Recurrent Miscarriage (Pregnancy Loss)

Essentials

  • Overview (jump to section): Recurrent miscarriage occurs when a woman has miscarried two or more consecutive pregnancies. Unlike singular miscarriages, it is uncommon.
  • Symptoms: Signs of miscarriage include vaginal bleeding, abdominal pain and cramping, and vaginal discharge of fluid and/or tissue.
  • Causes: Pregnancy loss is most often caused by a genetic defect in the fetus, rendering it unable to grow and develop. Other medical conditions and lifestyle factors can also play a role.
  • Risks: Several conditions and lifestyle factors can increase one’s risk of miscarriage.
  • Treatments: Nearly two-thirds of women who have recurrent miscarriages eventually carry a full-term, healthy pregnancy, often without treatment. Other interventions such as lifestyle changes, medications and assisted reproductive technologies can assist in bringing a pregnancy to term.

Miscarriage, especially recurrent pregnancy loss, causes grief, concern and frustration. Our fertility specialists provide support to patients through this emotionally traumatic time, and expert help when they are ready to try again.

What are recurrent miscarriages?

Recurrent miscarriage, also known as recurrent pregnancy loss, is two or more consecutive miscarriages of a pregnancy that are clinically confirmed (doctor-provided positive pregnancy test). A clinical pregnancy is defined by having medical evidence, such as an early ultrasound visual of the gestational sac (the cavity of fluid surrounding an embryo).

Miscarriages are fairly common, occurring in about 10% of clinically recognized pregnancies. However, the likelihood of recurrent miscarriage is small, occurring only in about 1% of pregnancies according to the American College of Obstetricians and Gynecologists (ACOG). Recurrent pregnancy loss often indicates a fertility issue or another medical condition.

Most miscarriages occur within the first trimester (first 12 weeks of pregnancy). Loss of pregnancy occurring during the second and third trimesters are far less common, and are generally not classified as miscarriages. Instead, a pregnancy loss experienced outside the first trimester is called a stillbirth.

 It’s OK to talk about miscarriages: Read about the feelings women often don’t discuss.

 

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Signs of miscarriage (pregnancy loss)

Some women experience symptoms before a miscarriage actually occurs, while others do not. For example, if vaginal bleeding occurs after a viable pregnancy has been confirmed by a doctor, that signals that the chance of miscarriage is increased to about 20%. Symptoms of recurrent pregnancy loss are not any more severe than those of a single miscarriage.

Signs include:

  • Abdominal pain and cramping.
  • Vaginal bleeding.
  • Passing of fetal tissue.

If a woman experiences any of the above issues while pregnant, she should see her doctor or go to the emergency room if symptoms are severe.

 Common Miscarriage Questions You’re Afraid to Ask.

Diagnosing and testing for multiple miscarriages

Our fertility specialist may perform one or more of the following tests to determine the cause of recurrent pregnancy loss.

  • Medical history and a complete physical exam.
  • Blood tests to detect problems with the immune system or hormones.
  • Imaging tests to rule out structural issues preventing successful pregnancy.
  • Karyotype genetic testing, an analysis of each partner’s chromosomes.

In about 50% of cases, we aren’t able to arrive at a clear diagnosis of the cause of recurrent miscarriage.

Causes of miscarriage and recurrent miscarriage

When searching for what causes miscarriage, the first very important answer is that it was likely nothing anyone could have prevented.

Most miscarriages are completely out of the woman’s or couple’s control and are largely caused by random genetic defects preventing a specific fetus from coming to term. These are some common causes that can lead to a miscarriage.

Genetics

According to ACOG, about 60% of miscarriages are due to an abnormal number of chromosomes the embryo receives during fertilization, either from the sperm, the egg or both. Put simply, the embryo is not genetically viable (able to grow). These chromosome issues occur by chance and randomly, and are not generally influenced by anything a woman or couple did or did not do.

In some cases of recurrent miscarriage, the cause is due to a chromosome defect called a translocation. This is when one of the parents has a piece of one chromosome misplaced in another chromosome.

Structural abnormalities in the uterus or cervix

Approximately 10% to 15% of women with a history of recurrent miscarriage have an abnormally shaped uterus. A septate uterus, which involves tissue protruding into the inner cavity of the uterus, causes miscarriage due to inadequate blood supply to the fetus.

Second trimester miscarriages may also occur due to a weakened cervix. After trauma or surgery, cervix muscles may not be able to hold the growing fetus. Uterine fibroids and polyps also can affect the womb’s ability to retain a pregnancy.

In these cases, it’s important to work with our fertility specialists to find treatments that could help.

Hormonal issues

Hormones play a big part in ovulation and reproduction, so any imbalance can lead to an increased risk for miscarriage. For example, some women may suffer from low levels of progesterone, which can prevent the embryo from implanting in the uterus. After the age of 30, most men will experience a drop in testosterone that can lead to decrease in sperm production and quality.

Infections or illness

In rare cases, an infection or illness could contribute to a miscarriage risk. These may include:

  • A sexually-transmitted infection, such as chlamydia or gonorrhea.
  • AIDS and HIV.
  • Food poisoning during pregnancy.

Pregnancy loss and its relationship to the immune system is under investigation.

Ectopic pregnancy

An ectopic pregnancy occurs when a pregnancy develops outside the womb, typically in a fallopian tube. An ectopic pregnancy may result in miscarriage naturally. However, ectopic pregnancy is very dangerous to a woman’s health and an ectopic embryo cannot survive because it lacks space to grow, so if it does not miscarry naturally, a medical provider must intervene for the patient’s safety.

Can I still get pregnant after recurrent miscarriage?

  • Yes, and the chances are fairly good. If we are able to diagnose the underlying cause of past miscarriages, we can usually correct the issue or work around it with fertility treatments.
  • Even when we can’t pinpoint a cause for a woman’s recurrent miscarriage, she has a 65% chance of carrying a subsequent successful pregnancy.

Factors increasing miscarriage risk

Several conditions and lifestyle factors can increase one’s risk of miscarriage.

Age

One of the biggest factors in miscarriage risk is maternal and paternal age. This is because as we age, the risks for chromosomal abnormalities increase.

In general, a woman who is 35 years old has a 20% chance of a miscarriage compared with 15% in a woman under the age of 35. Those who are over the age of 45 have a 50% chance of miscarriage. Sperm from men over the age of 40 also have increased risk of genetic mutations.

 How does aging affect fertility in men?

Smoking, alcohol and drug use

Smoking, drinking alcohol and drug use can increase the risk of miscarriage. Women should always consult their physician before taking any medicine during pregnancy, and they should also alert doctors and dentists before receiving X-rays or prescriptions for medicine.

Underlying health conditions

Some maternal health conditions can lead to an increased risk for miscarriage, either due to the condition itself or related symptoms. These conditions include:

    • Poorly controlled diabetes.
    • Heart disease and high blood pressure.
    • Polycystic ovary syndrome (PCOS).
    • Thyroid disease.
    • Autoimmune disorders, like lupus.
    • Exposure to harmful chemicals or radiation.
    • Physical trauma.
    • Obesity or being underweight.

 How endometriosis causes recurrent miscarriage.

Recurrent miscarriage treatment

Many women will not require any medical treatment during or following a miscarriage. But for women experiencing recurrent pregnancy loss, intervention can help.

Treatment depends on the cause of a particular woman’s miscarriages. It can range from lifestyle changes and medication to surgery and assisted reproductive technologies to increase the chance of a successful pregnancy. With certain conditions surrounding recurrent miscarriage, medical or surgical treatments can lower a woman’s risk for future miscarriage.

The most common treatments include:

  • Medications to correct hormonal imbalances.
  • Genetic testing of both partners to identify possible problems.
  • Surgery to remove uterine fibroids, or to correct uterine structure.
  • In vitro fertilization (IVF) with preimplantation genetic testing to identify embryos that have a genetic problem.
  • Use of blood thinners when pregnant, in women with clotting disorders
  • Weight management and making other healthy lifestyle choices.

Don’t lose hope

Some women who have experienced recurrent miscarriage may feel doubtful that they will ever have a child, but the encouraging news is that the chance for successful pregnancy is high, particularly with IVF.
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