Recurrent miscarriage

If you’ve had 3 or more miscarriages in a row (pregnancy loss before the 20th week), it’s called recurrent miscarriage or repeated miscarriage. Miscarriage is more common than people think, affecting up to 15% of clinical pregnancies (confirmed with ultrasound). Around 1% of women have recurrent miscarriages.

This article has been verified by a medical professional

Impact on fertility

Recurrent miscarriage raises the probability of more miscarriages, which is why it’s very important to get an in-depth checkup and testing to search for the cause. The good news is that most women who have had recurrent miscarriages are able to have a successful pregnancy. Studies show that around 70% of women who have had 3 miscarriages have a live birth later on. 

Potential causes

There are many possible causes for recurrent miscarriages, including:

• Chromosomal defects (the most common cause of all miscarriages)
• Structural abnormalities in the uterus, such as the septate uterus
• Uterine fibroids
• Uterine polyps 
• Blood clotting disorders, including Antiphospholipid syndrome (APS)
• Overactive immune system
• Thyroid disorders
• Hormonal conditions, such as polycystic ovary syndrome and luteal phase deficiency
• Diabetes
• Bacterial vaginal infections, such as chlamydia
• Cervical insufficiency
• Inflammation in the uterine lining (endometriosis, adenomyosis, chronic endometritis)

Women over 35 have a higher chance of miscarriage because as egg quality goes down, the risk of chromosomal problems goes up.

Certain lifestyle factors including smoking, using drugs such as cocaine, and being overweight are linked with recurrent pregnancy loss.

Symptoms

Signs of a miscarriage include:

• Vaginal bleeding
• Cramping and pain in the lower abdomen
• Discharge of fluid or tissue from the vagina
• Not having the typical pregnancy signs anymore, such as nausea and breast sensitivity

If you experience the following symptoms during pregnancy, please seek urgent medical care:

• Severe pain in your tummy or shoulder
• Diarrhea and vomiting
• Feeling very faint and lightheaded

These signs can indicate an ectopic pregnancy, which can lead to life-threatening bleeding if left untreated, so it’s very important to get medical attention right away.

Diagnosis

There are many tests to look for the cause of recurrent miscarriages. Which tests you get depends on your medical background and any other symptoms you’re experiencing.

Diagnostics can include:

• Taking a detailed medical and family history
• Genetic chromosomal testing
• Genetic testing of the pregnancy tissue
• Imaging tests of the uterus (ultrasound, hysteroscopy)
• Blood testing for a clotting disorder
• Immunological testing for natural killer (NK) cells
• Smear test of the vagina
• Tests for thyroid hormones, menstrual cycle hormones, and blood glucose levels

Treatment to improve fertility

Going through a miscarriage is a devestating experience, but try to take comfort in knowing that the majority of women with recurrent miscarriages are able to have a baby. Depending on what’s causing your miscarriages, there are many treatment options available that can greatly improve your chances of a successful pregnancy. 

For instance, hormonal conditions, blood clotting disorders, thyroid disease, an overactive immune system, diabetes, and infections can be treated well with medication. Structural abnormalities in the uterus can be corrected through surgery, and operations are available to help with inflammation in the womb like endometriosis. Uterine fibroids and polyps can also be treated with medication or surgery. For cervical insufficiency, a band (called a cerclage) can be placed in the cervix to prevent the pregnancy tissue from descending prematurely.

If chromosomal defects are the culprit, you can opt to have preimplantation genetic testing of your eggs or embryos before they are placed in the uterus while undergoing in vitro fertilization (IVF). 

In addition to medical treatment, leading a healthy lifestyle can go a long way towards helping you have a successful pregnancy. Here are some things you can do to prep your body for pregnancy: Aim for a BMI between 18-25 if you are overweight, use relaxation techniques like mindfulness to manage stress, avoid smoking, limit consumption of alcohol and caffeine, eat well (learn about fertility-boosting foods here), and get regular exercise. 

This article has been verified by a medical professional

• Repeated Miscarriages. The American College of Obstetricians and Gynecologists. Accessed 11 Oct 2022.
• Pirtea MD P et al.: Endometrial causes of recurrent pregnancy losses: endometriosis, adenomyosis, and chronic endometritis. Fert Stert. 2021;115(3):546-560.
• Miscarriage and Recurrent Pregnancy Loss (RPL). University of Chicago Medicine. Accessed 12 Oct 2022.
• Symptoms Miscarriage. NHS. Accessed 12 Oct 2022.
• Sneider K et al. “Recurrence of second trimester miscarriage and extreme preterm delivery at 16-27 weeks of gestation with a focus on cervical insufficiency and prophylactic cerclage.” Acta Obstet Gynecol Scand. 2016;95(12):1383-1390. 
• Guideline on the management of recurrent pregnancy loss. European Society of Human Reproduction and Embryology. 
• The Practice Committee of the American Society for Reproductive Medicine: Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fert Stert ASRM PAGES. 2012;98(5):1103-1111. 
• What is Recurrent Pregnancy Loss (RPL)? ReproductiveFacts.org from the American Society for Reproductive Medicine.