Monday, June 04, 2007

Solving the mystery of recurrent miscarriage

A world-class unit that helps the childless is under threat, Victoria Lambert finds

Last Updated: 12:01am BST 04/06/2007

A world-class unit that helps the childless is under threat, Victoria Lambert finds

'Few seem to understand how low it can bring you," says Katrin Roskelly, her voice tight with emotion at the memory of her three recent miscarriages.

"I was heartbroken. You're expected to dust yourself down and just keep trying, yet instinct told me I needed a period of mourning.

"One nurse, when she learnt my age, told me I couldn't hang about and said I had to 'get back on the bike'. I found it devastating. I'm a person, not a breeding machine."

Katrin, a 42-year-old financial PR from Notting Hill, married Michael, 45, who works in property, late in life.

Their marriage, two years ago, was a joyous event, and they were keen to try for a child - although sanguine about their chances. "Time was not on our side, and we had no expectations."

So when Katrin quickly became pregnant they were thrilled. "I knew how difficult many women found conception, so it seemed an incredible bonus that I could do it so easily."

But Katrin was "shattered" when she miscarried at eight weeks.

Six months later, she miscarried again; another six months passed and, having become pregnant with twins, Katrin was horrified to learn that there was no sign of either heartbeat on the scanner - they had not made it.

Instead, she had to undergo an ERPC (evacuation of retained products of conception), a traumatic procedure to clear the womb of the foetal remains.

She had lost four babies in 18 months.

Sadly, Katrin's heartache is far from unique. One in seven couples is affected by infertility, one in every four pregnancies ends in miscarriage, and between one and two per cent of women suffer recurrent miscarriages (classified as three or more consecutive losses), as she did.

In desperation, Michael and Katrin paid for private tests to see if there was anything broken that science could fix, but all came back negative. It was their lowest moment. Finally, they were referred to Professor Lesley Regan, head of obstetrics and gynaecology at St Mary's Hospital, west London: "That's when our luck changed," says Katrin.

The hospital's Recurrent Miscarriage Clinic (RMC), opened in 1990, is the largest of its kind in the world.

It deals with more than 1,000 new referrals each year and has an astonishing 80 per cent success rate, delivering, on average, three healthy babies every day.

It's a tribute to its dedicated, multi-disciplinary team, but also to years of pioneering research.

No wonder their regime, based around regular testing for abnormal hormone levels, sub-fertility, genetic conditions and clotting disorders, and the use of drugs such as heparin and aspirin, combined where necessary with surgical procedures such as cervical stitches, has been imitated worldwide.

Most crucially, the team pioneered the correct diagnosis and treatment of Antiphospholipid Syndrome.

Antiphospholipid antibodies in the blood make the immune system work too hard, increasing clotting. This affects the placenta, where small clots form that may prevent its implantation or prevent it from getting vital nutrients to the foetus.

Sufferers have only a 10 per cent chance of their pregnancy surviving to full term. The clinic has established that up to 20 per cent of all women who have had recurrent miscarriages have the condition. It can be difficult to diagnose, but is comparatively easy to treat with blood-thinning drugs.

Since the clinic is on one site, the team enjoys a constant flow of ideas from the labs to the bedside.

"An observation made by a patient leads us to posing a question and then designing an experiment to try to answer it," says Prof Regan.

Yet this great British success story is under threat. Last year, a health and safety inspectorate declared one of the RMC's two laboratories, which are housed in Victorian stables, unfit for purpose and the other in need of an overhaul - something the hospital cannot afford.

"For patients with repeated miscarriages, every month counts as their fertility declines," explains Prof Regan.

"We don't have time for endless consultations; rebuilding the unit quickly means the difference between giving our patients the promise of a baby or condemning them to childlessness for ever."

But the unit's 30-odd members of staff refuse to give up: earlier this year, they launched the Save the Baby Unit Appeal to raise the desperately needed £1 million, and with the help of hospital executives, patients and friends of the hospital, £450,000 has been pledged.

For Katrin, her appointment with Prof Regan was a turning point.

"She carried out more tests, then confidently told me to go away and get pregnant. Incredibly, I conceived that month, and with Prof Regan's work, advice, encouragement, regular scans, and a feeling of positivity that I can't begin to explain, my pregnancy developed normally."

Katrin went to "masses of yoga classes, took naps, found a brilliant antenatal counsellor, and ate like a horse".

Her recurrent miscarriages remain unexplained, but Prof Regan's inspiring care undoubtedly helped her through.

A previous operation for fibroids meant that she had to book in for a Caesarean on April 19. It was quick and remarkably pain free. And then came that heart-stopping moment when midwife turned to the new mother and said: "Would you like to meet your baby daughter?" Alexandra Constance Roskelly - 8lb 2oz - had arrived safely. "It was overwhelming," says Katrin.

"She's beautiful, extraordinary. She is a miracle."

The Save the Baby Unit Appeal is holding a Literary Auction on June 12 in Mayfair, hosted by Alan Coren. For information and tickets to this event or the Appeal's charity ball, email ; or see


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