Recurrent Miscarriage / Implantation Failure Service

Mr Raj Rai BSc MD MRCOG

Sub specialist in Reproductive Medicine

Senior Lecturer / Consultant Obstetrician & Gynaecologist

Imperial College London @ St Mary’s Hospital

Miscarriage is the commonest complication of pregnancy. Of 100 conceptions only 50 reach the stage of a recognised pregnancy – the embryo being lost even before a woman has missed her period.

• There is a close link between infertility, unsuccessful IVF cycles, miscarriage and later pregnancy complications such as premature labour and pre-eclampsia.

Whilst traditionally in the UK recurrent miscarriage is said to be the loss of three or more consecutive pregnancies, this definition is of limited value.

• The miscarriage rate in a pregnancy that has reached at least 8 weeks gestation is less than 2% and it is therefore unusual to miscarry after this time point.

• Consideration should be given to investigate couples who have experienced even only 1 miscarriage after 10 weeks gestation.

Whilst the most common cause for any single miscarriage or unsuccessful IVF cycle is a random genetic abnormality in the embryo, the incidence of which increases with advancing maternal age, the rationale for investigation is either to confirm or to exclude the presence of an underlying treatable cause for pregnancy loss. This is particularly important as couples who lose 3 or more pregnancies, at any gestation, tend to lose genetically normal pregnancies. Miscarriage is therefore not always due to ‘bad luck’ alone.

At 92 Harley Street we offer a comprehensive investigative service of both partners for

• Those who have experienced pregnancy loss (early or late).

• Unsuccessful IVF cycles.

Blood tests performed investigate genetic, hormonal, blood clotting and immune causes of miscarriage. In addition, an ultrasound scan is performed to determine any structural abnormalities of the uterus that may be associated with miscarriage and an infection screen performed if indicated.

• After investigation a plan of management for the next pregnancy is made

Early pregnancy Clinic

Close supervision and appropriate reassurance has been reported in several studies to be associated with an increased live birth rate amongst women with miscarriage. We ask all patients to contact us as soon as they become pregnant. All are offered early pregnancy scans on a fortnightly basis during the first 12 weeks of pregnancy. If appropriate certain investigations are performed in early pregnancy and supportive care offered.