Key points of recurrent miscarriage

• Recurrent miscarriage is defined as having two or more miscarriages of a clinically recognized pregnancy in a row.
• While miscarriages are not uncommon, recurrent miscarriage is estimated to affect fewer than 5 in 100.
• There are many possible causes of recurrent miscarriage, including genetic abnormalities, hormonal problems and immune system disorders.
• Lifestyle factors and other unknown causes can also play a role.
• Ember offers fertility testing and treatment to help determine factors contributing to recurrent pregnancy loss and options to overcome them.

What is recurrent miscarriage?

Recurrent miscarriage, also known as recurrent pregnancy loss, is defined as the occurrence of two or more consecutive miscarriages of clinical pregnancies (signs of a fetus are present). While miscarriages in general are common, the American College of Obstetricians and Gynecologists (ACOG) estimates recurrent pregnancy loss affects less than 5% of those trying to conceive.

Both men and women can contribute to the causes of recurrent miscarriage, and it can affect couples of all reproductive ages and backgrounds. While the emotional toll of miscarriage can be devastating and double miscarriages even more so, it’s important to seek medical attention and support to identify and address potential underlying causes.

Causes of recurrent miscarriages

There are several causes of recurrent miscarriage, some of which can be treated with the help of a fertility doctor. Causes can be broadly categorized into chromosomal, anatomic, immunologic, infectious and egg quality-related factors. Sometimes miscarriages are also caused by unknown reasons.

• Chromosomal factors are genetic abnormalities such as errors in chromosomal division. Our preimplantation genetic testing can identify such issues to help ensure that only genetically healthy embryos are transferred. Early miscarriages often occur due to a missing or extra chromosomes in the fetus, which disrupts normal development.
• Anatomic causes refer to issues related to the structure of female reproductive organs, such as abnormalities, blockages or growths that may hinder a successful pregnancy.
• Immunologic problems and infections may also increase the chance of pregnancy loss.
• Poor egg quality is associated with an increased rate of miscarriage and can be detected through ovarian reserve testing.
• Unexplained factors for recurrent miscarriages refer to cases where no underlying cause can be identified. It is estimated that about 50% of recurrent miscarriages fall into this category, although some theories suggest that these cases are related to immune system issues or other yet-to-be-understood genetic factors.

Related reading: preimplantation genetic testing (PGT)

Who does recurrent miscarriage affect?

Recurrent pregnancy loss can affect anyone, but it is more commonly seen in women who are older than 35 years. This is in part due to age-related increases in the concerns noted above. Additionally, lifestyle factors such as smoking, alcohol consumption and obesity may also increase the risk of recurrent pregnancy loss.

Symptoms of recurrent miscarriage

While women with recurrent miscarriage will often experience symptoms before a miscarriage, others may not. Moreover, the number of symptoms and severity differ among women, but some of the more common ones are:

• Vaginal bleeding, with or without cramping.
• Lower back pain.
• Abnormal vaginal discharge.
• Fatigue.
• Sudden disappearance of typical pregnancy symptoms such as nausea, vomiting, breast tenderness or food aversions.

It’s important to note that many of these symptoms can also be a normal part of pregnancy or occur with other conditions. So it’s important to consult with a healthcare provider if any symptoms are present.

Risks & side effects of recurrent pregnancy loss if not treated

Recurrent pregnancy loss is emotionally and psychologically devastating for many couples who are trying to conceive. The treatments for miscarriage after the fact mostly relate to preventing infection. But if the causes of recurrent pregnancy loss are left untreated, that can increase the risk of developing certain medical conditions such as depression, anxiety and post-traumatic stress disorder.

Depending on the underlying cause of the pregnancy loss, untreated recurrent miscarriage can also lead to further complications. For example, untreated hormonal imbalances such as polycystic ovary syndrome (PCOS) can increase the risk of developing type 2 diabetes and heart disease. An untreated anatomical abnormality such as a uterine septum can also make it difficult for a woman to carry a pregnancy to term, increasing the risk of premature delivery and other pregnancy complications.

It is important for those who have experienced recurrent pregnancy loss to seek medical attention in order to identify and treat any underlying causes of the miscarriages. Doing so can help improve the chances of a successful pregnancy in the future, as well as help alleviate the emotional toll of recurrent pregnancy loss.

Next steps: infertility diagnosis and treatment  

If trying to conceive after experiencing recurrent pregnancy loss, it is important to seek an evaluation from a fertility specialist. The goal of this evaluation is to identify the underlying cause(s) of the recurrent miscarriages and to develop a treatment plan tailored to every person’s specific situation.

An infertility evaluation typically involves a comprehensive medical history, physical exam, blood tests and imaging studies such as ultrasounds. Our fertility specialist may also recommend specialized tests, such as hysteroscopy, to further evaluate the anatomy of the uterus.

Once a diagnosis is made, treatment options will depend on the underlying cause of the recurrent pregnancy loss. This can range from lifestyle changes, surgery and medication to the use of assisted reproductive technologies such as in vitro fertilization (IVF) or IVF with PGT. IVF can help bypass sperm-related issues and uterine abnormalities, while PGT can help overcome chromosomal abnormalities.

It is important to remember that the best treatment plan for recurrent pregnancy loss will depend on an individual’s situation. At Ember, our fertility specialist will help guide patients through the evaluation process and develop a treatment plan that is right for them.