Reassurance from the earliest weeks.

Early pregnancy ultrasound provides reassurance and accurate dating, and helps identify problems early. Scans are performed and interpreted by your consultant, with results discussed with you at the same visit.

If you experience pain or bleeding in early pregnancy, we offer rapid assessment to exclude complications such as ectopic pregnancy, and sensitive, evidence-based management of miscarriage.

Where surgical management of miscarriage is needed, Mr Subramanian offers minimally invasive treatment with the compassion and clarity that a difficult time deserves.

Recurrent miscarriage means two or more miscarriages in the first twelve weeks, and it affects about one woman in a hundred. The causes are varied: chromosomal abnormalities in the pregnancy account for more than half of early losses, and the others include clotting disorders such as antiphospholipid syndrome, thyroid disease, diabetes and PCOS, abnormalities in the shape of the womb, chronic inflammation of the womb lining (endometritis), and DNA fragmentation in sperm. Age, smoking, alcohol and weight all play a part.

Mr Subramanian offers a structured assessment after two or more losses: blood tests for clotting, thyroid and hormone disorders, a detailed 3D ultrasound of the womb and ovaries, HyCoSy or saline sonogram where the cavity or tubes need a closer look, a biopsy of the womb lining for endometritis where indicated, sperm DNA fragmentation testing, and hysteroscopy to treat a polyp, fibroid, septum or adhesions if one is found. In about half of couples no cause is identified, and he will say so plainly, because that itself carries a good outlook.

The male partner is part of the assessment, not an afterthought. Sperm with a high level of DNA fragmentation can fertilise an egg and still lead to miscarriage, and the risk rises with age, smoking, alcohol, heat, weight, infection and varicocele. A semen analysis and a sperm DNA fragmentation test are offered to every couple with recurrent loss. Where fragmentation is raised, treatment starts with the cause: lifestyle changes and antioxidant supplements, treating infection or a varicocele, and where IVF is planned, ICSI with sperm selected to minimise DNA damage.

Treatment depends on what is found: correcting thyroid or hormonal problems, blood-thinning treatment for antiphospholipid syndrome, antibiotics for endometritis, surgery to the womb cavity, progesterone support in the next pregnancy, or IVF with genetic testing of embryos (PGT-A) where chromosomal problems are the likely cause. In the next pregnancy, reassurance scans start from six weeks and continue through the first trimester, with a direct line to the practice for questions in between.