Recurrent miscarriage is when someone experiences three or more early miscarriages. These losses don’t need to occur consecutively, and healthy pregnancies may happen in between. Usually, recurrent miscarriages affect 1% of women (1 out of 100).
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Several factors can increase the likelihood of a miscarriage:
The most frequent cause of both single and recurrent miscarriages is abnormal chromosome development in the embryo. Approximately 50% (1 out of 2) of miscarriages result from this issue, and the risk increases as parents age.
Mostly, this occurs even when the parents have normal chromosomes. But in about 6% (6 in 100) of couples who undergo three miscarriages, one parent might be carrying a chromosomal abnormality. While this doesn’t affect the parent, it can lead to miscarriage if passed on to the embryo.
The risk of miscarriage, whether single or recurrent, increases with the mother’s age. This is mainly due to a decline in egg quality over time. For women below 35 years, the likelihood of miscarriage is 11-15%, while those aged between 35 and 39 have a 25% risk. In addition, the risk of miscarriage in females at the age of 40 to 45 years is 51%, and those above 45 is 93%. Miscarriage is also likely if the father is over 40.
Being overweight (BMI over 25) or underweight (BMI below 19) raises the risk of one or even more miscarriages. Smoking, excessive alcohol consumption and high caffeine intake may also contribute to miscarriage.
About 5-6% of women have a congenital uterine abnormality—an unusual uterine shape from birth. Among women who experience recurrent miscarriage, the frequency of such abnormalities is higher, around 13%. Certain shapes, like a septate or bicornuate uterus, may increase miscarriage risk. A septate uterus has a thin wall dividing the uterus, while a bicornuate uterus has a deep muscle indentation that makes two halves.
Some women may also develop fibroids (muscle knots in the uterine wall) or scar tissue in the uterus with time. Hence, this may impact miscarriage risk depending on their size and location.
Several hormonal conditions may increase miscarriage risk:
Sometimes, there is no clear explanation for recurrent miscarriages, and each loss may have occurred for different reasons. Unfortunately, tests may not always identify the exact cause in each instance.
Being informed that your recurrent miscarriages are unexplained can be very challenging, as it means there may be no specific treatment or adjustments to prevent it next time. However, it may be reassuring to know that most women who experience three unexplained miscarriages do eventually carry a healthy pregnancy.
Determining if there is a specific or treatable reason for repeated miscarriages is essential to provide you with the best possible support and care. Therefore, you should ask your physician for a referral to a specialized recurrent miscarriage clinic if necessary. It’s advisable that both you and your partner are diagnosed together.
Recurrent miscarriage diagnosis may take time to arrange and process, and you may need to wait for the results. Deciding whether to try for another pregnancy while waiting is a personal choice, and discussing this with your healthcare provider may be helpful.
Additional blood tests may be conducted if other hormonal issues, like PCOS or prolactin imbalance, are suspected.
After a third or later miscarriage, genetic testing may be recommended to check for inherited chromosomal issues that could have caused the miscarriage. You and your partner might undergo this if testing the pregnancy is not possible or the results indicate an inherited problem.
A pelvic ultrasound scan may be done to assess the shape of the uterus. Further detailed imaging may be recommended if an unusual uterine shape is suspected.
Treatment options for recurrent miscarriage may include:
Your healthcare provider will guide you on maintaining a healthy weight and give you support you in quitting smoking. It’s recommended to limit caffeine intake to under 200 mg per day (about two cups of instant coffee or tea) and to avoid excessive or regular alcohol consumption.
For women with APS and recurrent miscarriages, treatment involving low-dose aspirin and blood-thinning injections (heparin) during pregnancy can improve the odds of a successful pregnancy. These medications reduce the likelihood of blood clotting.
Having APS increases the risk of pregnancy complications. Therefore, your doctor will want to monitor your condition closely.
Routine treatment has not been proven to improve pregnancy outcomes in cases of inherited thrombophilia. However, if you are diagnosed with this condition, heparin may be prescribed depending on your situation and any additional clotting risks during pregnancy.
You may be referred to a genetic counselor if you or your partner has a genetic abnormality. He/she will discuss your risk of future miscarriages and explain your options based on your situation.
Women with a uterine septum may have to undergo surgery to correct it. However, it is unclear if surgery to treat fibroids or other uterine abnormalities reduces miscarriage risk. Your healthcare provider will discuss the potential advantages and risks with you, considering factors like fibroid size and location.
For women with diabetes or thyroid disease, the healthcare provider will work with them to manage these conditions as effectively as possible before trying to conceive again.
There isn’t any proof that progesterone prevents recurrent miscarriage unless bleeding occurs in early pregnancy. Therefore, if you’ve experienced a previous miscarriage and bleeding during a pregnancy, progesterone may be given to help prevent another miscarriage.
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