Recurrent miscarriage

Some couples experience infertility as both delayed conception and recurrent miscarriage. Also often called recurrent pregnancy loss, it is a condition that is defined as two or more consecutive clinical pregnancy losses before 20 weeks gestation.

Due to the nature of recurrent pregnancy loss, many people may not immediately seek help to treat this condition, as they are able to conceive. However, it’s important that a physician helps address the underlying cause of the miscarriages.

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Indicators of recurrent miscarriage

It’s 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.

Diagnostic testing for recurrent miscarriage

Your medical history, a pelvic exam, and one or more of the tests listed below are necessary for diagnosing possible causes of recurring miscarriages:

  • Karyotype: A mapping of your chromosomes used to diagnose genetic defects.
  • Hysterosalpingogram (HSG): A procedure that uses x-rays to evaluate the shape of your uterus and a special dye injected into your Fallopian tubes to see if they are open or blocked.
  • Hysteroscopy: A procedure in which your doctor uses a narrow fiber-optic telescope inserted into the uterus to look inside your uterine cavity.
  • Ultrasound: A scan that uses high-frequency sound waves to identify 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.
  • Endometrial biopsy: 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.
  • Glucose screening: A blood test used to diagnose diabetes, which, if left uncontrolled, increases the likelihood of miscarriage.
  • Antibodies tests: Blood tests are 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’s commonly seen that there is an extra or missing chromosome.

Treatment options: A physician may recommend preimplantation genetic testing of embryos 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 person’s uterus may affect their ability to carry a pregnancy. If a person’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 person’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 people experience a decreased risk of miscarriage when all involved partners address certain lifestyle factors, such a smoking cessation.

Age

Although the overall incidence of miscarriage is 1 in 4 pregnancies, or 25 percent, this rate increases as a person with female reproductive organs ages. The rate of miscarriage climbs to 50 percent or higher for people over the age of 40. Most often, this increased risk is linked to genetic abnormalities. For people 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 person’s eggs may be decreasing in quality, their uterus is often still able to carry a healthy pregnancy to term.

FAQs

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 people with female reproductive organs will experience two consecutive miscarriages, and only 1 percent will experience three or more.

The risk of miscarriage increases with age, especially if you are 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.

While miscarriage happens within a person’s body, emotional pain happens to all involved partners. It’s important to know you’re not alone when it comes to miscarriage or recurrent pregnancy loss. Our patients find support via online communities like our Facebook page or free support groups.

Success stories from patients who experienced recurrent miscarriage

Patient Story

Jackie & Mike

Patient Story

Kat & Mike

Patient Story

Aren & Jeff

Patient Story

Susan & Dave

How to get started

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