It is devastating when a desired pregnancy ends in miscarriage. It is natural to wonder whether a pregnancy loss will affect future fertility. Patients may wonder, “Will this keep happening to me?” or “Was there anything I could have done to prevent this loss?”
The unfortunate truth is that miscarriages are common. Approximately 20 percent of medically confirmed pregnancies will end in miscarriage—this risk goes up with maternal age. The risk of miscarriage is ~50% for women who get pregnant in their mid to late 40s. For early and unconfirmed (or yet to be discovered) pregnancies, the rate of loss is even higher. Altogether, it is estimated that roughly 60 percent of pregnancies will end in miscarriage.
However, having one miscarriage or even more than one miscarriage does not mean you will be unable to carry a baby to term.
What caused my miscarriage?
“Approximately 50-70 percent of all miscarriages result from genetic abnormalities in the embryos,” informs Caleb Kallen, M.D., Ph.D., who sees patients at SGF’s Philadelphia and Chesterbrook, Pennsylvania offices. “In these cases, one or more chromosomal abnormalities within the embryo are incompatible with normal development so development “stalls.” Additional causes of pregnancy loss may include anatomic, immunologic, or hormonal issues during the pregnancy. In many cases, the cause of pregnancy loss remains unknown.”
Patients who have had a dilation and curettage D&C may choose to have the tissue collected and tested for genetic/chromosomal abnormalities. Genetic abnormalities fall into 2 broad categories:
- Non-recurrent: not likely to repeat in future pregnancies. The majority of genetic abnormalities are non-recurrent. These include random chromosomal errors in the formation of each embryo—wherein each consecutive loss is attributed to an error different than the one before.
- Recurrent: likely to repeat in future pregnancies—most commonly something called a balanced chromosomal translocation in the male or female partner.
There are treatments that reduce the risk of pregnancy loss from recurrent and non-recurrent genetic causes. If your physician finds that your pregnancy losses resulted from a recurrent genetic cause, there are treatments to minimize the risk of future losses. One strategy is to pursue in vitro fertilization (IVF). The process of IVF includes generating embryos outside of the body, in culture. Embryos can then be sampled by taking cells that the embryo doesn’t need, cells destined to become the placenta—and to screen the genetic content of each embryo. This testing, called Preimplantation Genetic Testing (PGT) can greatly reduce the risk of pregnancy loss from recurrent and non-recurrent genetic causes.
Patients who have experienced recurrent miscarriage are commonly tested for an immunologic disorder for which risk has clearly been established. This condition is known as Antiphospholipid Antibody Syndrome (APS) and is treatable.
Imaging studies such as pelvic ultrasound and hysterosalpingogram (HSG) may detect anatomic causes of recurrent loss: conditions such as fibroids, intrauterine adhesions, or uterine malformations (known as congenital uterine anomalies). If an anatomical concern is identified, it can often be corrected through surgery.
Using blood tests, doctors can screen for hormonal disorders such as diabetes or thyroid hormone disorders. Because endocrine disorders are often treatable, endocrine causes of pregnancy loss can be corrected prior to attempting pregnancy.
Will a miscarriage impact my future fertility?
In most cases, it will not.
Early pregnancy losses are unlikely to create uterine problems that might impact future pregnancies.
With some losses, tissue may be evacuated from the uterus with a procedure known as a dilation and curettage (D&C). Rarely, the D&C procedure, like any surgery, may cause scarring within the uterus. This scarring might increase the risk of infertility or recurrent losses. Often, scarring can be surgically reversed.
If I’ve had a miscarriage, what can I do to reduce the likelihood of having another?
Because miscarriages are quite common, one miscarriage is not considered cause for exceptional concern.
Patients who’ve had two or more miscarriages, however, are considered to have “recurrent miscarriage,” and warrant evaluation by a fertility specialist.
For patients with recurrent miscarriage, determining the underlying cause can be critical. If your physician can pinpoint the cause, your physician may be able to offer preventive measures that reduce the likelihood of future miscarriage.
There are a number of different tests your physician will perform that may determine the cause of the recurrent losses.
How can I stop worrying about having another miscarriage?
Fear of miscarriage exists during all pregnancies—but especially for those who have experienced a prior miscarriage. This fear is understandable. There are support groups that may help to minimize the stress prior to and during early pregnancies.
It may help if your physician is able to diagnose and treat the cause of your prior losses. Even if unexplained, there can be relief in knowing that the most common causes of recurrent loss have been ruled out.
It is important, also, to remember that the majority of couples experiencing recurrent pregnancy loss will ultimately succeed in having a child.
If you’ve experienced recurrent miscarriages, Dr. Kallen encourages you to seek medical support from a fertility specialist. Take control of your reproductive health and together we can improve your chances for a successful next pregnancy.
Medical contribution by Caleb Kallen, M.D., Ph.D.
Caleb Kallen, M.D., Ph.D., FACOG, is board certified in obstetrics and gynecology and reproductive endocrinology and infertility. Dr. Kallen has expertise in the diagnosis and treatment of infertility, including in vitro fertilization (IVF), ovulation induction with intrauterine inseminations (IUI), donor egg treatments, endometriosis, polycystic ovary syndrome, and preimplantation genetic diagnosis. He sees patients in SGF’s Philadelphia and Chesterbrook, Pennsylvania, offices.
Editor’s Note: This article was originally published in October 2020, and has been updated for content accuracy and comprehensiveness as of July 2022.