1. Pregnancy
  2. Pregnancy health
  3. Miscarriage

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Recurrent Miscarriage: Causes, Treatment, and Testing

Miscarriage can be a painful and emotional experience. Some women experience multiple miscarriages, which can be devastating for couples trying to conceive. If you’ve experienced more than one pregnancy loss, we can give you insight into possible causes and treatments.

What is a recurrent miscarriage?

Recurrent miscarriage is defined as two or more pregnancy losses in a row. It’s estimated that around 1 percent of American women experience multiple miscarriages, although some may have a successful pregnancy afterward.

Experiencing a miscarriage can be emotionally painful and may affect other aspects of your life and health. Women who have had a miscarriage may find life different afterwards. Understanding the things that can cause multiple miscarriages and exploring your treatment options may be able to help you during the grieving process that follows a miscarriage.  

Recurrent miscarriage causes

More than 60 percent of miscarriages occur when the embryo receives an abnormal number of chromosomes during fertilization. This is a genetic problem that happens by chance, without an underlying medical condition. As women get older, the chances of this happening increase.

Some couples may experience repeated miscarriages when one partner has a chromosome that has a piece of it transferred to another chromosome. This is known as chromosomal translocation. Those who have it generally don’t have any signs or symptoms; however, their eggs or sperm will have a different number of chromosomes, either more or less than normal. This leads to the embryo getting either too much or too little genetic material to be viable, thus leading to a miscarriage. In these instances, the woman has likely experienced recurrent early miscarriage, when the fetus is just forming. 

Recurrent miscarriage may be attributed to an underlying health condition. For example, an autoimmune disorder called antiphospholipid syndrome (APS) is associated with miscarriage and fetal death. In this condition, the immune system creates antibodies to certain substances involved in normal blood clotting.

Diabetes can also contribute to frequent miscarriages. The high levels of blood glucose, especially if the disease isn’t managed well, can be harmful to the fetus. 

Polycystic ovary syndrome (PCOS) is another medical condition that increases the rates for repeated miscarriages. Hormonal disorders such as hyperprolactinemia and thyroid disorders (e.g., hypothyroidism and autoimmune thyroiditis) may also lead to increased chances of recurrent pregnancy loss. 

Recurrent miscarriage may be attributed to an underlying health condition. For example, an autoimmune disorder called antiphospholipid syndrome (APS) is associated with miscarriage and fetal death.

Woman with abnormalities in their reproductive organs have a higher chance of recurrent early miscarriage. A congenital uterine abnormality, such as a separated uterus partly divided into two sections by a wall of tissue, is one of the most common causes of multiple miscarriages.

A condition called Asherman syndrome is associated with repeated miscarriages. Women with this disease have adhesions and scarring in their uterus as well as fibroids and polyps (noncancerous growths in the uterus) that can contribute to recurrent pregnancy loss. In these cases, implantation cannot happen, so women might lose the pregnancy before knowing about it.

Certain environmental and lifestyle choices may cause repeated miscarriages. Women who smoke or drink to excess may have an increased chance of carrying nonviable fetuses that will spontaneously abort. Working in an area where you’re exposed to certain dangerous chemicals may also increase your chance of miscarriage. If your doctor thinks you’re in a high-risk environment, they may suggest lifestyle changes to increase your chances of having a healthy pregnancy.

Testing after a recurrent miscarriage

After three miscarriages, your doctor may recommend recurrent miscarriage testing. You’ll undergo a complete physical exam, including a pelvic exam. Other internal exams include a vaginal ultrasound to detect abnormalities in the uterus, fallopian tubes, and ovaries. You may also have an X-ray of your uterus to evaluate its shape. A saline sonohysterogram is another procedure that can diagnose growths in the uterus, such as scar tissue or fibroids.

To check for underlying health conditions, the doctor may perform blood tests. One of these tests may check the levels of certain hormones — specifically prolactin, thyroid, and progesterone — that can affect your ability to carry a pregnancy to term. An antibodies test may be given to detect any abnormalities with your immune system like testing for antiphospholipid antibodies and lupus anticoagulant if APS is suspected. Finally, your doctor may recommend a glucose screening to test for diabetes, which, left uncontrolled, increases the chances of miscarriage.

After three miscarriages, your doctor may recommend recurrent miscarriage testing. You’ll undergo a complete physical exam, including a pelvic exam.

One of the procedures often suggested after recurrent miscarriages is a hysteroscopy. In this procedure, a narrow fiber-optic scope is inserted into the uterus to examine the uterine cavity for Asherman syndrome, endometrial polyps, fibroids, or congenital uterine anomalies. The doctor may perform an endometrial biopsy to determine if you have an infection that can cause miscarriages.

If your doctor suspects that you have a genetic condition causing multiple miscarriages, they may order a karyotype test, which is a mapping of your chromosomes and an analysis to diagnose genetic defects. This particular recurrent miscarriage test is typically one of the last to be performed and may also include your partner to rule out genetic defects coming from them. 

Recurrent miscarriage treatment

Recurrent miscarriage treatments depend on the underlying causes. Surgery can fix some problems with your uterus, including separation of the intrauterine septum and removal of scar tissue, adhesions, and benign growths. If the shape of your uterus is affecting your pregnancy, some surgeries can correct its shape. These surgeries are typically done laparoscopically, with recovery times of a few weeks.

Women with autoimmune disorders may find relief with certain prescription medications or low doses of aspirin. However, you’ll want to talk to your doctor if you’re susceptible to bleeding problems or stomach ulcers.

Treating underlying health conditions — for example, regulating your blood sugar or better managing your diabetes — may help reduce multiple miscarriages. An overactive or underactive thyroid gland or other thyroid dysfunction can affect your ability to have a successful pregnancy. Correcting or better managing these conditions can increase your chances of a healthy pregnancy.

If your multiple miscarriages are due to translocation of your chromosomes, which affects about 5 percent of couples, your doctor may suggest fertility treatments such as in-vitro fertilization. This treatment involves combining the sperm and egg outside the body in a lab. Before the embryos are implanted in your uterus, they can be tested to ensure that no translocation has occurred. The lab can screen for healthy embryos to improve your chances of a healthy pregnancy. Pregnancy after recurrent miscarriage in these circumstances is generally likely. 

Recurrent miscarriage prevention

Certain lifestyle changes can help prevent repeated miscarriages. Stopping smoking, drinking, or using illegal drugs can improve both your overall and reproductive health. Being overweight is linked with an increased risk of miscarriage and the likelihood of developing PCOS, a condition that makes it more difficult to conceive and carry a baby to term. Losing weight may improve your PCOS or diabetes symptoms and help you carry a baby to term.

Being overweight is linked with an increased risk of miscarriage and the likelihood of developing PCOS, a condition that makes it more difficult to conceive and carry a baby to term.

Having less stress in your life may create conditions that improve your chances of sustaining a pregnancy. You may have a demanding job or difficulty in your personal life that creates undue stress. While the direct connection between added stress and miscarriage isn’t exact, some studies demonstrate that improving your mental state may contribute to preventing repeated miscarriages.

Some women may not make enough progesterone early in their pregnancies, which can lead to miscarriages. Some women may benefit from supplements of progestin (a synthetic form of progesterone) at the outset and over the course of their pregnancies to help them maintain their pregnancy.

What to expect from pregnancy after recurrent miscarriage

Women who have had multiple miscarriages may view a positive pregnancy test with apprehension, instead of joy. It’s very normal to worry about sustaining a pregnancy if you’ve miscarried before. Some women may benefit from seeking therapy after a miscarriage. Pregnancy means changes in your hormones and can be an emotional time with mood swings, even if you haven’t had a previous miscarriage.

Depending on the treatment you’ve received for multiple miscarriages, your doctor may choose to monitor the progression of your pregnancy more closely. If your multiple miscarriages were caused by chronic health conditions, then your blood sugar or thyroid conditions may be checked more closely.

During pregnancy, make sure to follow your ob-gyn’s directions precisely. Take folic acid and prenatal vitamins, and make sure to eat and sleep well. You may or may not be allowed to exercise, so make sure to consult with your doctor about your recommended level of activity.

Conclusion

If you’ve experienced repeated miscarriages, it’s important to consult with your doctor. They’ll help you discover the underlying causes for the multiple miscarriages and recommend the best treatment options for you. Talking to your partner about genetic testing can be an important conversation. You may also benefit from seeking therapy in a safe space to explore your feelings about losing pregnancies. Fortunately for many women, there are many different treatment options for repeated miscarriages.

https://www.acog.org/Patients/FAQs/Repeated-Miscarriages?IsMobileSet=false

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229790/

https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/treatment-of-recurrent-pregnancy-loss/

https://www.cochrane.org/CD003511/PREG_progestogen-preventing-miscarriage

https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage/art-20044134

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/ajo.12920

https://www.nhs.uk/conditions/miscarriage/diagnosis/

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