Ep.4 The Fertility Series: Miscarriage

 

00:00 - Intro

00:40 - Navigating miscarriage

01:58 - Physical recovery after miscarriage

04:06 - Emotional reality & relationship dynamics

05:09 - Trying to conceive after miscarriage

06:21 - What testing should I consider?

08:30 - We’re here for you

Transcript:

Gail: And I think as well, really important to be kind 
to yourself. We put so much pressure on ourselves, particularly the woman.

Thalia: And it doesn't, it's not something that can be predicted or prevented.

Gail: 1 in 5 pregnancies will end 
in miscarriage, so it's incredibly common.

*titles music*

Gail: Miscarriage is far more common than 
you think. What's less common is clear, honest conversations about what happens next. I'm Gail Madalena, a registered nutritional therapist with over eight years specialist experience  in fertility and preconception.

Thalia: I'm Thalia Pellegrini, I'm a registered nutritional therapist specialising in women's hormonal health with over 15 years experience. Gail, most miscarriages are not caused by anything 
you did. Let's start there.

Gail: Absolutely. You know, actually 1 in 5 pregnancies will end in miscarriage. So it's incredibly common.  And I think people just don't realise how common it is. Um, but fundamentally, you're right, it's not down to anything you have specifically done.

Thalia: So what are the most common causes?

Gail: In early miscarriage, particularly, we're looking at potentially genetic chromosomal issues or things 
like low progesterone. If we're going a bit later, there might be more underlying factors that need a bit of investigation, but classically it is mostly genetic.

Thalia: So to reassure women what's usually not the 
cause?

Gail: It's not, you know, over exercising, it's not necessarily stress. It's not anything that they've done in their day to day. This is kind of one of those things that sometimes it just happens, and it doesn't automatically mean that you will 
go on to have trouble conceiving down the line.

Thalia: And it doesn't, it's not something that 
can be predicted or prevented.

Gail: No. I mean, obviously there is things we can do to 
support egg and sperm health which can minimise the risk of genetic issues, but it is one of those things that can happen regardless.

Thalia: So what would you give as advice for, say, an 
expected time frame for a cycle to return?

Gail: This is really individual and it depends, 
because if it's something like an ectopic pregnancy, for instance, that might take a little bit longer to recover from. Typically speaking, you know, women will have 
their next cycle as normal, but for some, it's not uncommon for it to take a couple of cycles before things start to regulate.

Thalia: And that would include ovulation 
returning to normal as well.

Gail: Yes, exactly. So I think it also depends on things 
like nutrient status and other external factors that can feed into it. But yes, if your cycle has gone back to it's regular pattern, that's a good indication that ovulation is back to normal as well.

Thalia: But if there's some irregularity 
that's perfectly normal and not  a cause for concern?

Gail: No, absolutely. And it's to be expected. You know,  it's a huge hormonal shift going from being pregnant, then suddenly not. And some women that can just take a little bit longer 
to get back into that hormonal rhythm.

Thalia: And what advice do you give to women who 
are asking you as nutritional therapist, when should I try again?

Gail: This one is a tricky one because I personally would always try and give yourself at least three cycles. We know 
that it takes an egg roughly three months to mature. Likewise with sperm. And if we're thinking a lot of early miscarriages are around genetic and chromosomal factors, actually 
paying attention and really laying the foundations with egg and sperm health can can really help to minimise the risk of recurrent miscarriage. But a lot of couples are, you know, 
really eager to get back at it, understandably. But three months is a great time frame.

Thalia: So we want to think about when we think about those foundations, we want to be thinking about potential physical depletion or nutrient depletion that may have followed a miscarriage.

Gail: Absolutely. And if you think with a miscarriage 
quite often that will incur extended bleeding. And that's a really big loss of key nutrients like iron, which is fundamental for pregnancy. So if you're trying to go straight into 
another pregnancy you could actually go into it depleted. So you're not necessarily setting yourself up for that future pregnancy.

Miscarriage isn't just physical. It can 
be hugely emotional and deeply personal.  

Thalia: Absolutely. There's a huge emotional reality 
that can go along with the miscarriage, so we often advise women to get some extra support during this time. Grief isn't linear, so how they'll experience it will 
differ from from woman to woman. And there's no correct way to recover. 

Gail: Absolutely. And I think again, it will depend on at what point you have the miscarriage. If it's further into pregnancy,  that can actually be hugely traumatic. And that 
is where having that additional support network, potentially therapy as well, to help you process what's gone on.

Thalia: Absolutely. And there's also the element of 
navigating intimacy following a miscarriage. So there's so much that needs to be discussed and supported.

Gail: Yeah. It's you know hugely emotional. It can be 
very lonely as well because it's not something that everyone wants to talk about openly. So I think it's giving yourself, you and your partner time to heal and to grieve 
over it

Thalia: And reach out for additional help, whether it's counselling or from your GP, but additional support if you need it.

Gail: Absolutely.

Thalia: Women may find it really 
encouraging to know that chances of a successful pregnancy following miscarriage are still really high.

Gail: Absolutely. You know, as we touched on, it's really common to have a miscarriage across your fertile years. However, what's less common is recurrent miscarriage. It's actually about 5% of women that go on to have a recurrent miscarriage, and that's where we'd potentially be 
looking to dive a little bit deeper to see what's going on.

Thalia: So if we want to support 
a woman who is thinking about trying again, what are we focused on? Really, it's about, you know, optimising nutrient intake. It's about supporting hormonal health. It's about 
supporting mental health as well. So looking at all of those kind of touchpoints and ensuring that you're covered across the bases.

Thalia: So we're going back to those foundations, things that will leave you replenished and feeling nourished. So thinking about sleep, good food, trying to reduce your stress or finding ways to manage your stress. All of the key things that we talked about earlier are as important here.

Gail: Exactly. And  I think as well, really important to be kind to 
yourself. We put so much pressure on ourselves, particularly the woman. But actually we need to give ourselves that time and really just be kind to ourselves and that process.

Thalia: So for a woman who has experienced a miscarriage, 
when is testing appropriate? I think, as mentioned, one miscarriage, you wouldn't necessarily be looking to do any testing at that point, unless it was later in the pregnancy. Um, it's more when you get to 2 or 3 that you might be referred to the recurrent miscarriage clinic, or it might be worth exploring some additional tests.

Thalia: So what could be considerations potentially if 
women were exploring doing some testing?

Gail: Yeah, I'd be looking at checking progesterone levels. We know that that is so important for maintaining pregnancy, and low levels can increase the risk of miscarriage. I'd 
be looking at things like your thyroid. Again, a really common marker that can indicate a higher risk of miscarriage.  And that's a full thyroid panel. So the TSH but also antibodies to see if there's an immune element. And again immune health is 
a really big driver. And that's something that  if you're seeing a fertility clinic they can look into testing that a bit deeper.

Thalia: And what about uterine structural issues as 
well?

Gail: Absolutely. We'd be wanting to kind of, explore a ultrasound just to check structurally if there's anything that  could be inhibiting the pregnancy from progressing  

Thalia: And in terms of blood tests as well as thyroid, 
we might also look at vitamin D, iron, B12.

Gail: Yep. These are kind of much less thought of but 
can be huge contributors. And part of the puzzle for sure, in recurrent miscarriage particularly. 

Thalia: So a lot of women will come to us and ask how they can be nutritionally supported. I think it's so important to really take advantage of the fact that we offer a free consultation at Wild, because your individual experience will be so unique, so that helps us understand what you need, what might 
have been a root cause or a contributing factor, and that allows us to guide you about what we think will be supportive for you next.  

Gail: 100%. And what is needed for one person may 
not be for the other. And it can be really tailored. And we can ensure that you're getting those specific nutrients via your diet and also looking at lifestyle factors, but also the supplements that we would recommend.

A miscarriage doesn't define your 
fertility journey or affect your chances.

Thalia: You're not alone and you don't have to navigate this in the dark. There's so much support. If you've got any worries, 
reach out to your health care provider.