OK, you might have been referred already having had some tests, or else you might not have had any. At this clinic we can do a whole range of investigations working through your physiology, hormones and finally your immune system. The tests will enable us to establish exactly what is causing you to miscarry and what treatment we can best provide you with.
The following is a list of some of the possible causes of your miscarriage and their occurrence in the population.
(please note that the total percentage does not add up to 100% as the ranges quoted are from different studies)
| Cause | Percent |
| Immune mechanisms | 50% |
| Hormonal | 20% |
| Thrombophilias (blood disorders) | 10-13% |
| Anatomy | 5-10% |
| Chromosome abnormality | - |
| • Primary miscarrier (no live births) | 7% |
| • Secondary miscarrier (one or more live births) | 50% |
| Infection | 1% |
| Unknown | 15% |
The fetus contains foreign genetic material coming from the father, but in normal circumstances it does not get rejected. However, in some women the immune system may reject the fetus and cause a miscarriage either by being high in numbers or by abnormal hostile activity. There are several immune disorders:-
Thyroid antibodies
Antiphospholipid antibodies
Antinuclear antibodies
Natural killer cells CD16/56 and 69 activity
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Polycystic ovary syndrome - this disease can cause infertility and frequently affects success of even conceiving. This syndrome together with a raised hormone level luteinising hormone (LH) results is an increased risk of miscarriage.
Hormone 'deficiency' - in pregnancies ending in miscarriage, sometimes the levels of a hormone called progesterone are found to be low. This is thought to be the result rather than the cause of the miscarriage. Progesterone supplements do not appear to increase the likelihood of an ongoing pregnancy.
3- Thrombophilias (Blood disorders) (10-13%)
The thrombophilias are a group of disorders that promote blood clotting. Individuals with a thrombophilia tend to form blood clots too easily, either because their bodies make too much of certain proteins, called blood clotting factors, or too little of anti-clotting proteins that limit clot formation. As many as 1 in 5 people in this country has a thrombophilia. The major gene mutations that lead to Inherited Thrombophilias are:
Factor V Leiden
Protein C deficiency
Protein S deficiency
Antithrombin III deficiency
Acitvated Prothrombin C Resistance (APCR)
Methylene-tetrahydrofolate reductase MTHFR C677T, leading to hyperhomocytseinemia
G20210A prothrombin gene mutation
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4- Anatomical abnormalities (5-10%)
Uterine (womb) abnormality - eg. a septum down the middle. This condition is found in 2-4% of the normal population. Whether this type of problem is actually to blame for recurrent miscarriages hasn't been proven, and the risks of surgery to correct the problem must be weighed against any potential benefit.
Fibroids - whorls of normal uterus tissue growing in the muscle, sometimes causing miscarriage. Occasionally an operation to remove fibroids can be performed.
Cervical incompetence (weakness) - may cause miscarriage in 2nd trimester (after 13 weeks).
Chromosomes carry the genetic information for each individual. A baby inherits half of its chromosomes from its mother and half from its father.
Between 3-5% of couples with recurrent miscarriage have problems with chromosomal abnormalities.
Chromosomal abnormalities are found in 7% of women who miscarry without previous live children ( Primary miscarrier), and in 50% of women with one or more live births (Secondary miscarrier).
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Infections of the genital tract rarely cause a miscarriage, however, there is no clear evidence that they may lead to recurrent pregnancy loss.
Bacterial vaginosis (BV) is not considered an infection, but a change of the bacterial habitat that normally exists inside the vagina. BV is the most common cause of vaginal discharge in women of childbearing age. In some women it shows a relapsing and remitting course with apparently spontaneous onset and resolution. BV is associated with increased risks of late miscarriage.
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Some women despite thorough investigations, no known cause of their miscarriage is found. However, treatment is still available to these women and is usually tailored to each individual.
* Some women may have multiple reasons for miscarriages
