We Can Do Better On Women’s Health

Miscarriage & advanced maternal age

Anyone who has been reading this blog for any time, will know that over the past three and a half years my husband and I have been dealing with recurrent miscarriages through our mid to late 30s.

Then finally we both turned 40 this year and found ourselves unable to get pregnant again; something that we can only attribute to age-related declining fertility, since nothing else about our health or circumstances has changed.

So now, as we make the difficult decision to reluctantly give up on our fertility journey, the main question in my mind is this: why is advancing maternal age not factored into the treatment of recurrent miscarriages?

Something needs to change

Those who are happily less acquainted with the subject of miscarriage, may be surprised to know that the NHS expects women in the UK to go through three consecutive miscarriages before they will start investigating or prescribing anything to treat this as a recurring issue.

Whilst I can understand the reasons for this - most miscarriages are just a one-off and NHS resources are finite - personally I think this is a huge oversight in the care of women where advanced maternal age is a factor (defined in the medical profession as being 35+). And my feeling is that this policy needs adjusting because it is letting down to many women like me.

The reality is that it tends to take most older couples much longer to get pregnant, and to get pregnant again after each miscarriage, than it does for most younger couples due to declining fertility.

This factor is already well recognised in other areas of infertility treatment. It’s the reason why the NHS also stipulates that couples can start accessing fertility tests and treatment after 12 months of trying to conceive, or after just 6 months if the woman is 35+.

So why is there no similar approach taken when it comes to the treatment of recurrent miscarriages? Why not start tests and treatment with women over the age of 35 after one or two miscarriages rather than three?

There’s a real age inequality that urgently needs addressing here.

My own experiences

It took me three years to reach that ‘recurrent loss’ trigger point for accessing any medical intervention and support, and since this period also spanned between me being between the ages of age 37 to 40, I have experienced a steady decline in my fertility during this time as well.

At age 34 I got pregnant on the first month, and delivered my first (and only) baby as I just turned 35.

When we tried to conceive again, I was 37 and still got pregnant pretty quickly. But sadly it ended in a miscarriage that time.

After that, it took us 5 months to conceive again, by which time I was age 38, and it ended in a second loss.

And after it took us a further 6 months to conceive again, by which time I was 39.

It was only after an almost three year long cycle of trying to get pregnant, then being pregnant, then losing the pregnancy, then trying again, that I finally hit my third miscarriage which qualified me to access support.

Too often miscarriages in later life are written of as being due to age-related decline in the quality of egg or sperm, yet DNA testing on my third miscarriage showed a healthy baby girl which no detectable abnormalities at all.

This led my consultant to conclude that the cause of my recurrent miscarriage is most likely an embedding problem in my uterus, and she recommended medications such as progesterone pessaries and heparin injections that could possibly have reduced the risk of a further miscarriage.

Sadly, I will now never know if they could of had an impact on my ability to carry another child full term or not, because I was never able to get pregnant again by the time I finally received all of that information and medication.

Instead, my only option now is to spend thousands of pounds on expensive fertility treatments that have very low odds of working (5-10% chance) because of our advanced age, and still risk a high chance of loss again even if it succeeds.

I am generally a big fan of the NHS, I work in this healthcare system myself and I have received great care under it may times. But in this instance I am left wondering, is this really the best we can do? Is this world class that we’re providing for women and families, just like me?

We can do better

I will probably always be left wondering whether, had I got access to those drugs during my last pregnancy two years ago, I would be holding my baby daughter today rather than giving up after 18 months of infertility.

Ultimately, we will never know for sure. But it will always be a big question mark for me.

I’m not writing this to criticise the NHS. I am so grateful for our healthcare system in the UK which is free to everyone at the point of access. But I do think we can do better for women in this important area of maternal health.

It’s absolutely awful to have to endure three miscarriages in a row before you can access any treatment or support. In what other area of healthcare would we let people suffer this level of trauma, before beginning to address the cause? Try as I might, I can’t think of another parallel at all.

Miscarriage is not just a few days of ill health, it’s the loss of a pregnancy and it causes significant psychological and physical distress - not only to the mother, but also to her entire family who are left to grieve that loss. Especially when that process is repeated over and over again. And the current system just doesn’t seem to factor in these human and mental health costs enough.

If this is this is true for women of all ages facing recurrent miscarriage, then it’s often especially true for older women, who have the added worry about their fertility ebbing away whilst they continue to wait to become eligible for help.

A false economy

What’s more, to me these wonky health policies also seem like a false economy too.

Surely the continued treatment of recurrent miscarriages (monitoring, surgeries, follow up appointments, counselling support), and then the advancement onto other fertility treatments when a woman’s remaining fertility dwindles away, places a much greater cost burden onto the health service than earlier intervention would?

Instead, the current situation basically seems like a lose/lose; both for the NHS system, but also for the woman involved. The only winner in this that I can see is private fertility clinics which many women end up attending in their desperation.

What’s more, there’s also a social inequality to all of this too, because those who can afford to get tests and treatments via private clinics will get to skip the queue, but those that can’t afford that option will simply get into debt or get left behind. And isn’t that against the very values that the NHS was set up with in the first place?

The truth is that miscarriage has long been such a poorly understood area of maternal health, which has seen little medical advancement over the years, despite other areas of fertility care such as IUI, IVF and donor technologies coming on leaps and bounds.

When the statistics show that miscarriage affects as many as 1 in 4 women, as opposed to 1 in 8 being affected by difficulties trying to conceive, I don’t know why it is that it doesn’t get more focus in terms of medical research and investment.

Not all of those issues are quick or easy to solve of course, but this issue around the need for faster access to support for women over 35 who are experiencing recurrent miscarriage is. All of this to say, that we desperately and urgently need to see policy changes in this area of maternal health a

For women everywhere, we can and must do better.