P., Descamps, P., Legendre, G., & Bouet, P.-E. (2017). Recurrent pregnancy loss: current perspectives. International Journal of Women’s Health9, 331–345. http://doi.org/10.2147/IJWH.S100817
No, G. T. G. (2011). The investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage. April 2011.
Haas, D. M., & Ramsey, P. S. (2008). Progestogen for preventing miscarriage. Cochrane Database Syst Rev2.

5 Natural & Effective Ways to Increase Uterine Lining Thickness

By | Fertility Acupuncture, Fertility Supplements, Natural Fertility Support, Prevent Miscarriage | No Comments

During natural cycles, cycle monitoring, IUI, IVF & FET

Uterine (or endometrial) lining thickness is a useful predictor of embryo implantation and miscarriage prevention. It is measured via ultrasound during cycle monitoring, IUI, IVF, and frozen embryo transfers. A thin lining can halt the entire fertility process, and not seeing any growth in thickness, despite medical efforts, can be really frustrating.

The Lining “Norm”


Uterine lining thickness varies depending on the phase of your menstrual cycle and hormonal influence.

On your period: 2-4mm

Follicular phase (before ovulation): 5-7mm

Ovulatory phase: 7-11mm

Luteal phase (after ovulation): up to 16mm

A lining < 8mm is associated with implantation failure, poor receptivity, and low pregnancy rates. The numbers aren’t the only measurement that matters. The endometrial pattern is also relevant; the most receptive lining is called triple-line or tri-laminar (due to its 3 layer appearance).

The most common pharmaceutical approach to a thin lining is supplementation with synthetic hormones; conjugated estrogen, progestin, or a combination of both like the oral contraceptive pill. Viagra is also used to increase pelvic blood flow (it ain’t just for men!) Not all women respond to these options, but thankfully there are natural alternatives. Naturopathic medicine and fertility supplements can be used in conjunction with hormones or alone to optimize your lining.

  1. Vitamin E

    .

    A 2017 study showed that 12 weeks of low-dose vitamin E supplementation in women with prior implantation failure increased endometrial thickness by 2mm and decreased inflammatory cytokines.

    .

  2. L-Arginine

    .

    A pilot study in 2010 used high-dose L-arginine to increase endometrial thickness and pelvic blood flow.

    .

  3. N-Acetyl-Cysteine

    .

    NAC is a super-fantastic-marvelous supplement. It has proven to improve endometrial thickness (pertinent here) as well as: induce ovulation, recruit mature follicles, reduce insulin sensitivity, and break down endometriomas! Woah!

    .

  4. Fruit: lemon, lime, orange, pomegranate, watermelon

    .

    What do all of these fruits have in common? They are nitric oxide producers. Nitric oxide dilates your blood vessels so more blood can be delivered to your uterus to build up that lining. Viagra works the same way, which means pomegranates are nature’s Viagra!

    .

  5. Acupuncture (including electro-acupuncture)

    .

    Fertility acupuncture is used to support embryo implantation and promote pelvic blood flow. It supports endometrial thickness by reducing stress on the uterine artery. Multiple studies have shown a statistically significant increase in pregnancy rates with acupuncture before embryo transfer and on the day of transfer.

When all else fails, remember that lifestyle makes a huge difference! Simple strategies like drinking at least 2L of water daily and moving your body with gravity can increase endometrial thickness.

Book an appointment to support your uterine lining!

References:

Jimenez, P. T., Schon, S. B., Odem, R. R., Ratts, V. S., & Jungheim, E. S. (2013). A retrospective cross-sectional study: fresh cycle endometrial thickness is a sensitive predictor of inadequate endometrial thickness in frozen embryo transfer cycles. Reproductive Biology and Endocrinology11(1), 35.

Zhao, J., Zhang, Q., & Li, Y. (2012). The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles. Reproductive Biology and Endocrinology10(1), 100.

Al-Ghamdi, A., Coskun, S., Al-Hassan, S., Al-Rejjal, R., & Awartani, K. (2008). The correlation between endometrial thickness and outcome of in vitro fertilization and embryo transfer (IVF-ET) outcome. Reproductive Biology and Endocrinology6(1), 37.

Hashemi, Z., Sharifi, N., Khani, B., Aghadavod, E., & Asemi, Z. (2017). The effects of vitamin E supplementation on endometrial thickness, and gene expression of vascular endothelial growth factor and inflammatory cytokines among women with implantation failure. The Journal of Maternal-Fetal & Neonatal Medicine, 1-8.

Takasaki, A., Tamura, H., Miwa, I., Taketani, T., Shimamura, K., & Sugino, N. (2010). Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertility and sterility93(6), 1851-1858.

Nasr, A. (2010). Effect of N-acetyl-cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study. Reproductive biomedicine online20(3), 403-409.

di Villahermosa, D. I. M., dos Santos, L. G., Nogueira, M. B., Vilarino, F. L., & Barbosa, C. P. (2013). Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial. Acupuncture in Medicine31(2), 157-161.