Recurrent miscarriage—often called recurrent pregnancy loss—is defined as two or more consecutive clinical pregnancy losses before 20 weeks gestation. It is important to consider clinical pregnancies rather than biochemical pregnancies, as biochemical pregnancies are usually not included in a diagnosis of recurrent pregnancy loss:
- Clinical pregnancy: a pregnancy that can be seen via ultrasound, typically as early as 5 to 6 weeks gestation, or 1 to 2 weeks after a missed period
- Biochemical pregnancy: a pregnancy that has only been detected via hormone testing (urine or blood) prior to the loss
Due to the nature of recurrent pregnancy loss, many couples may not immediately seek help to treat this condition, as they are able to conceive. However, it’s important that a physician help address the underlying cause of the miscarriages. Some couples experience infertility as both delayed conception and recurrent loss.
DIAGNOSTIC TESTS FOR RECURRENT MISCARRIAGE
Your medical history, a pelvic exam, and one or more of the tests listed below are necessary in diagnosing possible causes of recurring miscarriages:
A mapping of your chromosomes, used to diagnose genetic defects
A procedure that uses x-rays and a special dye to evaluate the shape of your uterus
A procedure in which your doctor uses a narrow fiber-optic telescope inserted into the uterus to look inside your uterine cavity
A scan that uses high-frequency sound waves to identify the many small cysts in the ovaries
Blood hormone levels
Blood tests that reveal the levels of certain hormones in your blood, such as prolactin, thyroid, and progesterone
A procedure, performed infrequently, in which your physician will obtain a sample of your endometrial tissue to determine if it is appropriately developed for an implanting embryo
A blood test used to diagnose diabetes, which, if left uncontrolled, increases the likelihood of miscarriage
Blood tests used to detect an immune system abnormality
TREATMENT FOR RECURRENT MISCARRIAGE
Treatment options vary by cause for recurrent miscarriage, as there are many factors that may lead to this diagnosis, including genetic, anatomic, and medical conditions, as well as lifestyle factors:
Genetic conditions: Miscarriages occurring within the first 3 months of pregnancy are often due to genetic abnormalities in the embryo or fetus. It is commonly seen that there is an extra or missing chromosome.
- Treatment options: A physician may recommend preimplantation genetic screening (PGS) with in vitro fertilization (IVF) treatment. This allows the medical team to screen all available embryos and determine which have abnormalities and which are cytogenetically normal.
Anatomic problems: The shape and size of a woman’s uterus may affect her ability to carry a pregnancy. If a woman’s uterus is too small due to a septum (a band of tissue formed inside the uterus), or if fibroids are present in or around the uterus, a miscarriage may result.
- Treatment options: Depending on the nature of the anatomic problem, your physician may recommend surgery.
Medical conditions: There are many medical conditions not directly related to a woman’s reproductive health that could lead to miscarriages, including thyroid disease, diabetes, hormonal imbalances, certain immune system conditions, and blood-clotting conditions.
- Treatment options: A physician may need to treat these medical conditions prior to, or in conjunction with, infertility treatment.
Lifestyle factors: Smoking, certain recreational drugs, excessive alcohol, excessive caffeine, and being overweight are all linked to an increased risk of recurrent miscarriage.
- Treatment options: Many couples experience a decreased risk of miscarriage when they address certain lifestyle factors, such a smoking cessation.
Age: Although the overall incidence of miscarriage is one in four pregnancies, or 25 percent, this rate increases as a woman ages. For women over the age of 40, the rate of miscarriage climbs to 50 percent or higher. Most often, this increased risk is linked to genetic abnormalities. For women under the age of 35, the chance of miscarriage due to genetic abnormalities is 15 to 20 percent.
- Treatment options: The best course of treatment for advancing maternal age is often using a donor egg to conceive. While the woman’s eggs may be decreasing in quality, her uterus is often still able to carry a healthy pregnancy to term.
How common is recurrent miscarriage?
A single miscarriage is very common, occurring in nearly 25 percent of all pregnancies. Recurrent miscarriage is seen less frequently. According to the American Society for Reproductive Medicine (ASRM), less than 5 percent of women will experience two consecutive miscarriages, and only 1 percent will experience three or more.
Are there any risk factors associated with miscarriage?
The risk of miscarriage increases with age, especially in women over the age of 35. Smoking, caffeine, and alcohol increase your risk of miscarriage. Also, some medications, including those you can buy without a prescription, may increase your risk.
Where can my partner and I find emotional support after a miscarriage?
While miscarriage happens within the woman’s body, the emotional pain happens to both partners. It is important to know you are not alone when it comes to miscarriage or recurrent pregnancy loss. Our patients—men and women alike—find support via online communities like our Facebook page or free lo
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