Recurrent Miscarriage

Dr Jenny Cook | Sydney Gynaecologist & Advanced Laparoscopic Surgeon

Understanding Recurrent Miscarriage

The most common reason for miscarriage is a spontaneous chromosomal abnormality. This happens when a normal sperm meets a normal egg but the cell divisions are not normal. Sadly, this is very common, and the risk increases with age, particularly in women over 40 years Recurrent failed implantation is defined as the transfer of at least three high-grade, chromosomally normal (euploid) embryos without a successful pregnancy. This is seen more often in older women, especially after 40.

Many women come to me for a second opinion after experiencing multiple failed cycles, seeking answers and a new perspective.

My approach is to investigate thoroughly, treat comprehensively, and support you with compassion throughout your fertility journey.

Additional assessments

Investigations and Underlying Conditions

A range of tests can help uncover possible causes of miscarriage or failed implantation:

Chromosome testing for you and your partner
Blood tests for clotting abnormalities and auto-immune conditions
Semen analysis to identify sperm abnormalities (linked with miscarriage risk)

Endometriosis

Endometriosis is often an underlying cause of infertility and miscarriage. A laparoscopy with excision of endometriosis, combined with hysteroscopy and endometrial biopsy, is known to have a positive impact on fertility.

Because of my background in Advanced Laparoscopy, I am uniquely placed to offer complete excision of endometriosis. In many cases, spontaneous conception occurs following surgery. (See the section on Surgery for more details.)

Uterine Assessment

A pelvic ultrasound can detect issues such as:

Endometrial polyps
Submucosal fibroids
Uterine septum
Intra-uterine adhesions

These can be treated with a hysteroscopy. During hysteroscopy, I may also perform an endometrial biopsy, which has been shown to improve implantation rates. The biopsy may reveal:

Hyperplasia (abnormal cells) – treated with high-dose progesterone
Endometritis (inflammation) – treated with antibiotics
Increased NK (natural killer) cells, which may play a role in miscarriage. These can sometimes be managed with a special immune protocol including antibiotics, low-dose steroids, and clexane (a blood thinner).

Treatment Pathways

Once investigations are complete, we will discuss the best treatment options for you.

Progesterone Support

Taking progesterone after conception reduces the risk of miscarriage and is usually continued until about 12 weeks of pregnancy.

IVF and Genetic Screening

IVF with genetic screening of embryos can also reduce miscarriage risk:

Many embryos are aneuploid (abnormal chromosomes) and have a higher chance of miscarriage
A chromosomally normal (euploid) embryo has a much lower risk

Immune and Hormonal Protocols

Where biopsy findings suggest immune involvement, treatment may include:

Antibiotics
Low-dose steroids
Clexane (blood thinner)

These can be tailored to your individual needs.

Emotional and Counselling Support

Fertility struggles can be one of the most emotional and stressful experiences for individuals and couples. The physical challenges are often compounded by psychological and emotional burdens, which is why emotional support is such an important part of fertility care.

Our fertility counsellor, Tanya Rubin, has extensive experience in supporting individuals and couples facing infertility. Travelling this road can feel lonely and scary, but it doesn’t have to be if you share it with someone who understands the journey.