Help!!What to do at 37 years old with 2 miscarriages and no previous children

[ELI81]

Good afternoon ladies, I need some help/suggestions from you seen that many are or have been in the same boat.
I'm 37 years old now, I had 2 weeks ago a miscarriage at 10 weeks and another 2 years ago at 8 weeks, both with huge lower cramping and heavy bleeding, with admission to the a&e and after gynaecology unit.
I'm fed up of not been taking seriously here in Uk where I live because it was and is not simple for a woman to lose all babies like this without an explanation and no further investigations from NHS until i'll be pregnant for the 3rd time (if this happens).
I'm originally from Italy where they told me that they would start investigations after 2 miscarriages and they would suggest to risky pregnancies hormone therapies and baby aspirin. Sorry but in Uk the health system sucks, and I'd happily go back to Italy if I wouldn't have a good job here, I'm not happy about Nhs. They also suggested for risky pregnancies to stop working in the first crucial 3 months as an early maternity leave also because I do night shifts and can be tiring..how does all this work in Uk according to the laws?
During the last miscarriage I also had surgery in total anaesthetic to clean my uterus from the remains that could infect me internally, not nice at all I can assure.
What do you suggest to do? It's not easy for me to get pregnant, it took 2 years from the last miscarriage and I don't want to be an old mum for my future child (if it will be the case).
Do you suggest to go privately to check my thyroid levels, progesterone in case of hormone imbalance, sticky blood deficiency? Anyone did this? Is that very expensive paying out of my pockets?
Thank you in advance to all the mums who will respond with suggestions and advices, our strength is in sharing our knowledge. Hugs!

Sympathies. It's horrible to lose a wanted pregnancy. I have been there many times.
The management you have had is standard management. The surgical treatment is also normal because retained products of the pregnancy leave you at risk of infection and haemorrhage.

The reasoning behind three miscarriages before investigation is that miscarriage is very common and two in a row happens quite often. They might well have each occurred for different reasons.

Even if a reason is found, ( and usually no reason is found) treatments only help a minority of women. Of those having a successful pregnancy with treatment, quite a lot would have been ok that time anyway. For example the evidence for hormones such as progesterone helping is quite weak. Anti clotting drugs such as aspirin and heparin can help with a proved clotting disorder, but not always. If the cause is poor egg or sperm quality, then drugs won't help.

There are things you and your partner can do to increase your success rate, normal BMI, good quality diet, vitamin supplements if needed, no smoking or drinking. This will improve your own hormone levels, intrauterine environment and sperm quality. Excess weight and smoking are the priorities to tackle if they apply.
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By all means make an appointment with a private gynaecologist but be wary of expensive treatments giving false hope.

The reason the NHS do not routinely investigate after 2 miscarriages is that 2 consecutive miscarriages is still more likely to have been pure chance than any underlying issue. So they would be spending reams of money investigating perfectly healthy women who were simply unlucky.

Be aware that for the majority of women who do have recurrent miscarriage investigation after 3 consecutive MCs, no defined cause is found either. There are a few different schools of thought on treatment plans but they're all slightly speculative/not fully validated yet. By all means pay for private investigation but truthfully there's a limited amount medicine can offer to many women in your shoes.

I can't really see any doctor in the UK signing you off work during the first trimester tbh, unless a specific high risk factor was found that could be affected by activity. Miscarriages generally aren't caused by activity.

Good luck with future pregnancies.

You won’t have any trouble finding a private doctor to take your money to do testing. But mayhew is right, until you get to 3 in a row, it’s so common that they’re unlikely to identify a medical cause.

Your gp should be able to order blood tests for your thyroid and progesterone though, especially if you’re having trouble conceiving too.

Sympathies, it’s horrible I know

Sympathies Eli, miscarriage is so tough. I'm British living in Italy and in my experience Italian doctors are more willing/able to order tests just in case, so I can understand your frustration with the different system. I had investigative screenings in Italy after a single miscarriage and was prescribed progesterone and aspirin, I did have some symptoms of low progesterone though which made my gyno keener to test quickly. I also took supplements and made dietary changes. My gyno says it could have been all or none of the above that made the difference this time round, sometimes it is just down to age and bad luck. In the UK I think you often need to make more of a case for testing to GPs, for example have you looked at the symptoms of different hormonal imbalances/ thyroid issues to see if you fit the symptoms? If so,mention those to your GP. Do you track ovulation and cycles so you could show them this data? Sorry if you've tried this, but sometimes they are more inclined to test with something specific in mind. I would try pushing on the basis of how long it took you to conceive as well as focusing on the miscarriages. Personally, if you have no luck I'd investigate private testing, but this is more expensive than in Italy - could you get the basic bloodwork done privately in Italy during a holiday to rule issues out, if nothing else? I'd also look into getting your partner's sperm tested as I think this is quicker/cheaper and if a problem is detected it could change your next steps. In terms of time off work during pregnancy there is a huge cultural difference and it's much, much less common to get signed off in the UK. If your specific job is risky or very physical or you are ill then you can speak to your doctor, and you can ask your employer to do a risk assessment and make necessary adjustments. But getting signed off for a whole trimester or whole pregnancy is unlikely in the UK unless there is a specific condition detected that requires it, whereas in Italy they seem to do it as a general precautionary measure. I'm in my 3rd trimester and have been off for my whole pregnancy, as have most of my ante natal class, but I'm not convinced there is much of an evidence basis for it in most cases. Tiredness and activity aren't generally the cause of miscarriage.

Sorry, not sure what happened to my paragraphs...

Thank you for your support

Good luck and be kind to yourself right now.

If you get pregnant again before investigations try baby aspirin. I'd also get private blood tests at least (I had them done for about £200) to rule out thyroid issues etc.

I'm amazed people are signed off for their whole pregnancy but it depends what you do I suppose. You would only be signed off here for a medical condition like hyperemesis for example. But if you are signed off for a pregnancy related issue your employers aren't supposed to log it as sickness so it shouldn't affect your sickness record. (Mine so record it but don't take any action around it.)

Sorry about your mcs. As you are over 35 and it is taking you more than 6 months to get pregnant I presume you are under the care of a fertility specialist? Unfortunately you are likely to have to pay for this privately though your GP would be happy to refer you. The specialist should do tests on you to see if there are any underlying issues on why you are likely to have a mc. Under the various health and safety legislation unless you are in a job where you are at risk from violence or other hazards in all the duties you would be exposed
to at work e.g. special needs teacher then you are unlikely to be signed off from work in the first trimester just for being pregnant in the UK. Most employers where you are at risk from violence or other hazards e.g. police officer will assign you to different duties where you are not facing those risks. To be medically signed off you need to have a specific pregnancy related illness and mc alone isn't considered to be one the first trimester. I've actually worked with women who were signed off for most of their first trimester due to pregnancy related-sickness but worked during most of their second and third trimesters.

I was going to ask the same question as the OP. Surely after two years of TTC unsuccessfully at the age of 37 you should be referred for fertility testing in the NHS regardless of the area you’re in?

Thank for your responses ladies! You are all fantastic!!
And Yes I was referred by Gp to a fertility clinic and I had only one informative appointment (without starting really) when I discovered I was pregnant this second time and I phoned them to cancel (and after 1 month had a miscarriage), so hopefully the Gp will refer me again, I don't know how's the process here really. But I must and want to know if it's in me the problem not being able to let the placenta attach to the uterus/foetus for medical reasons or is something else that doesn't depend on me, I can't simply wait for maybe a 3rd pregnancy if I'm lucky and risk a third miscarriage. Those 2 were emotionally and physically heavy for me and my husband so I want to prevent another one whenever possible. Hugs to all you

Sorry you are in this situation OP. If you've been TTC for more than a year (possibly 6 months depending on the age cut off in your area) unsuccessfully, regardless of previous losses, your GP should refer you for blood tests to rule out thyroid issues etc. Unfortunately that means you may have to wait to be seen on the NHS, but a GP will usually refer you for private treatment if you want it. As other posters have said, just be prepared that there may not be an 'answer', miscarriages even 2 in a row are sadly common and don't always indicate an underlying problem.

I have also suffered two misscariages in a row , one at 6 weeks managed at home and one at 12 weeks missed misscariaged , treated with d and c as had a massive haemhorage.
I spoke to my go and explained my concerns regarding getting pregnant again and that no one would see me as I had only had two , I asked go if she would test for the simple things like thyroid , clotting disorders etc and she was more than happy to help and ordered the tests right away.
I fell pregnant again and I am now 16 weeks with no issues at the moment ( fingers crossed ) .

All test were normal and they stayed it was just bad luck ..
I would suggest speaking to your gp and explaining everything , and ask if they could test for a few of the simple things x

I would phone up the fertility clinic and ask them to make another appointment in place of the one you cancelled. I would be surprised if they insist on another GP referral. That should save you some time.

I’m sorry for what you’ve been through. I have 2 IVF babies (am not in the UK though) so understand how hard it is when TTC unsuccessfully. I appreciate the NHS only has finite resources but there are some things which are cheap to test for and easy to treat but nevertheless get dismissed. For example thyroid and progesterone levels, which were both low in my case yet easily identified with a blood test and resolved with medication.

I wish you luck and hope you have some answers soon.