Treatments for recurrent miscarriages may include changes to your diet, prescription drugs, surgery, or genetic testing to improve the chances of a successful pregnancy.
Miscarriage happens when your pregnancy is no longer viable. It is also called spontaneous abortion, because the pregnancy is terminated without using any medical or mechanical intervention.
Miscarriage happens in about 10%–15% of all pregnancies, and about 80% happens during the first trimester, before the 12th week of pregnancy.
Threatened miscarriage is not the focus of this article but we want to clearly define it here.
A threatened miscarriage is when a newly pregnancy woman in her first trimester experiences period-like cramps or begins to bleed vaginally. This is understandably very scary to experience, and is a legitimate concern from a women health point of view. Less than 20% of threatened miscarriages end up as miscarriages; more than 80% proceed into the second trimester
We treat threatened miscarriage at Soma Clinic. You can find out more at Soma threatened miscarriage.
When you have experienced three or more consecutive miscarriages, this is when you receive the diagnosis of recurrent miscarriage or recurring pregnancy loss (RPL). It is very frustrating to miscarry repeatedly, and it doesn’t help that your risk of miscarrying yet again increases as you age.
Recurrent Pregnancy Loss (RPL) is a deeply concerning issue, and we want to empower you with knowledge from both biomedicine and Chinese medicine to make informed decisions about your health and future attempts to conceive.
In TCM, we talk about the “stirring fetus” (胎动不安), and there is often mention of obvious signs of Fire like that seen during a threatened miscarriage.
However, it is just as common to have the fetal not develop, as corroborated by fetal size and heartbeat, WITHOUT any apparent signs of Fire.
If you are seeking an option that is beyond bedrest, watchful waiting, and even more progesterone, do consider Chinese Medicine.
Recurrent Pregnancy Loss (RPL) is a medical label that requires 2 pregnancy losses to confirm that it is indeed possibly recurrent. The definition of RPL used to require 3 pregnancy losses but this definition has be prudently discard in favor of 2.
Each pregnancy loss is a distressing experience that can result from various factors, both genetic and non-genetic. It is possible after one pregnancy loss that the next pregnancy is viable to term.
It is also possible that there is a pattern. E.g. for some women it would be the 8th week mark where she finds out if the existing fetus will or will not survive.
It is paramount that you consult with a reproductive endocrinologist or an autoimmune fertility specialist to undergo a thorough medical evaluation. These might include:
We lay out below some possible factors to be looking out for:
A history of recurrent missed miscarriages requires diagnosis and management. A variety of tests are carried out on the mother and father in an effort to pinpoint the cause. There are many causes of recurrent miscarriage in a woman. Possible factors that could explain your repeated miscarriages include:
Some women may have an abnormally shaped uterus from birth, and some women may experience progressive uterine abnormalities. These are all causes of infertility and RPL due to structural causes.
Recurrent pregnancy loss may also be influenced by a woman’s immune system. Hormonal imbalances, genetic abnormalities, and uterine issues are some of the most frequently identified causes.
Inflammation or inadequate blood flow to the womb during pregnancy may be another cause of the miscarriage (read on to find out how you can get treatment for this using Chinese herbs).
While you cannot stop miscarriages, you can make healthy pregnancy choices. Some choices include (1) pregenetic testing, (2) supplementing with progesterone and (2) using Chinese medicine.
If you have access to assisted reproductive technologies (ART) like IVF, then you may also have access to PGD or PGT-A. This allows you to bypass possible miscarriages due to genetic reasons.
Several small trials on progesterone for recurrent miscarriage protocol have suggested that progesterone supplementation and inserts to reduce the risk of pregnancy losses in women with recurrent or threatened miscarriages.
This form of intervention is already routine in most clinics and may not help to prevent a miscarriage, especially if the cause is due to clotting disorders.
Most pregnancies end in miscarriage because of problems with the fetus. Chinese herbs won’t be able to prevent such a situation. However, Chinese herbs can be useful as an adjunct treatment to enhance microcirculation and possibly increase blood flow to the fetus.
When a recurrent miscarriage is not due to uterine abnormalities, thyroid disorders or genetic reasons, it is very important to explore clotting disorders.
This is especially so if two consecutive pregnancy losses happen at the same time e.g. at week 10. It could be a pattern of reduced blood flow and oxygen to the fetus and subsequent fetal growth restriction leading to no more heartbeat.
In these cases, no amount of lifestyle changes may be sufficient, and supplements and Chinese herbs may be a hit and miss. Sometimes, even routine employment of baby aspirin and heparin to thin the blood may not be enough.
If you are told by your gynecologist obstetrician that there is not fetal heartbeat, or that beta-hcg levels are not where they are supposed to be, the usual thing is to wait for the tissue to pass.
This is a very sensitive time, and there may be decisions to make like:
We also have patients writing in to ask about how Chinese medicine and acupuncture can help. The main reason to consider Chinese herbs and acupuncture is when you have decided to complete the miscarriage and you want to do so in a more gentle way.
At Soma Clinic, we have been supporting patients in this area. We also support patients after the miscarriage is complete, to ensure that there is ample circulation and healing in the uterus.
Depending on which stage in the pregnancy you are in, you may want to choose from the following:
All of the abovementioned choices can be used together. The aim is to expedite clearance of retained products of conception (RPOC) from your womb
It is very helpful to use Chinese herbs that enhance circulation in the pelvis and reproductive areas once a miscarriage is complete. A common formulation is called Sheng Hua Tang, which has the following effects:
You may not want to think about this during this time of intense grieving, but it is important to consider:
This is often neglected, but two important decisions to make are:
Substantial research has been done to inform us about how the key components of Sheng Hua Tang may help with clearing the uterus and accelerating recovery:
When Sheng Hua Tang is used in treating postpartum women, it is able to increase contractile activity of the uterus. It also facilitates uterine involution and helps the uterus in returning to its anteverted position. In dairy cows, Sheng Hua Tang increases myoelectrical activity of the uterus after calving. On top of that, it promotes endometrial involution and early discharge of uterine fluid.
What is even more amazing is this: Sheng Hua Tang caused the first postpartum ovulation to occur earlier than in control, which may be an early index for recovery of normal ovarian function and subsequent reproductive performance the context of fertility after miscarriage. In high producing dairy cows SHD promotes uterine involution and ovarian activity in postpartum dairy cows
Intervention to induce medical abortion includes the use of mifepristone and misoprostol. When Sheng Hua Tang was also used, the result was improved outcome in the following parameters:
If you use Sheng Hua Tang after early medical abortion, it can accelerate uterine involution by improving successful abortion, shortening duration of bleeding and induction-abortion time, and speeding up menstrual recovery time.
This is likely due to
More than that, it is the inflammation piece that TCM may be more helpful with, which is why the five herbs in Sheng Hua Tang is never going to be enough.
These are some other considerations we have in mind, so as to improve outcomes after miscarriage:
For patients recovering from miscarriage, whether recurrent or for the first time, the first phase is recovery of the uterus.
Subsequently, the focus will be on building up the body, enhancing circulation and regulating hormonal function. More on this is covered in the Use of Herbs for Confinement.
If you have a recurrent miscarriage, you should know that the TCM doctor at Soma Clinic understands the emotional toll of pregnancy loss. Dr. Mark is dedicated to supporting you through the challenges, finding the cause, and helping you have a healthy baby. If you’ve had recurrent miscarriages in Singapore, please schedule a consultation and let an expert help you overcome recurrent pregnancy loss.
Low thyroid hormone levels can potentially prevent women from getting pregnant or lead to miscarriages. A women with low thyroid levels can also be tested for antibodies which may then diagnose her with autoimmune hypothyroidism, also called Hashimotos.
There are many presentations of hypothyroidism that resemble pregnant symptoms. For instance, both share the same symptoms of weariness, weight gain, and irregular periods.
The converse is also true, that an over-active thyroid can be a risk factor for infertility and recurrent baby loss. When there is an autoimmune component to an over-active thyroid, it is called autoimmune hyperthyroidism or Graves.
Endometriosis, which affects one in ten women and results in inflammation and lesions inside the womb lining, is a common risk factor for recurrent miscarriages.
This condition is complex, and biomedical treatment is usually through drugs to suppress hormones or surgery (which has better outcomes).
Miscarriage risk may also be increased by exposure to specific chemicals, medications, x-rays, etc. Some of these elements have to do with your job, while others can have to do with your way of life. Both partners’ excessive consumption of alcohol, caffeine, and tobacco (both first- and second-hand) may have an effect on the pregnancy’s outcome.
A low-dose aspirin tablet, also called baby aspirin, is 81mg, although it can vary from 75 to 100mg.
This is the first line of medicine for pregnant women with antiphospholipid syndrome, a disorder marked by recurrent miscarriages.
Those with positive Anti-phospholipid antibodies will also use another blood thinner called heparin.
It is difficult to determine what the possible causes of RPL are on a case by case basis. Every is different and even women with RPL go on to conceive a healthy baby.
The first thing you should consider doing is to see an autoimmune fertility specialist. This specialist will do a panel of autoimmune tests on you and consult with you on adding on use of blood thinners, steroids as well as intralipids.
The next thing to consider is regular acupuncture to help with hormonal balance, immune regulation as well as circulation to the pelvic. It is important for some patients to also consider the use of Chinese herbs for regulating immunity.
We do a fantastic job of assisting you if you are trying to conceive, are pregnant, or experiencing challenges after birth.
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