Miscarriage can be devastating, but sadly, it’s not uncommon — one in eight pregnancies will end this way.
One lesser-known type of pregnancy loss is recurrent miscarriage. This is when a person experiences two or more miscarriages in a row, and although exact numbers aren’t known, it’s thought to affect between 1% and 2% of women who get pregnant.
The effects of one miscarriage can be hard enough to deal with, but experiencing multiple pregnancy losses can be incredibly traumatic. Especially as we know that the causes of recurrent miscarriage are often not entirely clear (more on that below), which makes testing and identifying treatments tricky, too. Don’t lose hope, though, because studies show lots of people go on to have a family after recurrent miscarriage.
We spoke to Dr. Allison Rodgers, Flo board member and obstetrician, gynecologist, reproductive endocrinologist, and infertility specialist, to answer all of our questions around recurrent pregnancy loss. We also share how you can get support if you’ve experienced multiple miscarriages.
Sometimes understanding more about what you’re experiencing can help you feel less alone. We now know that recurrent pregnancy loss affects between 1% and 2% of pregnant women. So while recurrent miscarriage is rare, it’s not unusual. But what exactly is it?
The American Society for Reproductive Medicine (ASRM) defines it as “the spontaneous loss of two or more pregnancies,” usually before the 20th week of pregnancy.
The ASRM also notes that recurrent miscarriage is “distinct from infertility,” so it doesn’t necessarily mean you have fertility issues if you’ve experienced multiple miscarriages, and you’re highly likely to be able to try again, should you wish to. They also note that each pregnancy loss is different, which means further assessment of the couple or person experiencing the pregnancy could be necessary. That’s why it’s so important to reach out to your doctor or health care professional for tests, advice, and support.
Understandably, many people look for answers after experiencing recurrent pregnancy loss, but unfortunately, the cause is unknown in around half of all cases. “Typically, 50% to 75% of the time, no clear cause is identified,” explains Dr. Rodgers.
Doctors believe there are potentially multiple factors that can affect your chances of having recurrent miscarriages, but — despite lots of studies and reviews — more research is needed to work out exactly what all of those causes are.
However, of those we do know, what’s the most common reason for recurrent miscarriage? According to Dr. Rodgers, “The most common cause by far is embryos having too many or too few chromosomes [DNA molecules that are the building blocks of the human body]. This can happen randomly but [is] more common as we get older. Since 95% of miscarriages are from having too many or too few chromosomes, doctors need to determine if a loss was just ‘bad luck’ or if it was from something different.”
That means that if you’ve experienced two or more miscarriages in a row, you should book an appointment with your doctor or OB-GYN for a checkup.
- Translocation (where a segment from one chromosome sticks — or becomes “heritably linked” — to another chromosome)
- An unusually shaped uterus like a septate uterus (where the uterus is divided into two parts by a membrane or thin sheet of cells)
- Hormonal illnesses like diabetes or thyroid disease
- Antibodies created by the immune system that could attack the fetus
- Low hormone levels, sometimes caused by increased prolactin levels,  which affect the function of the ovaries
If you’ve had multiple miscarriages, then you’ll probably want your doctor to run some tests or dig deeper into your medical history in the hope of finding some answers. So what should you ask for?
The ASRM recommends testing for karyotypes in both partners after recurrent miscarriage. This is where the parents’ (and sometimes fetus’) chromosomes are screened for any genetic abnormalities that could be causing the problem.
You could also request an ultrasound to check the structure of your uterus or to find out if you have a weakened cervix. Unfortunately, this diagnosis is often only made retrospectively after a miscarriage in the second trimester.
Please know that there is treatment available for recurrent miscarriage, especially if a cause can be found, so your first step should be an appointment with your health care provider. They’ll talk you through the testing options above (plus any others they recommend), run through your medical history, and then pull together a plan of action.
Depending on what's happening for you, fertility treatment could be an option. “Often, if the cause is poor egg quality, in vitro fertilization (IVF) with preimplantation genetic testing is the only way to decrease loss from aneuploidy (extra or missing chromosomes),” Dr. Rodgers says.
"Over 60% of couples who had experienced three or more miscarriages have a baby within five years, so there is hope"
Unfortunately, as Dr. Rodgers explains, recurrent miscarriage “can be very personalized, and there is only treatment to reduce the risk but not prevent it completely.”
However, it can help to remember that lots of people go on to start a family after experiencing recurrent pregnancy loss. In fact, a 2006 trial on couples who had experienced three or more miscarriages found that over 60% had a baby within five years, so there’s plenty of reasons to continue trying if that’s what you want.
“I would recommend that patients get evaluated by a doctor who specializes in recurrent pregnancy loss; most reproductive endocrinologists are trained in this,” Dr. Rodgers adds.
Those seeking support for recurrent miscarriage could also book an appointment with a clinical geneticist (gene expert). They’ll be able to explain your chances of a successful pregnancy in the future and whether there are any fertility treatments, such as IVF, that you could try. This type of advice is known as genetic counseling.
So, what do we now know about recurrent miscarriage? It occurs in a small number of pregnancies, and the cause is often unknown. However, a supportive health care provider will help you look further into your personal experience and medical history and create an action plan, whether that’s testing or trying again.
If you’re struggling with pregnancy loss, there are support services you can access such as March of Dimes in the US and Tommy’s in the UK. Get help from a counselor if you need it and remember that it’s absolutely OK to take your time. Despite what’s happened, you have every chance of starting a family in the future should you choose to do so.