- Genetic Counselling:
If a chromosomal abnormality is identified in either partner, genetic counselling is advised. This will provide insight into the particular abnormality involved and its likelihood of causing a significant imbalance in the embryo
- Treatment for antiphospholipid syndrome:
Patients with recurrent miscarriage found to have antiphospholipid antibodies should be treated with heparin (from positive pregnancy test until at least six weeks following delivery of the baby) and daily low-dose aspirin (LDA, commencing prior to pregnancy until 34 weeks of pregnancy).
- Surgery to correct structural abnormalities of the womb:
This involves hysteroscopic surgery to remove problems that distort the womb cavity such as fibroids, polyps and a uterine septum. For more detailed information, see my sections on Hysteroscopic Surgery, Uterine Fibroids and Uterine Septum.
In around 50% of couples, full testing does not reveal an abnormality in either partner. Recent research has shown that these women benefit from using progesterone. It is important that progesterone is started at the correct time and is continued for the correct duration. Progesterone should ideally be started around the time of ovulation prior to becoming pregnant.
- Tender Loving Care (TLC):
Patients find the psychological support associated with having regular ultrasound scanning very helpful.
- Preimplantation Genetic Testing for Aneuploidy (PGT-A):
This is a genetic test that is performed on embryos produced through IVF to determine whether their chromosome make-up is normal. By selecting a chromosomally normal embryo it might be expected that PGT-A could reduce miscarriage. However, PGT-A has not been shown to help patients with recurrent miscarriage achieve a successful pregnancy any faster than trying naturally. It is possible that even though PGT-A may not shorten the time to successful pregnancy, it might reduce the number of miscarriages en route to a successful pregnancy, but this remains to be proven. There is some evidence that for women with infertility undergoing IVF (as distinct from women with recurrent miscarriage who are typically not infertile), PGT-A may be able to reduce miscarriage rates.
For a more detailed discussion of the complex issues surrounding PGT-A, please see my recently published paper.
- Cervical Cerclage:
This is a surgical stitch that is inserted to help keep the neck of the womb closed. It is very unclear whether these stitches are effective in reducing miscarriage. They may be considered for a very small subgroup of women who have late pregnancy losses (after 12 weeks of pregnancy) and in whom the neck of the womb undergoes shortening during pregnancy.
For more details on treatments for recurrent miscarriage, please refer to my recent paper.