My doctor says my seven miscarriages are ‘just one of those things’
Q DESPITE following my doctor’s advice, I’ve had seven miscarriages. Now, I’ve read of a woman who has had 18. Her doctor, like mine, shrugged his shoulders and said it’s ‘one of those things’. Can you offer any constructive advice? Name and address supplied.
A Multiple pregnancy loss is emotionally traumatic and you need empathy, support and explanation. You should also have been sent for some investigations.
Miscarriage is common: one in four women will have at least one. However, only 2 per cent of women experience two consecutive pregnancy losses and 1 per cent have three consecutive losses.
What studies tell us is that the risk increases with every subsequent miscarriage: so a woman under the age of 30 faces a 10 per cent risk of having a miscarriage — but if she has one miscarriage, then there is a 15 per cent risk the next pregnancy will result in a miscarriage. this rises to almost 30 per cent after two miscarriages and further still after three or more miscarriages.
As upsetting as it must be, until women have had three or more consecutive miscarriages, they are not sent for further investigations.
this is because with miscarriage, there are often no answers — and i’m afraid that the cause can be determined in only around 50 per cent of cases.
the first stage is an ultrasound to examine the uterus and check whether there is any anatomical abnormality, such as unusual shape or contour, that is preventing the embryo embedding properly.
Some specialists will take this further and include a hysteroscopy, where a viewing instrument is passed via the cervix to inspect the uterus and its lining.
Blood tests should also be carried out to check for two important causes of recurrent miscarriage.
the first is for anti-cardiolipin antibodies — these are a sign of antiphospholipid syndrome, also known as Hughes syndrome — as well as lupus anticoagulant, another type of antibody.
Both these antibodies can cause unwanted clotting. if this occurs in small blood vessels of the placenta, it can lead to miscarriage.
Secondly, checking the thyroid function is essential — an underactive thyroid may cause symptoms that are so subtle, they are barely obvious. However, there is evidence of an increased risk of miscarriage in women with low thyroid function.
Another immunological condition, coeliac disease — which causes the body to react to gluten — has been associated with multiple pregnancy loss.
this might not have previously been diagnosed, but should be ruled out.
You say that you’ve followed medical advice surrounding pregnancy, but i would stress theories about recurrent miscarriage being linked to obesity, smoking, alcohol and caffeine are not proven.
the important point is not to blame yourself for what is, too often, an unkind hand of nature, but one that may be treatable.
i would advise seeing your Gp and requesting a referral for investigation by a gynaecologist interested in fertility — there may be factors revealed that can be treated and therefore enable you, at a future stage, to carry a pregnancy to full term and hold a baby in your arms.
i wish you well in your quest to start a family.
Q I SUFFER with numbness in both legs that gets worse during the winter. I had an operation for a spinal stenosis six years ago, but the symptoms continue. I have a trapped nerve and poor stability.
Is there anything I can do to help myself? I’m 78 and still have a lot of life left. I would like to drive again to help my wife, who currently does all the driving. Arthur Jordan, Croydon, South London.
A For the benefit of other readers, spinal stenosis is where the central channel within the spine (the spinal canal) has narrowed, putting pressure on the spinal cord.
it’s caused by wear and tear — as we age, degenerative changes cause the canal to narrow.
often referred to as arthritis, these changes are seen in the spines of more than 90 per cent of people by the age of 50.
typically, symptoms occur by the age of 60 — firstly as lower back pain.
But, when the space around the spinal cord is so narrowed that there is pressure on the nerves, it can cause numbness — often in the legs.
in the later stages, weakness and poor coordination follow.
the aim of surgery is to enlarge the canal to take the pressure off the nerves, but the degree of recovery is variable and cannot be predicted preoperatively. the hope is at least to stop the condition getting any worse. At best, the nerves recover from any residual damage and the symptoms cease.
unfortunately, at this stage, six years after your surgery, any residual nerve damage will not recover further — the best chance of recovery was in the first two years.
every emphasis has to be on making the best — in terms of mobility and stability — of the function you have.
Your best prospect is with physiotherapy to help build and maintain strength and flexibility and, hopefully, improve balance and agility.
My concern would be if the symptoms you describe are deteriorating, which needs reinvestigating. this would involve a consultation with your Gp — a referral for examination by a spinal surgeon or neurosurgeon specialising in spinal surgery might lead to an uptodate magnetic resonance scan (Mri), possibly in conjunction with nerve conduction studies (involving the application of electrodes to your legs), which can help assess to what degree the function of nerves in your legs are impaired.
i would recommend you talk to your Gp again.