Why Do I Keep Having Unexplained Miscarriages?

Physician Doong Jing Yi Experiencing the loss of a pregnancy is a deeply emotional journey for couples aiming to conceive. Unexplained miscarriages add layers of confusion and heartache, leaving many seeking answers and support. In these challenging times, it’s crucial to understand the causes, signs and steps to take after a miscarriage, especially if you are looking to optimise the chances of your next pregnancy. Understanding Recurrent Miscarriages Recurrent miscarriages, where a couple experiences at least two consecutive miscarriages, pose a significant challenge for those hoping to start a family. Despite advances in medical knowledge, about half of recurrent miscarriages remain unexplained, adding emotional distress and uncertainty to the journey to parenthood[1]. The causes of recurrent miscarriages can stem from various factors affecting the woman, man, fetus, or placenta[2]. Women may face issues like abnormalities in the uterus or cervix, chromosome abnormalities, or poorly controlled chronic conditions such as diabetes, hypertension, lupus and thyroid disorders, all of which can contribute to pregnancy loss[2]. Similarly, genetic or structural abnormalities in the fetus can greatly affect pregnancy outcomes[2]. While the causes from the father’s side are less clear, a higher risk of miscarriage is linked with abnormal semen analysis[2]. Despite thorough medical evaluations, a significant number of recurrent miscarriages defy clear diagnosis, highlighting the complexity of reproductive health. > Additionally, certain risk factors like extreme weight (either underweight or overweight), unhealthy habits such as smoking, and excessive caffeine intake can increase the likelihood of miscarriage[3]. Lifestyle choices thus play a pivotal role in overall wellness and reproductive health. The risk of another miscarriage after the first one occurs is higher, approximately 20%[4]. Therefore, it is crucial to focus on healing both physically and emotionally during this time before conceiving again. Deciding when to try again is a personal decision, and you may want to discuss the timing of your next pregnancy with your healthcare provider. While Western medicine does not strictly recommend a waiting period before trying again, some medical professionals suggest waiting for a certain amount of time, typically three months for the uterus to recover and menstrual cycles to normalise[5]. TCM self-care tips after a miscarriage After a miscarriage, TCM strongly recommends a period of “mini confinement” for recovery. This practice encourages ample rest and allows the body to restore its delicate balance, including addressing any potential hormonal imbalances that may have contributed to the loss. It is completely understandable to feel lost and helpless in the wake of a miscarriage. However, this restorative confinement period is crucial for promoting physical healing and emotional well-being. By taking the time to nurture yourself, you give your body the best chance to regain its equilibrium before trying to conceive again. Read What Should I Do After A Miscarriage? for guidance on post-miscarriage care and self-care tips from a TCM perspective. Identifying Root Causes with Traditional Chinese Medicine (TCM) TCM provides a distinctive approach to addressing unexplained miscarriages by identifying and treating underlying imbalances in the body. During a consultation, TCM practitioners conduct a thorough evaluation, which includes pulse diagnosis, tongue examination, inquiries about the frequency and timing of miscarriages, as well as menstrual history. This comprehensive assessment also involves analysing other factors such as the basal body temperature (BBT) curve, menstrual flow, colour, clot formation and mucus changes, all of which contribute to a deeper understanding of your body. While these questions may be sensitive, open and honest communication is crucial for the practitioner to develop a personalised treatment plan tailored to your unique condition, aiming to address the underlying imbalances effectively. From a TCM standpoint, the primary causes of recurrent miscarriage in TCM are deficiencies in Qi, Blood or both in the Kidney [6,7]. The Kidney plays a crucial role in growth, development, and reproduction, as it stores the essential Qi that warms and activates all other systems in the body. When there is sufficient Qi and Blood in the Kidney, the womb becomes a warm, safe, and comfortable environment where an embryo or fetus can thrive[6,7]. However, when there is insufficient Qi or Blood the embryo or fetus cannot be sustained, resulting in miscarriage[6,7]. TCM practitioners identify these deficiencies through detailed history taking, pulse diagnosis and tongue examination. Based on these assessments, they deliver personalised treatments aimed at restoring the balance in the Kidney. TCM treatments to help optimise chances of conception after a miscarriage Before trying to conceive again, ladies may seek guidance from TCM practitioners to facilitate a healing process for both mind and body. Here are some recommendations TCM practitioners may suggest: TCM believes that hair loss is due to Blood deficiency. Our Blood, which contains nutrients that support healthy hair growth, is closely associated with the Liver and Spleen. The Liver stores and circulates blood, while the Spleen facilitates nutrient absorption into the blood and ensures proper blood flow in the vessels. Another organ that plays a part in hair loss is the Kidney. Kidney governs the essence of our body and kidney essence is necessary for adequate hair growth. As we age, our Kidney weaken and may result in essence deficiency, leading to inadequate hair growth. Herbal Medicine Herbal medications are often used to nourish the Kidneys, improve blood circulation and provide warmth to the womb to improve female health. Common herbal concoctions like Wu Zi Yan Zong 五子衍宗, Si Wu Tang 四物汤 and Ba Zhen Tang 八珍汤 are often prescribed for their ability to nourish blood and kidney essence. These formulations usually feature herbs such as Dang Gui 当归, Shu Di Huang 熟地黄, Du Zhong 杜仲 and Xu Duan 续断, which serve to strengthen the foundation of female health. Depending on individual needs, a personalised herbal concoction is prescribed to address specific imbalances within the body. Acupuncture and Moxibustion Acupuncture involves the insertion of needles into specific points on the body, known as acupoints. This technique aims to improve the flow of Qi (energy) and blood, addressing imbalances in the body and alleviating emotional stress. Common acupoints used for reproductive issues include Qi

What should I do after a miscarriage?

Physician Eileen Lim Embarking on the journey to parenthood is a profound experience filled with hopes and dreams. However, amidst the joy, some individuals face the heartbreaking reality of miscarriage – an experience more common than often acknowledged, affecting approximately 10-20% of known pregnancies.[1] Miscarriage presents itself in various forms, each with its unique challenges from threatened to missed miscarriages, the spectrum is broad and often mystifying.[2] Threatened miscarriage occurs when the body signals the possibility of a miscarriage. Light vaginal bleeding or lower abdominal pain may persist for days or weeks, while the cervix remains closed. The situation may resolve, leading to a healthy pregnancy, or unfortunately progress into a miscarriage. Inevitable miscarriage can follow a threatened miscarriage or transpire without warning. It involves more pronounced vaginal bleeding and intensified lower abdominal cramps. During the miscarriage, the cervix opens, and the developing foetus is expelled amidst the bleeding. Complete miscarriage takes place when all pregnancy tissue is naturally expelled from the body without requiring medical intervention. Vaginal bleeding and cramping, akin to labour or intense period pain, signify the uterus contracting to empty. Incomplete miscarriage happens when only some of the pregnancy tissue remains in the uterus and medical intervention might be needed to remove it. Vaginal bleeding and lower abdominal cramping may continue as the uterus continues trying to empty itself. Missed or silent miscarriage occurs when the baby may have ceased development or passed away, yet the body hasn’t recognized it. Typically diagnosed during a routine ultrasound scan with the gynaecologist, usually around the 12th or 20th week “anomaly” scan. If you have a missed miscarriage, you may have a brownish discharge. Some of the pregnancy symptoms, such as nausea and tiredness, may have faded. You might have noticed nothing unusual. TCM views the Kidney Essence (Jing), Yin, Yang, and Qi as vital contributors to the reproductive system’s health and overall balance.[3] The Kidney Essence is considered the foundation of reproductive vitality, providing the raw material for conception and embryonic development. Yin and Yang represent the complementary forces maintaining harmony in the body, while Qi is the vital energy sustaining life processes. Imbalances in these elements, such as a deficiency in Kidney Essence, disruptions in Yin or Yang, or irregularities in Qi flow, are seen as potential contributors to the risk of miscarriage in TCM philosophy. TCM practitioners employ methods like pulse diagnosis and tongue examination to assess the flow of Qi and the balance of Yin and Yang within the body. Self-care after a miscarriage Navigating self-care after a miscarriage is a delicate but vital aspect of the healing process. TCM provides a holistic approach to recovery. It advocates a personalised approach, focusing on restoring balance to Qi, Yin, and Yang, integral to reproductive health. TCM also places a profound emphasis on the mind-body connection, acknowledging the intricate interplay between emotions and physical health. TCM believes that emotional well-being is integral to overall health, and imbalances in emotions can affect the Qi, the body’s vital energy and vice versa. A harmonious mind-body connection is fundamental to overall health. In TCM, a mini-confinement refers to a postpartum recovery period that involves specific practices aimed at promoting healing, restoring balance, and supporting overall well-being after childbirth or, in some cases, after a miscarriage. The duration of a TCM mini-confinement typically lasts around 14 days. During this period, individuals, especially new mothers, follow a set of guidelines and practices that vary based on TCM principles. These may include dietary recommendations, specific rest and sleep patterns, and limited physical activities. The goal is to allow the body to recover, replenish energy, and prevent the potential development of health issues in the future. Thus, a mini-confinement is essential for recovery as this intentional period set aside for self-care facilitates physical recovery, nurtures emotional well-being, and aids in restoring balance and addressing potential hormonal imbalances. TCM practices such as acupuncture and herbal remedies, are designed to restore balance and regulate emotions. During a consultation for mini-confinement, TCM practitioners will assess individual constitutions and symptoms, employing techniques like pulse diagnosis and tongue examination, and then personalise the treatments individually to address specific imbalances, promoting overall well-being. 1. TCM treatments i. Acupuncture Acupuncture, involving the insertion of thin needles into specific points, aims to stimulate the body’s energy flow, promoting balance and alleviating symptoms such as emotional distress and physical discomfort. Common acupoints used are ii. Herbal medication The herbal remedies, meticulously selected based on individual body constitutions and symptoms, complement acupuncture by nourishing the body’s Qi and Blood. These natural supplements support the body’s inherent healing processes, aiding in the restoration of energy and vitality. Herbs or herbal formulas such as Si Wu Tang (四物汤), Zuo Gui Wan (左归丸), Tu Si Zi (菟丝子) and Xu Duan (续断)[4] are commonly prescribed. 2. Tech-enhanced Therapies Integrating technology-enhanced therapies such as Cell Pro Therapy and Electro -Lymphatic Therapy (ELT) into TCM further enhances physical recovery and emotional well-being. i. Cell Pro Therapy Negative ions, abundant in natural environments like forests and waterfalls, are thought to positively affect overall wellness. Cell Pro Therapy (CPT) emits a large amount of negatively charged ions, also known as reducing electrons into the body. These reducing electrons act as an antioxidant and may promote recovery and overall wellness. Therefore, we can use Cell Pro Therapy to support the body’s recovery after a miscarriage. It may help to: Improve blood circulation by enhancing the production of nitric oxide, a molecule that helps dilate blood vessels, leading to increased blood flow and oxygen delivery to tissues which aid in recovery.[5] Improve sleep by balancing the serotonin and melatonin levels in the body. Negative ions contribute to overall well-being by enhancing oxygen flow and promoting a sense of calm and relaxation. It also balances the levels of serotonin and melatonin in the body. Serotonin is a neurotransmitter, which converts to melatonin, the hormone that helps to regulate our sleep-wake cycle, promoting better sleep quality.[6] Create a more favourable environment for reproductive health through