Miscarriage

Miscarriage

Miscarriage can be devastating for couples especially when they have experienced several miscarriages and don’t have a clear understanding as to why this is happening.

The normal rate of miscarriage in young women is approximately 12% with the rate rising with increasing age, the number of previous pregnancies as well as the number of previous miscarriages. Approximately 12-15% of pregnancies will end in miscarriage and approximately 80% of these occurring before 12 weeks.

Some of the main reason for miscarriage are:

Low progesterone

Progesterone is a female reproductive hormone that is produced in the ovaries after you ovulate. It is essential for implantation and maintenance of the pregnancy. It is also important as it prepares a woman’s immune system for a pregnancy.

Signs that you might have low progesterone are that you have a short cycle or get premenstrual spotting or you may get PMS symptoms such as irritability, insomnia and sore breasts.

Low progesterone can be caused by a stressful lifestyle, poor diet and oxidative stress. You may also be deficient in certain nutrients including Vitamin D, Vitamin B6, selenium and magnesium, which are important for making progesterone.

Thyroid autoimmunity

Normal thyroid functioning is essential for a healthy pregnancy. Subclinical hypothyroidism and hyperthyroidism during pregnancy are both associated with an increased rate of miscarriage.

Furthermore, the presences of thyroid antibodies such as thyroid peroxidase-specific antibody (TPOAb) and/or thyroglobulin-specific antibody (TgAb) that are present in Hashimotos or Graves Disease are also associated with increased risk of miscarriage. This is even the case for women undergoing IVF.

It is important to know that your thyroid levels might seem normal in a blood test but that does not necessarily mean that you don’t have thyroid antibodies. Antibodies can occur due to infections, food allergies or intolerances, intestinal dysbiosis (imbalance between good gut flora and bad gut flora), leaky gut and exposure to environmental toxins.

MTHFR gene mutation

There is a strong association between carries of the MTHFR gene mutation in both men and women and recurrent miscarriage. Yes, a man with the MTHR gene can cause miscarriage in a woman!

The MTHFR gene is involved in converting folate (from food) into the active form 5-methyltetrahydrofolate, which is the form the body uses for important processes such as DNA replication and detoxification. Proper replication of DNA is essential for cells to grow during pregnancy. If this does not occur, early miscarriage (under 12 weeks) may result.

It is common for those with the MTHF gene to have high levels of homocysteine, which can cause blood clotting. When a blood clot develops in the uterus the placenta can become cut off from the important supply of oxygen and nutrients that the baby needs to survive.

If you do have the MTHFR gene it is very important to do 4 months of preconception care (link) to ensure you have adequate amounts of folate and good homocysteine levels for pregnancy.

References

Di Renzo GC, Giardina I, Clerici G, Brillo E, Gerli S. Progesterone in normal and pathological pregnancy. Hormone Molecular Biology & Clinical Investigation. 2016

Lin C, Xiang Y, Li J. The contribution of thyroid autoimmunity to miscarriage in euthyroid women. Minerva Medica. 2016

Toulis KA, Goulis DG, Venetis CA, Kolibianakis EM, Negro R, Tarlatzis BC, Papadimas I. Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. European Journal of Endocrinology, 2010

Stagnaro-Green A, Pearce E. Thyroid disorders in pregnancy. Nature Reviews Endocrinology. 2012

Villar J et al. ‘Evidenced-based reproductive health in developing countries. The WHO Reproductive Library No. 8, Geneva, WHO

Shi X, Xie X, Jia Y, Li S. Maternal genetic polymorphisms and unexplained recurrent miscarriage: a systematic review and meta-analysis. Clinical Genetics. 2017

Tara SS et al, Methylenetetrahydrofolate Reductase C677T and A1298C Polymorphisms in Male Partners of Recurrent Miscarriage Couples. Journal of Reproduction & Infertility. 2015

Bugge, R.N.C.,a Jason G. Bromer, M.D.,b and Michael J. Levy, M.D, Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos, American Society for Reproductive Medicine. 2007