Care programme for recurrent miscarriages

Maybe you've experienced this? Extremely happy with the confirmation of pregnancy, and then bitter disappointment: the pregnancy is not progressing or ends in a miscarriage.
Unfortunately, you are not alone: many pregnancies end prematurely. Depending on when this happens, it is referred to as a miscarriage or not.

See “Recurrent miscarriage?” We also talk about the possible causes.

Consultations - Where and when?

By appointment, On Monday or Thursday
Contact us at the CRG contact centre, by mail or telephone

Care programme for prospective parents

The CRG usually uses its expertise for prospective parents who have problems getting pregnant and come to our centre for an Assisted Reproductive Treatment (ART).
But remaining pregnant is also an aspect of fertility of course.

This is why the UZ Brussel set up the 'recurrent miscarriage' care programme, a collaboration between the Obstetrics and Prenatal Medicine department on the one hand and the Centre for Reproductive Medicine (CRG) on the other hand.

You can be included in the 'Recurrent miscarriage' care programme if you belong to one of the following three groups of women:
  • CRG patients who followed an IVF|ICSI treatment and despite the recurrent transfer of qualitative embryos are not pregnant (recurrent implantation failure); 
  • CRG patients who followed an ART treatment (insemination or IVF|ICSI) – and after a positive pregnancy test and ultrasound confirmation – which repeatedly ended in a miscarriage (recurrent miscarriage); 
  • women who became pregnant spontaneously who had two or more consecutive miscarriages (recurrent miscarriage).
As no unambiguous cause has (yet) been found for recurrent miscarriage we are unable to offer a real solution.
What we do:
  • clinically monitor your situation (and possible pregnancy) ,
  • offer psychological support, and
  • conduct scientific research. The latter is multidisciplinary and organised in an international partnership (see research project).

Clinical follow-up
  • You will see (see contact us) a doctor-gynaecologist specialised in recurrent miscarriage.
    He/she provides:
    • up-to-date information, among others about lifestyle changes which could have a positive effect on your chances of becoming pregnant;
    • other tests; and
    • if possible (if the cause of your problem is identified), treatment.
  • You are able to take part in clinical and fundamental studies.
    They may not have any direct effect on your treatment or situation, but you will be contributing to research into recurrent miscarriages. And in the future this can result in a better approach or even a remedy for the problem.
  • Your next pregnancy will be closely monitored at UZ Brussel.
    In case of a positive pregnancy test your hormonal balance will be evaluated every week (with a blood test). From the seventh week of pregnancy you will have regular ultrasounds.

 

Psychological support
A non-progressing pregnancy is always a difficult thing psychologically. A huge disappointment after the initial good news of a positive pregnancy test. And if miscarriages keep recurring, it is even harder both psychologically and physically.
For this reason, the recurrent miscarriage care programme provides psychological support to any prospective parents who want it.
Via the 'recurrent miscarriage' care programme, UZ Brussel carries out additional tests:
  • for women younger than 33 after two consecutive miscarriages, and
  • for women older than 33 after three consecutive miscarriages.

We do this based on the following diagnostic means:
  • an extensive history which focuses both on your own history and your family context.
    We closely examine any previous (terminated) pregnancies to find out whether it was a biochemical pregnancy, a ‘wind egg’ or a real miscarriage;
  • a vaginal ultrasound, and a hysteroscopy;
  • a blood test to check your blood sugar level, thyroid gland, coagulation factors and antibodies; and
  • a caryotyping (chromosome map) of both you and your partner.

Unfortunately in approximately 75% of prospective parents we do not find any explanation for recurrent miscarriages. It shows that our current knowledge and the used diagnosis techniques are not sufficient.

It is possible that (a) specific risk factor(s) can be identified. In this case the following treatments or interventions are possible:
  • prevention: avoidance of risk factors such as alcohol consumption and smoking;
  • in case of hormonal problems: adequate treatment (e.g. of diabetes or thyroid dysfunction).
    This is advantageous for your general health and to increase the chance of a normal pregnancy;
  • if there is an abnormality in the uterus, this can be corrected surgically with a therapeutic hysteroscopy.
    This usually increases the chance of a normal pregnancy and delivery;
  • if there is an infection present, this will be treated with medication;
  • certain blood abnormalities (immunological system) can also be treated with medication;
  • if one of the partners has a genetic abnormality, there is the option of PGD treatment.
    PGD stands for preimplantation genetic diagnosis: an IVF|ICSI treatment in combination with a genetic diagnosis of the produced embryos. For the embryo transfer we select embryos without any genetic defects;
  • if an IVF|ICSI treatment despite the transfer of qualitative embryos repeatedly ends in implantation failure, patients without genetic abnormality can have a PGS performed.
    PGS is a chromosome screening of the embryos to establish whether there are any divisional faults, i.e. if the number of chromosomes in the embryo is normal. Here also, only normal embryos are selected for the embryo transfer.
    However, treatment is only useful if sufficient embryos are available for analysis and for diagnostic reasons.
    In case of a limited number of available embryos the technique does not increase your chances of a normal progressing pregnancy. The fertility doctor of the CRG can advise you whether the technique is useful in your case.