von Tempelhoff Fertility Practice
Since 1991 we have systematically investigated the possible causes in women and couples after recurrent miscarriage, after unsuccessful IVF or ICSI treatment and after pre-eclampsia or HELLP syndrome. The result is an individual plan for the next pregnancy, coordinated with your gynaecologist or fertility centre.
Who we help
Two or more miscarriages affect about 1 to 2% of all couples, up to 5% depending on the definition. The risk of recurrence rises with each further miscarriage and with age. Investigation is advisable after two or more miscarriages, after one miscarriage from age 35, after a late miscarriage beyond week 12 and after repeated miscarriages following a birth.
Request an appointment →If no pregnancy occurs after three or more transfers of good embryos, the cause does not always lie with the embryo. The receptivity and blood supply of the uterine lining also play a role. We work closely with your fertility centre.
Request an appointment →Hypertensive disorders occur in 6 to 8% of all pregnancies, pre-eclampsia in about 2 to 5%. After an early or severe course the risk of recurrence is clearly increased. We investigate possible causes and plan prevention before the next pregnancy begins.
Request an appointment →We also advise on thrombosis risk and hormone therapy (contraception, fertility treatment, menopause) and care for pregnant women with autoimmune diseases such as immune thrombocytopenia (ITP).
Background
Frequency, prognosis and the recommendations of the medical societies on investigation.
Up to 15% of all recognised pregnancies end in miscarriage, usually because of a random chromosomal abnormality of the embryo. When miscarriages recur, chance becomes less likely and other causes come to the fore.
Even after several miscarriages, most couples have a better chance of a good outcome in the next pregnancy than a risk of another loss. The prognosis depends mainly on the woman's age and the number of previous miscarriages.
According to the guidelines, the basic investigation includes a detailed personal and family history, examination of the uterus, thyroid function and a search for autoimmune diseases. Chromosome tests are recommended depending on the history, as is a look at lifestyle factors of both partners. In many couples the cause remains open afterwards. This is where our extended investigation begins.
Recurrent implantation failure means that no pregnancy occurs after several transfers of morphologically good embryos. Frequency and definition vary between studies because age, embryo quality and the number of transfers are counted very differently.
Successful implantation requires a viable embryo and a receptive, well-supplied uterine lining.
Recommended are examination of the uterine cavity, hormonal and metabolic factors, autoimmune diseases and assessment of the embryos. In addition, we examine immunological compatibility and the blood supply of the lining. We coordinate the plan with your fertility centre.
The cause of pre-eclampsia most probably lies in the placenta: already in early pregnancy the remodelling of the maternal spiral arteries is incomplete. The earlier the disease occurred, the higher the risk of recurrence: about 39% with onset up to week 28, about 29% in weeks 29–32, about 22% in weeks 33–36 and about 3% from week 37.
After HELLP syndrome the risk of another HELLP syndrome is about 13%; after two pre-eclampsias the risk of a third is about 32%.
The guidelines recommend low-dose aspirin, started before week 16, and close monitoring for women at high risk. We start earlier: before the next pregnancy we investigate immunological factors and the blood supply of uterus and placenta, and plan prevention before the placenta forms.
Sources: AWMF guideline “Diagnosis and therapy of women with recurrent miscarriage”, ESHRE guideline “Recurrent Pregnancy Loss” (2022), AWMF guideline “Hypertensive disorders in pregnancy”.
Placenta-related disorders
In the first weeks of pregnancy, the developing placenta remodels the blood vessels of the uterus so that your baby will be well supplied later. If this is only partly successful, the pregnancy may end early. Or it continues, and the consequences only show months later as pre-eclampsia, HELLP syndrome, growth restriction or preterm birth.
Research groups these conditions together as disorders of deep placentation (Brosens et al., 2011). Studies show that women who have had miscarriages develop pre-eclampsia more often in later pregnancies. For us this means: understanding the early phase helps protect the later one.
Our approach
Pregnancy loss and pre-eclampsia rarely have a single cause. We therefore look at all factors that matter for implantation, placental development and the supply of the baby. We take existing results into account and only add what is still missing.
Our main areas, immunological compatibility, the blood supply of uterus and placenta and clotting in this region, have been the subject of our consultations and research for more than three decades. You will find the scientific background in the “Science” section.
Genetic factors · shape and lining of the uterus · hormones and metabolism (thyroid, cycle, PCOS, glucose metabolism) · inflammation · autoimmune diseases · tendency to thrombosis or bleeding · lifestyle of both partners
Does the mother's immune system accept the pregnancy? We check whether there is an immunological cause and whether treatment is an option.
How well are the uterus and placenta supplied with blood? We examine the flow properties of the blood and the microcirculation.
Is there a tendency to bleeding or to small clots (microthromboses) in the uterus and placenta that could disturb implantation and blood flow? We examine the balance of clotting with a view to early pregnancy and embryo transfer.
Treatment
If the investigation shows that the immune system does not sufficiently accept the pregnancy, immunotherapy can counteract rejection reactions. It starts when pregnancy begins and is usually given at three-week intervals. We determine duration and dosage individually, depending on findings and history.
If the blood is too viscous, we improve its flow properties and with them the blood supply to the uterus and placenta. This is not anticoagulation: we do not use aspirin or heparin for it.
If the investigation shows a tendency to bleeding or to microthromboses in the uterus and placenta, we use targeted measures to reduce this risk: depending on the findings, inhibiting or strengthening clotting. This applies, for example, to antiphospholipid syndrome, sticky platelet syndrome, immune thrombocytopenia (ITP) or other tendencies to thrombosis and bleeding. The aim is undisturbed implantation and placental development and a safe pregnancy through to after the birth.
Immunotherapy and haemodilution are not part of the standard recommendations of the guidelines. They are based on more than 30 years of clinical experience and our own studies. We discuss openly with you whether treatment makes sense for you, what its limits are and what it costs.
How it works
Fill in our online form. Please bring any existing results to your appointment.
In a detailed consultation with you, ideally together with your partner, and taking your previous test results into account, we carry out our diagnostic investigations.
You receive an easy-to-understand report of the findings with treatment recommendations tailored to you.
We support you alongside your own gynaecologist, who remains responsible for your care. We adapt our treatment to your circumstances as they develop.
About us
“Many women come to us after being told it was simply bad luck. We take the time to look more closely.”
Prof. Dr. Georg-Friedrich von Tempelhoff is a gynaecologist specialising in obstetrics and perinatal medicine and in gynaecological oncology, with an additional qualification in haemostaseology (blood clotting). He is a Fellow of the International Academy of Clinical and Applied Thrombosis/Hemostasis (ICATH). In 1991 he founded the assessment clinic in Rüsselsheim together with Prof. Lothar Heilmann. Since May 2015 he has continued it in his own practice in Obertshausen-Hausen. From 2015 to 2023 he was also head of the Department of Obstetrics and Gynaecology at St. Vinzenz Hospital in Hanau.
Science
The scientific basis of our work, to expand. Our own publications follow directly below.
In the first weeks of pregnancy, cells of the placenta (trophoblast) migrate into the uterine wall and remodel the maternal spiral arteries into wide, low-resistance vessels. If this remodelling remains incomplete, the placenta is undersupplied. Depending on the extent, the pregnancy ends early, or the consequences appear later as pre-eclampsia, HELLP syndrome, growth restriction, placental abruption or preterm birth. In 2011 Brosens and colleagues grouped these conditions as disorders of deep placentation (“Great Obstetrical Syndromes”).
Half of the embryo's characteristics come from the father. To prevent rejection, the maternal immune system has to adapt at the interface with the placenta: specialised immune cells of the uterine lining support vascular remodelling, regulatory cells dampen defence reactions. If this tolerance is insufficient, implantation and placental development can be impaired. Research on tests and treatments in this field is ongoing; the guidelines assess them cautiously.
The supply of the placenta depends not only on the vessels but also on how well the blood flows. Key factors include plasma viscosity, haematocrit, and the deformability and aggregation of red blood cells. In a normal pregnancy plasma volume increases, the blood is physiologically diluted and flows more easily in the smallest vessels. If this adaptation fails, studies show an increased risk of pre-eclampsia and growth restriction. We have published our own studies on the flow properties of blood in pregnancy and in complications.
During pregnancy almost all clotting factors rise, some to three times their level. This protects against major blood loss at birth but increases the risk of thrombosis several-fold. Around 60% of all pregnancy-related thromboses are observed after delivery. Normalisation usually takes several weeks (up to about 6 weeks). In women with a known bleeding tendency, for example due to platelet disorders or a factor deficiency, this adaptation may be delayed. Whether this results in a bleeding risk in pregnancy or after birth must be assessed individually.
There is no exact prediction of the individual risk. However, statistical data on the timing, severity and accompanying circumstances of the earlier disease allow a rough estimate.
The risk of recurrence depends mainly on when the disease first occurred:
| First onset | Risk of recurrence |
|---|---|
| up to week 28 | approx. 39% |
| weeks 29–32 | approx. 29% |
| weeks 33–36 | approx. 22% |
| from week 37 | approx. 3% |
After HELLP syndrome the risk of another HELLP syndrome is about 13%; after eclampsia the risk of pre-eclampsia is 22 to 35%. Gestational hypertension recurs in 16 to 47%.
For further reading: AWMF guideline Recurrent miscarriage, ESHRE Recurrent Pregnancy Loss (2022), AWMF guideline Diagnosis and therapy before assisted reproduction, AWMF guideline Hypertensive disorders in pregnancy, AWMF guideline Prevention of venous thromboembolism.
Publications
Our work on clotting, blood flow and pregnancy. Titles are shown in their original language.
Frequently asked questions
We are a private practice and do not bill the German statutory health insurance funds. Patients with private insurance or Beihilfe receive an invoice under the German medical fee schedule (GOÄ), which they can submit to their insurer. Patients with statutory insurance are equally welcome and pay for their treatment themselves.
No. Letters and test results from your gynaecologist or fertility centre do help us a great deal to prepare your first consultation.
Reports on previous pregnancies and miscarriages, histology (tissue examination) and surgical reports, earlier laboratory results, especially blood clotting and thyroid tests, genetic counselling reports, reports on IVF or ICSI treatments, discharge letters after pre-eclampsia or HELLP syndrome, and your maternity record (Mutterpass). Please bring them to your appointment.
No. We do not repeat tests unnecessarily. If results are already available, they are usually sufficient. We only repeat a test if an update makes medical sense, and we discuss this with you beforehand.
Ideally before your next pregnancy or your next embryo transfer, so that there is enough time for assessment and planning. If you are already pregnant, please contact us as soon as possible and mention it in the form.
Yes, ideally. As part of the immunological assessment we also look at how well your immune system and your partner’s are compatible. It therefore helps if your partner comes to the first appointment. It is not essential, however. And it is easier to discuss the next steps together.
We usually reply by email within a few working days. If you have not heard from us after a week, please check your spam folder or call us during our telephone hours.
Yes. Your care stays in their hands. We are happy to coordinate our recommendations with your doctors and are available to them for questions.
Yes. Your details are encrypted in your own browser and can only be read in our practice. Nothing is stored on the website.
Registration
Your answers help us prepare well for the first consultation. If you are unsure about something, just leave it blank. We will go through it together.
Please note: we are a private practice and do not bill the German statutory health insurance funds (GKV). Patients with statutory insurance are welcome and pay for their treatment themselves.
Directions
KiWu vT · Kinderwunschpraxis von Tempelhoff
Freiherr-vom-Stein-Straße 29
63179 Obertshausen (Hausen)
We are happy to answer questions about directions by email.
Emergency number for patients in our care: 01522 1554988
In a life-threatening emergency, always call 112.
