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Recurrent Pregnancy Loss Clinic

We provide multidisciplinary care to those who are experiencing recurrent pregnancy loss.
What we do
We offer compassionate and comprehensive care in the evaluation, treatment and support of people experiencing recurrent pregnancy loss. Our areas of expertise include reproductive medicine, high-risk obstetrics, internal medicine, advanced surgical gynaecology, medical genetics and managing chronic histiocytic intervillositis.

We have health information and videos on the topic of Recurrent Pregnancy loss and Miscarriage.

We regularly conduct research on recurrent pregnancy loss, ensuring that the care we provide is the most advanced, effective and evidence-based care possible. 

BC Women’s Hospital is a provincial teaching centre, so there may be gynaecology fellows and residents participating in your care.

Our Team

Dr. Caroline Lee (MD, MSc, FRCSC) is a Gynaecologist at the BC Women's Centre for Pelvic Pain & Endometriosis. Dr. Lee completed her medical degree at the University of Alberta and her residency in Obstetrics and Gynaecology at the University of Saskatchewan. She joined the BC Women’s Centre Recurrent Pregnancy Loss clinic after completing her fellowship in Endometriosis, Pelvic Pain & Advanced Laparoscopy and Masters in Reproductive Sciences at the University of British Columbia in 2020. 


Dr. Lee’s primary clinical practice involves diagnosis and management of recurrent pregnancy loss, including surgical management focusing on endometriosis and fibroids. She is cultivating a clinical interest in the use of ultrasound and magnetic resonance imaging to aid in surgical diagnosis and planning prior to surgical management. She has played a central role in collaborative efforts with the department of radiology to create standardized protocols for management of non-tubal ectopic pregnancies including C-section scar, interstitial, and cervical ectopic pregnancies. 


As a Clinical Associate Professor in the UBC Department of Obstetrics & Gynaecology, Division of Gynaecologic Specialties, Dr. Lee is an active clinical and surgical teacher of residents and fellows. She is currently acting as the co-fellowship director for the Advanced Training Program in Endometriosis, Pelvic Pain and Advanced Laparoscopic Surgery and director for the Chronic Pelvic Pain residency rotation. 


Dr. Lindsay Porteous joined the BC Women’s OBGYN department in 2019.  She is originally from Winnipeg, Manitoba where she completed her OBGYN residency. Dr. Porteous has a general obstetrics practice with a special focus on medical disorders of pregnancy. She completed an OB Internal Medicine Fellowship at Brown University, Rhode Island. She has completed additional ultrasound training, and works in the Early Pregnancy Assessment and Recurrent Pregnancy Loss clinics at BC Women’s Hospital + Health Centre. 
 
Dr. Bedaiwy is Professor and Division Head, Division of Reproductive Endocrinology & Infertility, UBC Department of Obstetrics and Gynaecology.

Dr. Bedaiwy received his medical degree from Assiut University School of Medicine, Egypt where he graduated Valedictorian, summa cum laude.

Dr. Bedaiwy is a prolific author with over 200 publications, including 104 peer-reviewed publications. He is best known for his work in endometriosis, ovarian transplantation, in vitro fertilization (IVF) and minimally invasive surgery (MIS). His interests include IVF, MIS, robotic surgery, fertility preservation in cancer patients, and endometriosis. He is also the Associate Editor of the Human Reproduction Journal which is the official journal of the European Society of Human Reproduction and Embryology (ESHRE). Dr. Bedaiwy has had a career-long interest in high quality medical care, research and education.
 

We work closely with members of the C+W Department of Anatomical Pathology who have expertise in Perinatal Pathology. They guide our clinicians in the evaluation and diagnosis of causes of recurrent pregnancy loss. 

 
 

Nurses in the RPL Clinic are specialized in the care and support of people who have experienced recurrent pregnancy loss. Our wonderful team of nurses provide telephone consultation for patients newly referred to the program to prepare them for their initial consultation with one of the specialist physicians. They also provide telephone support to patients in the program who are newly pregnant or who are diagnosed with a miscarriage.

Sarah is the RPL clinic's extraordinary registration and booking clerk. She is the first point of contact for patients who have been referred to the clinic. She graduated with a Medical Office Assistant Certificate from BCIT in 2019.

 

 

Appointments

referral from your healthcare provider is required for this clinic. Referring physicians please fax referral and all supporting documentation (previous ultrasounds, pathology reports, consultations) to 604-875-3136.

Who is eligible for the RPL clinic?

Across Canada, there is no single definition of recurrent pregnancy loss. At the RPL clinic, we accept referrals for people who have experienced:

  • 2 or more consecutive pregnancy losses at  or before 10 weeks gestation, that are not explained by aneuploidy.
  • 1 or more pregnancy losses between 10 weeks and  20 weeks gestation by ultrasound that are not explained by aneuploidy
  • Patients with more than 1 documented, unexplained pregnancy loss at any gestational age who have the following conditions:
    • chronic histiocytic intervillositis, OR;
    • known antiphospholipid syndrome, OR:
    • suspected major uterine anomaly (includes fibroids and adenomyosis, but excludes arcuate uterus), OR;
    • known parental translocation.

We acknowledge that this doesn’t encompass all types of pregnancy loss that can occur. Please note we do not see patients whose miscarriage can be explained by aneuploidy. Aneuploidy is a genetic imbalance in which the embryo has too many or too few chromosomes. It is the most common cause of miscarriage (70%); it occurs randomly and is not treatable. 

For more information about aneuploidy, visit the miscarriage webpage.

What to expect

If you have been referred to this clinic, please visit the recurrent pregnancy loss health information page and watch the video Recurrent Pregnancy Loss - Causes and Testing before your first appointment.

What to expect at this clinic

To help you navigate the road ahead until your first visit, we have outlined the following steps so you know what to expect:

1Email confirmation

You will first receive an email welcoming you to the RPL clinic. Attached to that email will be an "Email Communication Consent form". Your consent is needed in order for us to communicate over email with you, and to send you our RPL Patient Intake Questionnaire.

2Questionnaire

When you receive the Patient Intake Questionnaire, please fill it out and send it back within 3 weeks. If we do not receive a completed form within 3 weeks, we will assume that you are no longer interested in pursuing care in our program and you will be discharged.

3Phone interview

Once we have received your completed RPL Patient Intake Questionnaire, we will call you to arrange a phone interview with the RPL nurse to review your history.

4Preliminary testing

At the time of your phone interview, you may be asked to complete some preliminary testing prior to your first visit so that we have all the information in hand. If this is necessary, it will be reviewed by one of the RPL nurses.

5Booking your first appointment

At this time, you will also receive a phone call to book your first clinic appointment. Appointments are being booked approximately 2-6 months in advance. If you wish to be placed on our cancellation list, please contact us via email at RPL@cw.bc.ca or phone at 604-875-3706. 
Please note if you become pregnant prior to your initial appointment, we will not be able to see you in our clinic. If you become pregnant, please contact us at your earliest convenience to cancel your appointment. You will be prioritized for an initial visit should you miscarry.

6Your first clinic visit

At your first visit, you will meet with one of our RPL physicians who will review your history and outline a care plan with you. You may have a pelvic ultrasound done at that first visit.

While you are enrolled in this program, you will be asked if you would like to participate in research. This research aims to gather information to guide future treatment options for people experiencing recurrent pregnancy loss. Your participation is optional and your decision does not impact your care.


Frequently asked questions about the RPL clinic 

Pre-screening blood tests should be done as soon as possible after your phone history with the nurse. The tests should be done when you are not pregnant.

 

Evaluating the shape of your uterus is part of the work-up we recommend for RPL. A list of facilities providing HSGs in the lower mainland will be emailed to you by the RPL Clinic. Please note that you must call on cycle day 1 of your period to one of these clinics to arrange the HSG on day 9-10 of your cycle.. Once you are booked, contact our RPL booking clerk at 604 -875-3706 to let us know your appointment date. You will be given a requisition to do a serum pregnancy test 2 days before your procedure. If you are finding it challenging to arrange this, please contact the RPL clinic team. 

 
Once you get a positive urine pregnancy test, call the RPL registered nurse (RN) at (604)875-3628. The RN will send you for a serum pregnancy test (BhCG) and will arrange for your first ultrasound.
 
If you have miscarried while a patient of the clinic, please call the clinic and we will help you with next steps: 604-875-3706. 

A large number of losses are due to random aneuploidy.  We recommend cytogenetic testing* at the time of the 2nd consecutive pregnancy loss over 10 weeks (by ultrasound size).
 
If you would like the miscarriage examined, this is called an "examination of products of conception". You will need to fill out a  C&W Embryopathology Requisition Form, then deliver the sample and the signed requisition form to the C&W laboratory, located on the second floor of BC Children's Hospital through Entrance 11. 

*Cytogenetics involves testing samples of tissue or blood to look for changes in chromosomes, including broken, missing, rearranged, or extra chromosomes.
 








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