Why a mis­car­riage can occur

Mis­car­riages are com­mon and, espe­cial­ly in ear­ly preg­nan­cy, are usu­al­ly caused by ran­dom chro­mo­so­mal changes in the embryo. A sin­gle mis­car­riage there­fore often remains a one-time event and does not auto­mat­i­cal­ly mean that an ill­ness or dis­or­der is present. In many cas­es, no fur­ther diag­nos­tic work-up is required after a sin­gle mis­car­riage. Many women sub­se­quent­ly become preg­nant again and expe­ri­ence a nor­mal­ly pro­gress­ing preg­nan­cy with the birth of a healthy child.

If mis­car­riages occur repeat­ed­ly, a tar­get­ed eval­u­a­tion may be use­ful. Pos­si­ble influ­enc­ing fac­tors range from genet­ic and anatom­i­cal caus­es to hor­mon­al con­di­tions and cer­tain clot­ting or autoim­mune dis­or­ders. It is not always pos­si­ble to iden­ti­fy a clear cause. The aim of diag­nos­tics is to iden­ti­fy pos­si­ble risk fac­tors and plan the next steps indi­vid­u­al­ly.

The immune sys­tem plays an impor­tant role in implan­ta­tion, ear­ly pla­cen­tal devel­op­ment, and main­tain­ing a preg­nan­cy. Cer­tain autoim­mune dis­eases and immuno­log­i­cal changes can be asso­ci­at­ed with an increased risk of mis­car­riage. These include, for exam­ple, antiphos­pho­lipid syn­drome, cer­tain autoim­mune thy­roid dis­eases, or pre­vi­ous­ly undi­ag­nosed coeli­ac dis­ease. In addi­tion, oth­er changes in the mater­nal immune response are being inves­ti­gat­ed as pos­si­ble influ­enc­ing fac­tors in recur­rent mis­car­riages.

Espe­cial­ly in cas­es of recur­rent mis­car­riages with no iden­ti­fi­able cause to date, fur­ther immuno­log­i­cal diag­nos­tics may there­fore be use­ful in select­ed sit­u­a­tions. We assess which tests are actu­al­ly help­ful on an indi­vid­ual basis, tak­ing into account your med­ical his­to­ry and pre­vi­ous find­ings. We also con­sid­er that the sci­en­tif­ic evi­dence for indi­vid­ual immuno­log­i­cal tests varies.

Who may ben­e­fit from fur­ther mis­car­riage diag­nos­tics

Logo Ikon Women with recur­rent mis­car­riages

Recur­rent mis­car­riage is defined as the loss of two or more preg­nan­cies. Even after two mis­car­riages, fur­ther diag­nos­tics are often advisable—depending on age, med­ical his­to­ry, and indi­vid­ual risk fac­tors. As the num­ber of pre­vi­ous mis­car­riages increas­es, the risk of anoth­er preg­nan­cy loss also ris­es.

Logo Ikon Women or cou­ples with cer­tain pre-exist­ing con­di­tions

Cer­tain pre-exist­ing con­di­tions can increase the risk of mis­car­riage or play an impor­tant role in an indi­vid­ual eval­u­a­tion. These include, for exam­ple, thy­roid dys­func­tion, poor­ly con­trolled dia­betes mel­li­tus, cer­tain autoim­mune dis­eases such as antiphos­pho­lipid syn­drome or coeli­ac dis­ease, as well as oth­er con­di­tions that can affect the course of preg­nan­cy. We also take gynae­co­log­i­cal con­di­tions such as endometrio­sis or changes in the uterus into account in the indi­vid­ual assess­ment.

Logo Ikon Women of advanced age who wish to con­ceive

As age increas­es, the risk of mis­car­riage ris­es sig­nif­i­cant­ly. Data from the Ger­man IVF Reg­istry show this asso­ci­a­tion: In younger women, the mis­car­riage rate is around 15%, but by age 40 it is already about one third. After that, it increas­es marked­ly with each addi­tion­al year of age and is around two thirds or high­er from age 45.
The main rea­son is the increas­ing like­li­hood of chro­mo­so­mal changes in the eggs—and there­fore in the result­ing embryos—as age increas­es. At the same time, both egg num­ber and egg qual­i­ty decline. In cas­es of recur­rent mis­car­riages and an ongo­ing wish to con­ceive, time­ly eval­u­a­tion is there­fore par­tic­u­lar­ly advis­able as age increas­es, in order to iden­ti­fy pos­si­ble caus­es and plan the next steps indi­vid­u­al­ly.

Two fertility specialists in professional discussion.

Expert assess­ment for recur­rent mis­car­riages

Recur­rent mis­car­riages can have dif­fer­ent caus­es. These include hor­mon­al fac­tors such as thy­roid or meta­bol­ic dis­or­ders, genet­ic changes, anatom­i­cal abnor­mal­i­ties of the uterus, cer­tain clot­ting and autoim­mune dis­or­ders, or oth­er immuno­log­i­cal fac­tors. Age and the asso­ci­at­ed egg and embryo qual­i­ty also play an impor­tant role. How­ev­er, it is not always pos­si­ble to iden­ti­fy a clear cause—often sev­er­al fac­tors come togeth­er.

This makes care­ful med­ical assess­ment of pre­vi­ous preg­nan­cies and all avail­able find­ings all the more impor­tant. Tar­get­ed diag­nos­tics can help iden­ti­fy pos­si­ble risk fac­tors and derive indi­vid­u­al­ly appro­pri­ate next steps. And even after sev­er­al mis­car­riages, in many cas­es there is still a good chance of a suc­cess­ful preg­nan­cy and the birth of a healthy child.

Overview of diag­nos­tic pro­ce­dures

Diag­nos­tics are used to specif­i­cal­ly clar­i­fy pos­si­ble caus­es and risk fac­tors for recur­rent mis­car­riages. Which tests are appro­pri­ate depends on your per­son­al med­ical his­to­ry and pre­vi­ous find­ings.

ANATOMICAL DIAGNOSTICS

Anatom­i­cal changes of the uterus are found in about 5% of all women, but are sig­nif­i­cant­ly more com­mon in women with recur­rent miscarriages—around 10–15%. These include, for exam­ple, a uter­ine sep­tum or oth­er con­gen­i­tal forms. Using high-res­o­lu­tion ultra­sound and 3D ultra­sound, we can assess the shape of the uterus and, in par­tic­u­lar, the uter­ine cav­i­ty.

Find­ings such as a con­gen­i­tal uter­ine sep­tum, fibroids, polyps, or adhe­sions can affect implan­ta­tion or the course of a preg­nan­cy. If indi­cat­ed, hys­teroscopy may also be use­ful. This allows changes in the uter­ine cav­i­ty to be assessed par­tic­u­lar­ly pre­cise­ly and—where pos­si­ble and appropriate—treated direct­ly.

Coag­u­la­tion diag­nos­tics

Cer­tain blood clot­ting dis­or­ders can be asso­ci­at­ed with recur­rent mis­car­riages and preg­nan­cy com­pli­ca­tions. Antiphos­pho­lipid syn­drome (APS) is of par­tic­u­lar importance—an autoim­mune dis­ease in which cer­tain anti­bod­ies can affect blood clot­ting and pla­cen­tal devel­op­ment. For eval­u­a­tion, so-called antiphos­pho­lipid anti­bod­ies are specif­i­cal­ly test­ed in the blood.

Depend­ing on your per­son­al and fam­i­ly his­to­ry, oth­er acquired or inher­it­ed changes in blood clot­ting may also be includ­ed in the diag­nos­tic work-up. We decide which coag­u­la­tion para­me­ters are appro­pri­ate in your indi­vid­ual sit­u­a­tion based on your pre­vi­ous preg­nan­cies, pos­si­ble risk fac­tors, and any exist­ing find­ings.

Genet­ic diag­nos­tics

Genet­ic changes are among the most com­mon caus­es of ear­ly mis­car­riages. Often, these are ran­dom changes in the num­ber or struc­ture of the embryo’s chro­mo­somes, the risk of which increas­es with the woman’s age.

In some cas­es, how­ev­er, genet­ic changes in the par­ents can also play a role—even if both are com­plete­ly healthy. In about 2–5% of cou­ples with recur­rent mis­car­riages, a so-called bal­anced chro­mo­so­mal rearrange­ment is found, often a translo­ca­tion. In this case, the entire genet­ic mate­r­i­al is present, but indi­vid­ual chro­mo­some seg­ments are arranged dif­fer­ent­ly. For the car­ri­er, this usu­al­ly has no health con­se­quences; how­ev­er, dur­ing the for­ma­tion of egg or sperm cells, an unfavourable dis­tri­b­u­tion of chro­mo­somes can occur, increas­ing the risk of mis­car­riage.

Fur­ther eval­u­a­tion may there­fore include a chro­mo­some analy­sis of both par­ents. In addi­tion, genet­ic test­ing of preg­nan­cy tis­sue can pro­vide impor­tant clues about pos­si­ble caus­es. We work with spe­cialised human genet­ics insti­tutes for this pur­pose.

Male fac­tor and sperm qual­i­ty

The male fac­tor can also play an impor­tant role in recur­rent mis­car­riages and should always be includ­ed in the joint eval­u­a­tion. In addi­tion to stan­dard sperm para­me­ters, sperm DNA integri­ty in par­tic­u­lar, as well as the man’s age, pre-exist­ing con­di­tions, and lifestyle, can influ­ence repro­duc­tive health.

A semen analy­sis ini­tial­ly pro­vides infor­ma­tion about sperm count, motil­i­ty, and mor­phol­o­gy. In addi­tion, espe­cial­ly in cas­es of recur­rent mis­car­riages, a DNA frag­men­ta­tion test may be use­ful. This exam­ines the pro­por­tion of sperm with increased DNA strand breaks. Ele­vat­ed DNA frag­men­ta­tion can be asso­ci­at­ed, among oth­er things, with oxida­tive stress, smok­ing, over­weight, inflam­ma­tion, a varic­o­cele, or increas­ing pater­nal age, and may be linked to an increased risk of mis­car­riage.

For this rea­son, in mis­car­riage diag­nos­tics we do not only assess the woman, but also include sperm qual­i­ty and poten­tial­ly mod­i­fi­able risk fac­tors in the man.

Immuno­log­i­cal diag­nos­tics

The immune sys­tem plays an impor­tant role in implan­ta­tion, pla­cen­tal devel­op­ment, and main­tain­ing a preg­nan­cy. Cer­tain autoim­mune dis­eases and changes in the mater­nal immune response may be asso­ci­at­ed with recur­rent mis­car­riages.

Estab­lished immuno­log­i­cal caus­es include, in par­tic­u­lar, antiphos­pho­lipid syn­drome (APS). Depend­ing on your his­to­ry, fur­ther indi­ca­tors of autoim­mune dis­ease may also be inves­ti­gat­ed, such as thy­roid autoan­ti­bod­ies, anti­nu­clear anti­bod­ies (ANA), or pre­vi­ous­ly undi­ag­nosed coeli­ac dis­ease.

In select­ed sit­u­a­tions, extend­ed repro­duc­tive immunol­o­gy diag­nos­tics may also be con­sid­ered. This can include, for exam­ple, test­ing var­i­ous immune cell pop­u­la­tions and nat­ur­al killer cells (NK cells) and—depending on the clin­i­cal question—other immuno­log­i­cal con­stel­la­tions such as KIR and HLA char­ac­ter­is­tics.

Not all immuno­log­i­cal tests are equal­ly well estab­lished sci­en­tif­i­cal­ly, and not every abnor­mal lab­o­ra­to­ry val­ue is auto­mat­i­cal­ly the cause of a mis­car­riage. There­fore, we select tests indi­vid­u­al­ly based on your med­ical his­to­ry and pre­vi­ous find­ings and always inter­pret the results in the over­all con­text. For spe­cialised analy­ses, we work with expe­ri­enced immunol­o­gy lab­o­ra­to­ries.

Hor­mon­al Diag­nos­tics

Hor­mones play an impor­tant role in egg mat­u­ra­tion, the build-up of the uter­ine lin­ing, and the ear­ly devel­op­ment of a preg­nan­cy. In cas­es of recur­rent mis­car­riages, we there­fore specif­i­cal­ly include pos­si­ble hor­mon­al and meta­bol­ic influ­enc­ing fac­tors in the diag­nos­tic work-up.
The thy­roid plays a par­tic­u­lar­ly impor­tant role. Both under­ac­tive and over­ac­tive thy­roid func­tion can affect the cycle and the course of preg­nan­cy. In addi­tion to the TSH lev­el, free thy­roid hor­mones and thy­roid autoan­ti­bod­ies may also be mea­sured depend­ing on your his­to­ry.

Cycle and ovu­la­tion dis­or­ders as well as poly­cys­tic ovary syn­drome (PCOS) can also be asso­ci­at­ed with an increased risk of mis­car­riage. In PCOS, in addi­tion to hor­mon­al changes, meta­bol­ic fac­tors such as insulin resis­tance often play a role.

Prog­es­terone is of cen­tral impor­tance for the uter­ine lin­ing and main­tain­ing preg­nan­cy, espe­cial­ly after ovu­la­tion and in ear­ly preg­nan­cy. Depend­ing on the clin­i­cal ques­tion, the sec­ond half of the cycle and prog­es­terone pro­duc­tion may there­fore also be assessed. As prog­es­terone lev­els fluc­tu­ate sig­nif­i­cant­ly in the nat­ur­al cycle, results are always eval­u­at­ed in the con­text of the cycle pat­tern and the oth­er find­ings.

We deter­mine which hor­mon­al tests are appro­pri­ate on an indi­vid­ual basis, based on your med­ical his­to­ry, your cycle, and any exist­ing find­ings.

Sup­port after a mis­car­riage: The path to an indi­vid­ual eval­u­a­tion

With mod­ern diag­nos­tics and many years of expe­ri­ence, we sup­port you in eval­u­at­ing recur­rent mis­car­riages.

  1. Ini­tial Con­sul­ta­tion

    At the begin­ning, we take time to review your med­ical his­to­ry, the course of your pre­vi­ous preg­nan­cies, and pos­si­ble risk fac­tors. Togeth­er, we assess which tests are appro­pri­ate in your per­son­al sit­u­a­tion.  

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  2. Blood tests

    Depend­ing on your his­to­ry and pre­vi­ous find­ings, var­i­ous lab­o­ra­to­ry tests may be use­ful. These include, for exam­ple, hor­mone lev­els, thy­roid para­me­ters, cer­tain autoan­ti­bod­ies, and select­ed coag­u­la­tion and immuno­log­i­cal para­me­ters.

  3. Ultra­sound and fur­ther exam­i­na­tions

    Using high-res­o­lu­tion ultra­sound, we can assess the uterus and its struc­ture. Depend­ing on the clin­i­cal ques­tion, a 3D ultra­sound or, in some cas­es, hys­teroscopy may also be use­ful.

  4. Genet­ic tests (if required)

    In cas­es of recur­rent mis­car­riages, a chro­mo­some analy­sis of both part­ners may be use­ful. If preg­nan­cy tis­sue is avail­able, genet­ic test­ing of this tis­sue can also pro­vide impor­tant clues about the cause of a mis­car­riage.

  5. Bring­ing the find­ings togeth­er

    We care­ful­ly eval­u­ate all results and dis­cuss them with you to obtain a com­pre­hen­sive pic­ture of the pos­si­ble caus­es.

  6. Indi­vid­ual rec­om­men­da­tion

    Based on the results, we dis­cuss togeth­er which fur­ther steps are appropriate—from tar­get­ed treat­ment of indi­vid­ual risk fac­tors to indi­vid­ual sup­port when try­ing to con­ceive again or dur­ing a sub­se­quent preg­nan­cy.

Union

Try­ing to con­ceive after recur­rent mis­car­riages: Pos­si­ble treat­ment approach­es

Which treat­ment is appro­pri­ate after recur­rent mis­car­riages depends on the pos­si­ble caus­es, the pre­vi­ous test results, and your per­son­al fer­til­i­ty his­to­ry. It is not always pos­si­ble to find a clear cause, and not every abnor­mal find­ing requires treat­ment. There­fore, togeth­er with you, we decide which ther­a­peu­tic mea­sures are appro­pri­ate in your indi­vid­ual sit­u­a­tion.

Depend­ing on the cause and indi­vid­ual sit­u­a­tion, dif­fer­ent ther­a­peu­tic approach­es may be con­sid­ered to specif­i­cal­ly sup­port a preg­nan­cy.

HORMONAL SUPPORT

Hor­mon­al dis­or­ders such as under­ac­tive or over­ac­tive thy­roid func­tion, ele­vat­ed pro­lactin lev­els, or cer­tain meta­bol­ic and cycle dis­or­ders can be treat­ed in a tar­get­ed man­ner. Prog­es­terone also plays an impor­tant role for the uter­ine lin­ing and main­tain­ing ear­ly preg­nan­cy. Whether addi­tion­al prog­es­terone sup­ple­men­ta­tion is advis­able is decid­ed based on your med­ical his­to­ry, your cycle, and the course of a sub­se­quent preg­nan­cy.

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Anti­co­ag­u­lant ther­a­py

In cer­tain con­firmed clot­ting dis­or­ders, anti­co­ag­u­lant treatment—for exam­ple with heparin or low-dose acetyl­sal­i­cylic acid—may be use­ful. Whether and which treat­ment is rec­om­mend­ed depends on the spe­cif­ic find­ings and your med­ical his­to­ry.

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Immunomod­u­la­to­ry treat­ment

In cas­es of recur­rent mis­car­riages, immuno­log­i­cal fac­tors may also play a role in some cas­es. If the extend­ed immuno­log­i­cal diag­nos­tics show rel­e­vant abnor­mal­i­ties, we assess these in a dif­fer­en­ti­at­ed way and in the con­text of your fer­til­i­ty his­to­ry and the oth­er find­ings.

Depend­ing on the indi­vid­ual sit­u­a­tion, dif­fer­ent immunomod­u­la­to­ry treat­ment approach­es may be con­sid­ered. Which ther­a­py may be appro­pri­ate depends on the type of abnor­mal­i­ty, pos­si­ble comor­bidi­ties, and pre­vi­ous preg­nan­cy cours­es. We dis­cuss with you the var­i­ous options, their poten­tial ben­e­fits and risks, as well as the respec­tive sci­en­tif­ic data and evi­dence. Togeth­er with you, we care­ful­ly weigh whether and which immunomod­u­la­to­ry treat­ment may be appro­pri­ate in your per­son­al sit­u­a­tion.

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Sur­gi­cal treat­ment of the uterus

If changes in the uterus are identified—for exam­ple cer­tain polyps, fibroids, adhe­sions, or a mal­for­ma­tion of the uter­ine cavity—surgical treat­ment may be use­ful. Whether an inter­ven­tion is rec­om­mend­ed depends on the type and extent of the find­ings.

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Indi­vid­ual sup­port in ear­ly preg­nan­cy

After pre­vi­ous mis­car­riages, a new preg­nan­cy is often asso­ci­at­ed with great uncer­tain­ty. Close mon­i­tor­ing and per­son­al care in the first weeks of preg­nan­cy pro­vide reas­sur­ance and enable us to assess the devel­op­ment of the preg­nan­cy ear­ly and respond indi­vid­u­al­ly if abnor­mal­i­ties occur.

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Fur­ther fer­til­i­ty treat­ments

IVF or ICSI may be use­ful if, in addi­tion to recur­rent mis­car­riages, oth­er fac­tors are present that make it more dif­fi­cult to achieve preg­nan­cy. We assess indi­vid­u­al­ly whether repro­duc­tive med­ical treat­ment offers an advan­tage, based on your med­ical his­to­ry and the diag­nos­tic results.

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Ten­der Lov­ing Care: Com­pas­sion­ate sup­port after a mis­car­riage

After recur­rent mis­car­riages, a new preg­nan­cy is often asso­ci­at­ed with many wor­ries and fears. As part of what is known as Ten­der Lov­ing Care, we there­fore sup­port you par­tic­u­lar­ly close­ly, espe­cial­ly in the first weeks of pregnancy—with reg­u­lar ultra­sound checks, per­son­al con­sul­ta­tions, and con­tin­u­ous med­ical care.

Stud­ies sug­gest that such inten­sive and sup­port­ive care after recur­rent mis­car­riages can have a pos­i­tive effect on the fur­ther course of preg­nan­cy. At the same time, the reg­u­lar check-ups pro­vide reas­sur­ance and enable us to assess the devel­op­ment of the preg­nan­cy ear­ly and respond indi­vid­u­al­ly if need­ed.

Close-up of a flower vase in the bright practice atmosphere at the fertility center in Munich for a relaxed consultation.

Per­son­al sup­port after recur­rent mis­car­riages

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  • Time for your sto­ry

    After recur­rent mis­car­riages, many ques­tions and uncer­tain­ties often remain. We take the time to under­stand your med­ical his­to­ry in detail, car­ry out thor­ough diag­nos­tics, and plan the next steps togeth­er with you.

  • Com­pre­hen­sive diag­nos­tics

    We clar­i­fy pos­si­ble caus­es in a struc­tured man­ner and in line with cur­rent sci­en­tif­ic evi­dence. A par­tic­u­lar focus is on extend­ed and immuno­log­i­cal diag­nos­tics.

  • Psy­cho­log­i­cal sup­port

    Mis­car­riages can be emo­tion­al­ly very dis­tress­ing. If you would like addi­tion­al sup­port, we can arrange accom­pa­ny­ing psy­cho­log­i­cal care.

  • Sup­port in the next preg­nan­cy

    Even after you become preg­nant again, we remain by your side. With close mon­i­tor­ing and per­son­al med­ical care, we sup­port you espe­cial­ly in the first weeks of preg­nan­cy. 

 
  
 
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What Our Patients Say

 
 
 
 
 
 
 
 
 
 
 
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 Sandra B 
 
105 days ago
 
 
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Had a very good experience, I felt very well taken care of, everyone very professional, standardized routines, can definitely recommend
  
 
 
 
 
 
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 Lauren W 
 
141 days ago
 
 
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We flew from overseas to work with Dr Mann and her team. Everyone was so kind, empathetic and extremely helpful. Everyone spoke English and made us feel very welcome. We could not have asked for better care than what we received from Dr Mann and her team. Bonus, the offices are beautiful.
  
 
 
 
 
 
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 Andrea C 
 
185 days ago
 
 
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After visiting two other fertility clinics (one of which I left in tears), I had almost lost hope of finding a place where I would truly feel heard. Then I met Dr. Sarah Comploj, and everything changed.

From the very first consultation, I felt genuinely listened to and treated as an individual. Unlike my previous experiences, where I was quickly told I needed IVF without anyone really taking the time to understand my situation or carefully review my test results, here I felt that my case truly mattered. Every step was explained thoughtfully, and my concerns were taken seriously.

What stood out the most was that I never felt like just another patient or that the focus was on money. Instead, I felt that the entire team was committed to helping me achieve my dream in the most appropriate and personal way possible.

Today, I am holding my one-month-old baby in my arms, and I will forever be grateful for the care, compassion, and expertise I received here. I can only highly recommend this clinic and Dr. Comploj 🩷
  
 
 
 
 
 
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 Viktoria O 
 
323 days ago
 
 
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Every appointment I’ve had over the last few months has been consistently informative, professional, and conducted in a personal manner. The treatment plan was explained in detail and any concerns or questions always answered. She also speaks perfect English if required. I’m impressed with how well organised the clinic is and how quickly results are processed, and last-minute appointments made available. For anyone who is going through the struggle of infertility it’s a difficult and vulnerable time, but I always felt so reassured and in good hands with Dr Mann.
  
 
 
 
 
 
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 Local R 
 
331 days ago
 
 
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A heartfelt thank you to Dr. Gerber for the exceptional support and warmth during a very sensitive journey. I always felt respected and in good hands. Truly grateful.
  
 
 
 
 
 
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 V D 
 
452 days ago
 
 
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I'm very grateful for my experience, the staff from reception to the doctors were very kind. You can feel  accompanied during the treatment. Also, overall I had a successful treatment, especially considering my age, it's a costly treatment but it's worth it. So I'm very happy for the result, my doctor was Sara Comploj.
  
 
 
 
 
 
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 Marina 
 
489 days ago
 
 
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I had a wonderful experience with the Kinderwunsch practice, and especially with dr. Corina Mann. From the very beginning, dr Mann was attentive, knowledgeable, and truly invested in helping me achieve the best possible outcome. She took the time to understand my goals and tailored my treatment plan to make sure I had the best chance of success.

Thanks to her care and expertise, I was able to maximise my results and reach my goals. I always felt supported, informed, and in the best hands. Dr Mann always answered my countless questions with a smile :) I’m incredibly grateful for her dedication and would wholeheartedly recommend her to anyone starting their fertility journey.
  
 
 
 
 
 
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 Carmencita 
 
491 days ago
 
 
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I just want to say a big thank you to the whole team of Dr. Mann and Dr. Albrecht. I felt really taking care off  in this Praxis and really can recommend everyone to go to this clinic, as here you can get at least the most possible personalization and time dedicated to you! Thanks again for your support!
  
 
 
 
 
 
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 Maria K 
 
587 days ago
 
 
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Since my doctor was busy and couldn't do the procedure herself, I had an appointment with Sarah to have my fallopian tubes checked. I was very nervous before the procedure, but it turned out to be for nothing! Sarah described and explained every step of the procedure and was extremely friendly.
  
 
 
 
 
 
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 Jay B 
 
1149 days ago
 
 
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Our multiple years-long Kinderwunsch journey was spent under the care of Dr. Mann and her Kinderwunsch practice team. Dr. Mann is not only a highly competent expert in her field, she's also empathetic and kind. She treated each appointment with a sense of being genuinely invested — listening to concerns or questions, planning for my unique treatment needs, and explaining processes or procedures without rushing (because she knows it's likely your first time going through something ... even though it might be her 40000th time). Her practice is busy and it's because she's the best. The practice team is cheerful and helpful. The waiting area is comfortable with pleasant music, flowers, and they even laid out gingerbread during Christmas time. They have a lab on-site so results are often same-day. I particularly found the technology they use to share results via email quickly so helpful. And I always felt at ease speaking in my native language and not pressured to try to keep up with unfamiliar German terminology. I'm forever grateful to have found Dr. Mann. We plan to visit soon with our new plus-one :)

- RB & JB
  
 
 
 
 
 
 Posted on Google Google 
 
 
 Aparna P 
 
1649 days ago
 
 
 Trustindex verifies that the original source of the review is Google. 
Dr.Albrecht is really good and friendly. She is best at her own way. But reception staff is very very very worst and disappointing. They themselves book an appointment and say it’s not booked. Luckily in Doctorlib my appointment was visible. Staff is very very rude. And they respond very rudely. I can give 0 rating for Staff at reception.
  
 
 
 
 
 
 Posted on Google Google 
 
 
 Cindy L 
 
1670 days ago
 
 
 Trustindex verifies that the original source of the review is Google. 
We had an absolutely wonderful experience with Dr. Mann. Her positive energy and competence was so reassuring and much appreciated during the potentially stressful time of trying to have a baby. I really loved how we could communicate in either English or German over complicated and sensitive reproductive matters. She took the time to answer all of our questions and offered us a wealth of information regarding the treatments. And her staff brought the same good vibes and Expertise to the practice. Some of the best and painless blood draws I’ve ever had, and they were always very responsive through emails as well as telephone communication. Online appointment system was also great. Video consults super convenient. The setting of the practice itself is an oasis of peace and calmness. As soon as I stepped through the doors I felt relaxed with the music, green plant wall, and well designed and decorated space. Technology and quality of equipment is very good. Yes, sometimes the waiting time had been 30+ minutes, but because the patient care is so excellent, I’ll be back for future treatments as needed, and would highly recommend this practice and team to anyone.
  
 
 
 
 
 
 Posted on Google Google 
 
 
 Raluca O 
 
1854 days ago
 
 
 Trustindex verifies that the original source of the review is Google. 
I have only the best words to describe my experience at the clinic. I personally worked with Dr. Albrecht and she was amazing. Every appointment was done on time, informative and clear on what the next steps are. She offered details and support with my every question. Where I wasn’t sure of my German we swapped to English to make sure I understood everything.

The clinic is run in a very efficient way, organized, planned and as a process oriented person I loved it!
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Costs of mis­car­riage diag­nos­tics

The costs depend on the exam­i­na­tions required in your indi­vid­ual case. Which diag­nos­tic steps are appro­pri­ate depends on your per­son­al sit­u­a­tion and pre­vi­ous find­ings.

To the cost overview
Ini­tial con­sul­ta­tion incl. basic diag­nos­tics — approx. €470–510*

Detailed med­ical his­to­ry, ultra­sound, and ini­tial basic hor­mone tests as an intro­duc­tion to the eval­u­a­tion. Help­ful for clas­si­fy­ing the course to date and plan­ning the next diag­nos­tic steps in a tar­get­ed man­ner.

*Note: Con­sul­ta­tion only with­out diag­nos­tics approx. €120

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Fal­lop­i­an tube exam­i­na­tion with hydrosonog­ra­phy (HyCoSy) — approx. €295

This exam­i­na­tion is pri­mar­i­ly part of fer­til­i­ty diag­nos­tics. If need­ed, it can be used as an addi­tion­al test, espe­cial­ly if a longer peri­od of unsuc­cess­ful attempts to con­ceive is also to be eval­u­at­ed. In addi­tion, there are costs for a spe­cial con­trast foam of approx. €90.

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Endome­tri­al biop­sy (micro­bio­me, uter­ine killer cells, ERA) — approx. €200

Brief tis­sue sam­pling from the uter­ine lin­ing for extend­ed diag­nos­tics (e.g. micro­bio­me, immune markers/uterine NK cells, ERA test). Addi­tion­al costs are incurred for the exter­nal lab­o­ra­to­ries that analyse the sam­ples. These are billed direct­ly by the exter­nal lab­o­ra­to­ry.

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Semen analy­sis — approx. €164

In addi­tion to diag­nos­tics for the woman, a semen analy­sis is use­ful to also include the male fac­tor (e.g. sperm count, motil­i­ty, and mor­phol­o­gy) in the eval­u­a­tion of mis­car­riages.

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DNA frag­men­ta­tion test (with exist­ing semen analy­sis) — approx. €265

If a cur­rent semen analy­sis is avail­able, sperm DNA frag­men­ta­tion can also be test­ed sep­a­rate­ly. The analy­sis is per­formed in our in-house androl­o­gy lab­o­ra­to­ry and eval­u­at­ed by a spe­cial­ist. You will usu­al­ly receive the results with­in a few days, encrypt­ed by email.

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Notes on Billing

No fixed or flat-rate prices: We bill on the basis of the offi­cial scale of fees for doc­tors (GOÄ). Accord­ing to the GOÄ, we are not allowed to quote fixed or flat-rate prices for med­ical ser­vices. The prices men­tioned are intend­ed to pro­vide ori­en­ta­tion and are typ­i­cal for the treat­ments men­tioned.

Pos­si­ble VAT lia­bil­i­ty: Med­ical ser­vices may be sub­ject to VAT (cur­rent­ly 19%). This applies if, after diag­nos­tics have been car­ried out, no med­ical indi­ca­tion or con­firmed diag­no­sis is present and it is there­fore not a med­ical treat­ment in the strict sense. This can be the case in par­tic­u­lar with social freez­ing treat­ments, but also with the treat­ment of sin­gle moms and same-sex cou­ples.

Note on Cost Cov­er­age

We would be hap­py to pro­vide you with detailed cost infor­ma­tion for the planned treat­ment in advance. This allows you to clar­i­fy cost cov­er­age with your pri­vate health insur­ance (PKV) as best as pos­si­ble before­hand. Statu­to­ry health insur­ance (GKV) does not cov­er costs at our cen­ter.

Fre­quent­ly asked ques­tions after a mis­car­riage

How do you recog­nise a mis­car­riage, and what does it feel like?

A mis­car­riage can present with dif­fer­ent symp­toms. Bleed­ing, cramp-like low­er abdom­i­nal pain, or back pain are com­mon. A sud­den decrease in preg­nan­cy symp­toms such as nau­sea or breast ten­der­ness can also be a sign.

How­ev­er, not every mis­car­riage caus­es symp­toms. In a so-called missed mis­car­riage, the preg­nan­cy ini­tial­ly con­tin­ues even though the embryo is no longer devel­op­ing. The diag­no­sis is then often only made at the next ultra­sound.

What does the bleed­ing look like in a mis­car­riage?

Bleed­ing dur­ing a mis­car­riage can vary great­ly. It may start like a light peri­od or spot­ting, but can also become heav­ier and be accom­pa­nied by low­er abdom­i­nal cramps.

The blood may be bright or dark red, some­times brown­ish. With heav­ier bleed­ing, blood clots and—depending on the week of pregnancy—tissue may also pass.

Impor­tant: The colour, amount, or appear­ance of bleed­ing alone does not reli­ably indi­cate whether a mis­car­riage has occurred. Bleed­ing can also occur in an ongo­ing preg­nan­cy. There­fore, bleed­ing dur­ing preg­nan­cy should always be med­ical­ly eval­u­at­ed, espe­cial­ly if symp­toms are more severe.

How long bleed­ing lasts after a mis­car­riage varies from per­son to per­son. It often lasts a few days, some­times longer than a week.

When can you become preg­nant again after a mis­car­riage?

After a mis­car­riage, ovu­la­tion can gen­er­al­ly occur again just a few weeks later—making a new preg­nan­cy pos­si­ble. How­ev­er, when the right time is for a new attempt depends on the indi­vid­ual sit­u­a­tion, phys­i­cal recov­ery, and also when you feel emo­tion­al­ly ready again.

After an uncom­pli­cat­ed ear­ly mis­car­riage, from a med­ical per­spec­tive a longer wait­ing peri­od is usu­al­ly not nec­es­sary. Even after a curet­tage, you gen­er­al­ly do not need to wait sev­er­al months. We often rec­om­mend giv­ing the body a few weeks to recov­er and wait­ing for the next men­stru­al peri­od. After that, if the course is uncom­pli­cat­ed, preg­nan­cy can usu­al­ly be attempt­ed again.

In cas­es of recur­rent mis­car­riages or a longer peri­od of try­ing to con­ceive, tar­get­ed diag­nos­tics may be use­ful before a new preg­nan­cy to clar­i­fy pos­si­ble caus­es and plan the next steps indi­vid­u­al­ly.

If you become preg­nant again, we can sup­port you par­tic­u­lar­ly close­ly in the first weeks if you wish—with per­son­al con­sul­ta­tions and reg­u­lar check-ups.

What are com­mon caus­es of recur­rent mis­car­riages?

Recur­rent mis­car­riages can have dif­fer­ent causes—and some­times sev­er­al fac­tors come togeth­er. Most com­mon­ly, chro­mo­so­mal changes in the embryo are the under­ly­ing rea­son. These usu­al­ly arise ran­dom­ly dur­ing the devel­op­ment of the egg cell or embryo and become more fre­quent with increas­ing mater­nal age.

In addi­tion, changes in the uterus, hor­mon­al or meta­bol­ic con­di­tions such as thy­roid dys­func­tion or poly­cys­tic ovary syn­drome (PCOS), as well as cer­tain clot­ting disorders—especially antiphos­pho­lipid syndrome—can play a role. Endometrio­sis and ade­no­myosis may also be asso­ci­at­ed with an increased risk of mis­car­riage.

More rarely, an inher­it­ed chro­mo­so­mal change is found in one of the part­ners. Male fac­tors can also be involved: In par­tic­u­lar, increased sperm DNA frag­men­ta­tion is asso­ci­at­ed with recur­rent mis­car­riages.

How­ev­er, it is not pos­si­ble to iden­ti­fy a clear cause in all cou­ples. Struc­tured diag­nos­tics help us iden­ti­fy pos­si­ble influ­enc­ing fac­tors and plan fur­ther treat­ment indi­vid­u­al­ly.

What most com­mon­ly trig­gers a mis­car­riage?

The most com­mon cause of an ear­ly mis­car­riage is chro­mo­so­mal changes in the embryo. These usu­al­ly arise ran­dom­ly dur­ing the devel­op­ment of the egg or sperm cell or dur­ing ear­ly embry­on­ic devel­op­ment. As a result, the embryo can­not con­tin­ue to devel­op nor­mal­ly and the preg­nan­cy ends. Such chro­mo­so­mal changes become more fre­quent with increas­ing mater­nal age.

In addi­tion, oth­er fac­tors can also increase the like­li­hood of mis­car­riage, such as changes in the uterus, hor­mon­al or meta­bol­ic con­di­tions, cer­tain autoim­mune or clot­ting dis­or­ders, and oth­er mater­nal or pater­nal fac­tors. How­ev­er, after a sin­gle mis­car­riage, it is often not pos­si­ble to iden­ti­fy a clear cause.

A sin­gle mis­car­riage there­fore usu­al­ly does not mean that some­thing is fun­da­men­tal­ly wrong or that anoth­er preg­nan­cy can­not be suc­cess­ful.

Can you still have a suc­cess­ful preg­nan­cy after sev­er­al mis­car­riages?

Yes—successful preg­nan­cy is often still pos­si­ble even after sev­er­al mis­car­riages. What mat­ters is an indi­vid­ual eval­u­a­tion of pos­si­ble risk fac­tors and tar­get­ed sup­port in ear­ly preg­nan­cy. We dis­cuss with you which next steps are med­ical­ly appro­pri­ate.

What role do hor­mones or immune fac­tors play in mis­car­riages?

Hor­mones play an impor­tant role in implan­ta­tion and main­tain­ing an ear­ly preg­nan­cy. This includes prog­es­terone in par­tic­u­lar, which pre­pares the uter­ine lin­ing for preg­nan­cy and sup­ports ear­ly preg­nan­cy. Thy­roid dys­func­tion, PCOS, or meta­bol­ic con­di­tions such as dia­betes can also affect the risk of mis­car­riage. How­ev­er, it is not always pos­si­ble to clear­ly deter­mine whether an iso­lat­ed prog­es­terone defi­cien­cy is actu­al­ly the cause of a mis­car­riage. In cer­tain sit­u­a­tions, treat­ment with prog­es­terone may still be use­ful.

The immune sys­tem is also involved in implan­ta­tion and preg­nan­cy. Cer­tain autoim­mune dis­eases, espe­cial­ly antiphos­pho­lipid syn­drome, are well estab­lished as pos­si­ble caus­es of recur­rent mis­car­riages. In addi­tion, oth­er immuno­log­i­cal fac­tors are being inves­ti­gat­ed, the sig­nif­i­cance of which has not yet been con­clu­sive­ly clar­i­fied sci­en­tif­i­cal­ly.

Which exam­i­na­tions and treat­ments are appro­pri­ate there­fore always depends on the indi­vid­ual med­ical his­to­ry and pre­vi­ous find­ings.

Can genet­ic caus­es in the par­ents also play a role?

Yes. In addi­tion to ran­dom chro­mo­so­mal changes in the embryo, genet­ic changes in one par­ent can more rarely play a role. If need­ed, genet­ic test­ing of preg­nan­cy tis­sue or a chro­mo­some analy­sis of both part­ners is pos­si­ble.

When is fur­ther mis­car­riage diag­nos­tics advis­able?

Fur­ther diag­nos­tics are par­tic­u­lar­ly advis­able in cas­es of recur­rent mis­car­riages or if addi­tion­al risk fac­tors or pre-exist­ing con­di­tions are present. The aim is to nar­row down pos­si­ble caus­es in a tar­get­ed man­ner and plan the next steps indi­vid­u­al­ly. We clar­i­fy which tests are nec­es­sary in a per­son­al con­sul­ta­tion.

What is the risk of anoth­er mis­car­riage?

After a sin­gle mis­car­riage, the chances of a suc­cess­ful next preg­nan­cy remain very good. The key fac­tors are the woman’s age and the num­ber of pre­vi­ous mis­car­riages.

For exam­ple, the prob­a­bil­i­ty of a lat­er live birth after a mis­car­riage is around 80–85% in women under 35, around 70% between 35 and 39, and around 50% between 40 and 44. With mul­ti­ple pre­vi­ous mis­car­riages, the like­li­hood of a suc­cess­ful preg­nan­cy decreases—nevertheless, a live birth is still very pos­si­ble even after recur­rent mis­car­riages (source: Kolte AM et al., Human Repro­duc­tion 2021).

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Herzogspitalstraße 5
80331 Munich
Germany

T: +49 89 123 595 65
F: +49 89 123 595 56
hallo@kinderwunschaerztin.de

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