MiscarriageIf you have suffered a miscarriage, you may feel grief, frustration and anger. Miscarriage is a very common experience among all women, but the fact that it is common doesn’t lessen the loss and grief that women and their partners can feel. Causes There are many causes of miscarriage, which can include maternal age above 35, paternal age over age 45, genetic conditions, chronic illnesses, and uterine or cervical problems. We also know from research that women who have been diagnosed with myeloproliferative neoplasms (MPNs) have a higher risk of miscarriage than women in the general population, although exactly how much higher the risk may be still isn’t clear today due to lack of research in this area. Prevention In most cases, you can’t prevent a miscarriage. However, if you have an MPN, we recommend that you begin any pregnancy by planning with your MPN health care team. Have a full physical before you try to become pregnant and take very good care of your overall health. Work with your haematologist to develop a treatment plan, and eliminate drugs like hydroxycarbamide and anagrelide from your system six months before becoming pregnant. Having a good treatment plan in place may help to reduce the risk of miscarriage in MPNs. If you have suffered a miscarriage If you have suffered one or more miscarriages, you may feel grief, frustration and anger. You may find that others don’t understand, including your partner, your friends and family members. Women with MPNs who have experienced miscarriage recommend contacting the Miscarriage Association (UK) for support and information about miscarriage. If you are suffering a miscarriage If you are concerned that you may have suffered a miscarriage, please contact your GP and haematologist. It is important to inform your haematologist so that he or she can adjust your medication after miscarriage, if necessary, to prevent any risks to your own health. Options after miscarriage Couples affected by MPNs often need to consider what is best for them. The pain and loss caused by miscarriage is sadly often underestimated by family, friends and health professionals. The euphoria and excitement of planning for a family can turn to sadness, anxiety, feelings of failure and sometimes depression for couples who suffer one or recurrent miscarriages. Pregnancy complications in MPNs Research studies conducted at numerous centres have shown that MPNs are associated with pregnancy complications. The research indicates that there is around a 65% success rate for live births for women with MPNs. This is slightly less than the normal pregnancy success rate. The risk of miscarriage or fetal growth problems can thus be a real concern. Couples affected by MPNs often need to consider what is best for them. While these challenges are often distressing, many options and potential solutions exist for creating families. Coping with miscarriage The Miscarriage Association a UK charity offering support and information to anyone grieving the loss of a pregnancy. Surrogacy If a couple affected by an MPN has decided to consider an alternative route to having a family, surrogacy may be an option. In surrogacy, a woman’s eggs are collected and combined with her partner’s sperm. The fertilised eggs are transferred to a surrogate mother, often a sister or cousin, who carries the baby to term. The numbers of surrogacy births are relatively small in the UK but surrogacy can be an option if adoption and natural childbirth are not suitable or possible. The Surrogacy Charity (UK) offers information and resources, reach them at their website. Adoption Adoption may be another consideration for some MPN couples for whom a full-term pregnancy is not a viable option. The first step in adoption is to contact your local adoption agency to make an initial inquiry. After this, your adoption agency may ask you to a meeting where you can meet and chat with social workers and adoptive parents. The process can take some time but if successful can provide an equally fulfilling route to parenting. Contact Adoption UK, or the British Association for Adoption and Fostering. As with any consideration for pursuing parenthood, anyone considering adoption or surrogacy is urged to consider their own long-term health issues and ability to be there for children as they grow.