Miscarriage Myths

Miscarriages affect 25% of all pregnancies and  1 in 3 pregnancies for women over the age of 40. Though these figures are already quite shocking,  we actually think this figure is much higher since most miscarriages go unreported. For something so common we are wildly uneducated on the subject and so I wanted to give you some examples of the types of conversations I have during a consultation to put some of those myths to bed!


Me: Is your partner not joining us for the consultation? 
Patient: No. I have miscarriages and so it’s obviously just a problem with me. 
Me: At this point in time, knowing nothing more about your case, there’s at least a 50% chance the miscarriages are due to a paternal factor.

The reality is that first trimester miscarriages are now more likely to be due to a paternal factor than maternal since we have seen a steady and dramatic decline in semen parameters in recent years. 

Read this article to understand more about plummeting semen parameters: http://www.verityallenacupuncture.com/blog/the-reason-why-the-handmaids-tale-gave-me-sleepless-nights 

My first port of call, when a patient has had a miscarriage is to test the sperm. This will include a basic semen analysis to give us an idea of count, motility and morphology. If the basic test is below average I will also run a Sperm DNA Fragmentation test to check the genetic robustness of the sperm. 

You can read more about sperm DNA fragmentation here: http://www.verityallenacupuncture.com/blog/could-it-be-sperm-dna-fragmentation 


Patient: It can’t be a problem with my thyroid. I had a blood test and the TSH was normal.
Me: Can you give me your TSH level?
Patient: It’s 2.56 
Me: That’s too high for pregnancy. 
Patient: But the GP and fertility consultant said that’s fine. 
Me: The British Thyroid Foundation advise that a person planning a pregnancy should have a TSH below 2.5. And actually my view, which is shared by thyroid experts in the know, is that the TSH should be below 2. 

I've lost count of the amount of pregnancies that have been lost to unstable thyroids… It is my absolute biggest frustration, not to mention the saddest. Especially as it’s one that can so easily be avoided with the right care and attention. 

America, Australia and most European countries work to get a TSH to below 2. But in this country the NICE guidelines changed their stance several years ago so that they have lumped women of all age groups into one category. Therefore you could be a menopausal woman or a 20 year old and in the eyes of the NHS you should be treated no differently. This is why your “normal” TSH reading of 3.76 might be normal for a 50 year old but certainly isn’t optimal for a woman in her fertile years. 

Therefore your UK NHS fertility consultant might not be willing to help you in creating a stable thyroid but go anywhere else in the world and you would likely be given different attention. 

Cue me… who can’t help but send that nagging email asking that we run thyroid bloods before a planned transfer, or immediately after a positive pregnancy test. I’ve seen too many lost pregnancies that all could have been avoided to throw caution to the wind! 

And, if you needed any further encouragement to check those levels, having an elevated TSH in pregnancy has been shown to have detrimental effects on foetal brain development. “Recent evidence suggests that even more moderate forms of maternal thyroid dysfunction, particularly during early gestation, may have a long-lasting influence on child cognitive development and risk of neurodevelopmental disorders. Moreover, these observed alterations appear to be largely irreversible after birth.” (Moog et al, 2015)


Patient: I know I’m being silly even trying. Clearly my eggs are just too old. 
Me: It’s possible that your eggs are too old but it’s also entirely possible there are other reasons, not linked to your age. 

I see so many women who seek our help in trying to conceive, looking sheepish and embarrassed that they’re even toying with the idea of a pregnancy at 40. 

Yes, for some, age matters. But for others you can have a bigger and better quality egg supply than some 30 year olds. Basic blood tests and a simple ultrasound scan can give us a good understanding of the state of play. 

As Dr Shanna Swan so starkly wrote in her book, Countdown: 
Nowadays, women in their 20s are less fertile than their grandmothers were at 35. 

Therefore, you will find that some women’s fertility has been greatly affected by poor fertile genes, environmental factors, poor diet, being born prematurely, etc. And some women have been blessed with very good fertility longevity. 

Therefore my stance is that age is just a number. Let’s see what’s going on from the inside out before we make a call on your pregnancy options. 

It’s also worth noting that if you have been diagnosed with PCOS you will, on average, enter menopause two years later than your non-PCOS counterparts. 

In contrast, if you were born prematurely, it is more likely you will hit the menopause earlier than had you been born at term. 


Patient: We’ve been struggling with recurrent miscarriage and so we’re just going to pay for a round of IVF and I heard acupuncture can help with that. 
Me: Yes acupuncture does help with that. It can improve the live birth rate by 65%. However, having IVF doesn’t decrease the chance of you having another miscarriage. 

It’s a common misconception, and at present there is not enough evidence to suggest that IVF improves live birth outcomes when there is a background of recurrent miscarriage. (Kirschenbaum & Orvieto, 2019) 

Where IVF can be useful is in pre-genetic screening. This is where the embryos are sent off for testing to check for chromosomal abnormalities before they are transferred to the mother. It’s a fantastic advancement in reproductive science however, one would argue that a simple blood test, before going through the rigmarole of IVF would be a more sensible, not to mention cheaper option! 

Again… go to any clinic abroad and you would be offered karyotyping blood testing as standard before engaging in any talks of IVF. In this Country it’s so often IVF first, ask questions later. 

Top tip: Head over to IVF Matters for a UK clinic who refreshingly present IVF after exploring whether less invasive options might be all that are needed. 

You can read more about balanced translocations, karyotyping and PGS testing here: http://www.verityallenacupuncture.com/blog/balanced-translocation-ever-heard-of-it 



Patient: I keep getting chemical pregnancies. It’s very unclear when I ovulate so we just try all the time. 
Me: It’s possible you ovulate twice in a month. 
Patient: I didn’t think that was possible? 
Me: Yes. Studies suggest that women can ovulate twice or even three times a month, which is why the rhythm method for contraception is fraught with complications! 

Pop into any Google search or speak to most doctors and they will tell you it’s not possible to ovulate twice in a month. But if that’s true, why are we told not to use the rhythm method as a form of contraception? 

Canadian researchers decided to pick this apart… In their study of 50 women, who all had ‘normal’ cycles, 68% of them exhibited two waves of follicle development, and 32% exhibited three waves. 

“Dr Roger Pierson, director of the reproductive biology research unit at the University of Saskatchewan, who led the study, said 40% of the subjects had the clear biological potential to produce more than one egg in a single month. Moreover, they could be fertile at any time of the month.”

“Professor Robert Winston, head of the department of reproductive medicine at the Hammersmith Hospital in London, said the findings were “logical and not altogether surprising.””

My advice to these women is to abstain from unprotected sex until day 14 so that they are not trying to fertilise an immature egg. By day 14 any eggs released should be mature and therefore more viable. 


Discussion
I hope you’ve found these examples useful? 

Of course, there are a myriad of reasons why miscarriages happen. It’s my job to run the right diagnostics to understand why and put the necessary actions in place to avoid it from happening again. This is why our live birth rates for those of our patients with recurrent miscarriage is so high at 78%, according to our 2017/18 clinical audit. (http://www.verityallenacupuncture.com/birth-rates--statistics.html)

We ask questions first, run the necessary diagnostics, spend time optimising your combined fertility before we give you the green light to start trying to conceive again. 

We repeat diagnostics and support you with acupuncture throughout those anxiety-inducing first weeks of pregnancy. It’s a method we’ve been putting into practice for nearly a decade and we have it running like a well-oiled machine so that we know exactly what you need and when you need it. 

Plus, our associates and myself are always on hand to offer emotional support when you need it the most so that you can feel that both body and mind are in safe hands. 


References: 

Moog et al, 2015, Influence of maternal thyroid hormones curing gestation on fatal brain development.   [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819012/]


Swan, 2020, Countdown: How our modern world is threatening sperm counts, altering male and female reproductive development and imperilling the future of the human race.


Kirschenbaum & Orvieto, 2019, Should we offer in vitro fertilisation to couples with unexplained recurrent pregnancy loss? [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912379/]


Baerwald, Adams & Pierson, 2003, A new model for ovarian follicular development during the human menstrual cycle. [https://pubmed.ncbi.nlm.nih.gov/12849812/]


Dyer, British Medical Journal, 2003, Women may ovulate two or three times a month. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126506/]