Recurrent Pregnancy Loss

What Can Cause Recurrent Miscarriage?

Several factors may contribute to repeated pregnancy loss.

Genetic Factors

Chromosomal abnormalities in the embryo are an important cause of miscarriage. In selected couples, parental chromosomal testing may also be considered.

Uterine Abnormalities

Certain structural abnormalities of the uterus, such as a uterine septum, intrauterine adhesions, or selected fibroids and polyps, may interfere with implantation or continuation of pregnancy.

Antiphospholipid Syndrome

Antiphospholipid syndrome (APS) is an important and potentially treatable cause of recurrent pregnancy loss. Appropriate laboratory testing is required for diagnosis.

Hormonal & Metabolic Conditions

Thyroid disorders and poorly controlled diabetes can adversely affect pregnancy. Other endocrine or metabolic factors may need evaluation according to the patient's clinical history.

Age & Egg Quality

The risk of chromosomal abnormalities and miscarriage increases with maternal age, particularly after the mid-30s.

Other Factors

Lifestyle, obesity, smoking, alcohol use and certain medical conditions may influence pregnancy outcomes and should be considered as part of an overall assessment.

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Recurrent Pregnancy Loss

Understanding the cause. Planning the next pregnancy with care.

Experiencing repeated pregnancy loss can be physically and emotionally difficult. A structured medical evaluation can help identify possible causes, assess future pregnancy risks, and guide appropriate treatment and monitoring.

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What is Recurrent Pregnancy Loss?

Recurrent pregnancy loss refers to repeated pregnancy losses and warrants a careful clinical assessment, particularly when a woman has experienced two or more miscarriages.

Pregnancy loss may occur for many different reasons. In some women, an identifiable cause can be found, while in others no definite cause is established even after appropriate investigations.

The purpose of evaluation is not simply to order multiple tests, but to identify investigations and treatments that are relevant to the individual patient.

Treatment of Recurrent Pregnancy Loss

Treatment depends on the underlying cause.

Antiphospholipid Syndrome

Women with confirmed APS may require specific treatment during pregnancy under medical supervision.

Uterine Abnormalities

Some structural abnormalities may benefit from hysteroscopic or other surgical treatment, depending on their nature and clinical significance.

Thyroid & Metabolic Disorders

Optimising thyroid function, diabetes and other relevant medical conditions before conception can improve the environment for a future pregnancy.

Genetic Causes

When a genetic abnormality is identified, genetic counselling can help the couple understand recurrence risk and available reproductive options.

Unexplained Recurrent Pregnancy Loss

Sometimes investigations do not reveal a definite cause. This does not mean that a successful pregnancy is impossible. Preconception counselling and appropriate surveillance in the next pregnancy remain important.

Evaluation After Repeated Pregnancy Loss

The evaluation should be individualized rather than using the same battery of tests for every patient.

Depending upon the history and previous pregnancy losses, assessment may include:

• Detailed obstetric and medical history

• Review of previous ultrasound and pregnancy records

• Pelvic ultrasound

• Assessment of the uterine cavity when indicated

• Thyroid and relevant metabolic investigations

• Testing for antiphospholipid syndrome

• Genetic evaluation in selected couples

• Review of medications, lifestyle and other medical conditions

A careful review of when the pregnancy losses occurred and whether fetal cardiac activity had previously been documented can provide important diagnostic information.

FAQ

Can I have a normal pregnancy after recurrent miscarriages?
Yes. Many women with previous recurrent pregnancy loss subsequently have a successful pregnancy. The individual prognosis depends on factors such as maternal age, previous pregnancy history and any identified underlying cause.

Should investigations be done after two miscarriages?
Clinical evaluation can reasonably begin after two pregnancy losses, particularly when there are additional risk factors. The investigations required should be individualized.

Is recurrent miscarriage always caused by a problem in the mother?
No. Pregnancy loss can result from chromosomal abnormalities in the embryo and many other factors, and sometimes no definite cause is found.

Does every patient need genetic testing?
No. Genetic testing is useful in selected circumstances and should be decided after reviewing the couple's pregnancy and family history.

When should I consult before trying again?
A preconception consultation is useful before attempting another pregnancy because it allows investigations, treatment of relevant conditions and planning for early pregnancy surveillance.

Understanding Recurrent Pregnancy Loss

To understand and address recurrent pregnancy loss, we perform a comprehensive, evidence-based diagnostic workup tailored to your unique medical history.

Genetic Factors

Uterine Anatomy

Endocrine Evaluation

Parental karyotyping identifies balanced chromosomal translocations, which can lead to unbalanced gametes. Pre-implantation genetic testing (PGT) may be discussed as a clinical pathway.

Evaluating uterine structure via saline infusion sonography or hysteroscopy helps detect congenital anomalies like a uterine septum, or acquired issues like fibroids and polyps.

Uncontrolled thyroid dysfunction, prolactin disorders, and poorly managed diabetes can impact pregnancy maintenance. Optimizing these metabolic markers is a key first step.

Antiphospholipid Syndrome

Thrombophilia Screening

Lifestyle Optimization

APS is a treatable autoimmune cause of recurrent loss. Testing for lupus anticoagulant and anticardiolipin antibodies helps guide anticoagulant therapy in subsequent pregnancies.

Inherited blood clotting disorders can affect placental circulation. Targeted screening helps determine if low-dose aspirin or low-molecular-weight heparin is clinically indicated.

Modifiable factors such as maintaining a healthy BMI, smoking cessation, reducing alcohol intake, and managing stress play a supportive role in improving future pregnancy outcomes.