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Recurrent Miscarriages and Pregnancy Loss: Treatment Options in Ottawa

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Recurrent pregnancy loss is perhaps the most challenging condition to go through. The frustration and pain of a loss is unbearable for many Women. When working with recurrent miscarriage, the only method with which we treat this is the "leave no stone unturned" approach. There are so many variables and factors which can increase the risk of a miscarriage, so we approach every single one possible to help maximize the chances of a healthy pregnancy for patients.

Common Factors Increasing the Risk of Miscarriage

1. Thin Uterine lining: a healthy uterine lining is a must to help support implantation. And a thin uterine lining, especially early in the pregnancy, can contribute to an increased risk for miscarriage. The uterine lining can be support with the use of various nutrients and supplements which have shown in early research trials to support a healthier and thicker uterine lining. Additionally, the use of fertility acupuncture has been shown to help improve blood flow to the reproductive organs and support implantation rates for fertility treatments.

2. Elevated Sperm DNA Fragmentation: elevated sperm DNA fragmentation is often undiagnosed. Simply because this is a test that is not performed by many doctors until there is a significant history of miscarriages, and even then sometimes it is missed. It is a relatively cheap test which checks to see what percentage of the DNA in a sperm sample is fragmented (hairline fractures in the DNA). The best thing about DNA fragmentation, is that its treatment is usually straightforward: diet and lifestyle changes along with specific high dose antioxidants are extremely valuable in treating this issue.

3. Low Progesterone: progesterone is absolutely vital to supporting a healthy pregnancy. When deficient or low, the likelihood of having early spotting and a miscarriage increases significantly. The progesterone helps to keep the uterine lining (where the embryo implanted) healthy and well perfused with nutrient rich blood.

4. Low Egg Quality: low ovarian reserve increases the risk of low egg quality. And follicles of suboptimal quality may have a higher risk for miscarriage.

5. Low Vitamin D: Vitamin D is such a simple treatment, that it often goes unchecked. In fact, clinical trials have shown that low vitamin D increases the risk of miscarriage significantly compared to Women with optimal Vitamin D levels. The Vitamin D also is important for IVF success and supporting healthy hormone function and production.

6. Suboptimal Thyroid Function: even when thyroid stimulating hormone (TSH) is normal, some Women still have symptoms of under-functioning thyroid. Some more detailed tests are important in this case, particularly, looking at reverse T3, free T3, and free T4. If reverse T3 is elevated, it means your body is producing a form of the thyroid hormone which is not beneficial to support fertility and a healthy pregnancy. It is a relatively inert form of the actual T3 hormone.

7. Elevated Androgen: elevated androgen hormones can increase the likelihood of miscarriage. A common example is polycystic ovarian syndrome (PCOS), where the elevated androgen hormone levels have been observed to increase the risk of miscarriage during early pregnancy. This is a result of the impact the androgen hormone has on the uterus.

8. Uterine fibroids: types of fibroids will vary based on their location in the uterus. Submucosal fibroids grow in such a way that they can impinge on the internal uterine cavity and make it difficult for a baby to grow in a healthy uterine environment as it reduces space for the baby. Some research has shown that even polyps can reduce the chances of implantation and a successful pregnancy.

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Treatment Options for  Unexplained Infertility

1. Fertility Acupuncture: Specific acupuncture protocols, as studied in clinical trials, have been shown to help reduce the risk of miscarriage symptoms. It works by improving the blood flow to the uterus and keeping the lining healthy and thick, it support relaxation, it reduces the risk of uterine muscular cramps, and improve hormone function and balance during pregnancy. Trials have shown that using fertility acupuncture seem to significantly reduce the risk of miscarriage, especially during the first trimester.

2. Clinical Nutritional Supplements: nutritional supplements in their correct doses significantly improve the quality of sperm cells and egg cells. By improving their integrity, we support healthy DNA expression and this can reduce the risk of miscarriages. This is particularly true for patients with elevated sperm DNA fragmentation rates.

3. Hormone Replacement with Progesterone: Bioidentical progesterone supplementation, helps to improve concentration of progesterone in the uterus by up to 30x! New scientific reviews published in 2018 showed that using a progesterone suppository during until week 10 of pregnancy significantly reduces the risk of miscarriage in Women with recurrent miscarriages, especially when the cause of the miscarriages is undiagnosed/unknown. 

4. Diet & Lifestyle: supporting patients achieve a healthy weight, reducing unhealthy habits, such as cannabis and tobacco use, and choosing healthy dietary choices support overall fertility and may be beneficial in reducing the risk of miscarriages as well. 

5. Vitamin D Injections: The supplementation of Vitamin D with drops or capsules is a slow process and a mother who has low levels will need a few months to help get those levels up. The delivery of a high dose of Vitamin D by an intramuscular injection is helpful in increasing the levels circulating in the blood much more quickly. The optimal Vitamin D levels are important for supporting IVF success rates as well as reducing the risk of miscarriage for Women going through IVF, IUI, or ICSI.

6. Botanical Formulas: can be helpful in restoring hormone balance during the prenatal period and supporting optimal health prior to conceiving. This includes supporting healthier ovulation, progesterone production, decreasing excess androgen hormone production, and decreasing stress levels (and the levels of the hormone cortisol).

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