Recurrent Miscarriage
Michael provides empathetic and evidence-based care for those experiencing recurrent miscarriage. Any pregnancy loss is highly distressing, and the recurrent nature can exacerbate and compound this grief. His expertise in recurrent miscarriage stems from his Clinical Fellowship, when he updated the Monash Health clinical guidelines for Recurrent Pregnancy Loss.
Chromosomal Factors: The most common cause of early pregnancy loss is an abnormal number of chromosomes in the embryo (aneuploidy). This usually reflects that not every sperm or egg is perfect in couples with normal genetic tests. However, in a small proportion of couples, one partner may carry a "balanced translocation"—a genetic arrangement that is harmless to them but can lead to unbalanced chromosomes in a pregnancy.
Anatomical Factors: Structural issues within the uterus, such as a uterine septum, fibroids, or scar tissue can interfere with healthy implantation.
Endocrine Factors: Poorly controlled thyroid disorders or uncontrolled diabetes can create a hormonal environment that is less supportive of a developing pregnancy.
Immune Factors: Conditions such as Antiphospholipid Syndrome (APLS) cause the body to produce antibodies that impinge on placental function.
Lifestyle Factors: Smoking and high BMI in the male partner has been linked to DNA fragmentation in sperm.
A Supportive Path Forward
Even when investigations return "normal" results, the prognosis for a future successful pregnancy remains high. Michael’s management plans are tailored to your specific history:
Targeted Treatment: If a specific cause is identified, treatment is directed towards that cause.
Folic acid: Folic acid is recommended for all women attempting to conceive, to reduce the risk of neural tube defects.
Lifestyle modifications: Both partners are encouraged to optimise health by stopping smoking, limiting alcohol and diet and exercise to maintain a healthy weight in order to reduce sperm DNA damage and improve implantation.
Progesterone: Vaginal progesterone supplementation in the first trimester can be considered in couples with no cause identified, especially in the context of bleeding
Preimplantation Genetic Testing (PGT-A): IVF with PGT-A testing of the embryos can be considered in order to select an embryo with a normal number of chromosomes.
Supportive Care: Michael advocates for "tender loving care" protocols, including frequent ultrasounds in the first trimester, which have been shown to improve psychological well-being and pregnancy outcomes.