When a pregnancy ends unexpectedly, it is not only a medical event. It is dates on a calendar, a body that suddenly feels unfamiliar, and questions that arrive at night. When it happens again, recurrent miscarriage can feel like being pushed back to the starting line.
A step‑by‑step medical plan can help: defining what recurrent miscarriage means, looking for treatable causes, reducing risks you can actually change, and preparing closer follow‑up for the next pregnancy.
What doctors mean by recurrent miscarriage
One miscarriage vs recurrent miscarriage
A single miscarriage is sadly common. Very often, it happens because the embryo had a chromosomal abnormality (a random copying error when chromosomes are shared). Most parents did nothing to cause it.
Recurrent miscarriage (also called recurrent pregnancy loss) is usually used when pregnancy loss happens more than once and the pattern justifies a structured evaluation.
In many clinics across India, evaluation may start after two confirmed (clinical) miscarriages—meaning the pregnancy was seen on ultrasound or confirmed by tissue testing. Some systems use three losses. Age, medical history, and the timing of losses can justify earlier testing.
Early, late, missed, and biochemical losses: why timing matters
- Early miscarriage: before ~12 weeks
- Later miscarriage: around 12 to 20–24 weeks of amenorrhoea
- Missed miscarriage: pregnancy stops developing without obvious bleeding, ultrasound detects it
- Biochemical pregnancy: positive hCG, then hCG falls before anything is visible on ultrasound
Very early loss often points towards embryo aneuploidy (an abnormal number of chromosomes). A later loss pushes doctors to think more about the uterus, cervix, placenta, and clotting/immune conditions.
Primary and secondary recurrent miscarriage
- Primary recurrent miscarriage: losses without a previous live birth
- Secondary recurrent miscarriage: losses after at least one live birth
How common recurrent miscarriage is—and what the outlook can be
- Miscarriage occurs in about 15–20% of recognised pregnancies.
- Recurrent miscarriage affects around 1% of women of reproductive age.
Even when tests do not find one clear cause, the next pregnancy can still go well. In unexplained recurrent miscarriage, many studies show roughly 65 out of 100 people have a live birth in the next pregnancy.
Maternal age (and paternal age)
- Maternal age matters because embryo chromosome errors increase with age.
- Paternal age may contribute via sperm quality and sperm DNA fragmentation.
Causes of recurrent miscarriage: the main medical groups
Embryo chromosomal problems (aneuploidy)
Embryo aneuploidy remains the most common recognised cause of miscarriage overall. In early losses, chromosomal abnormalities are often found in 50–60% of cases.
When possible, testing the pregnancy tissue (products of conception) using chromosomal microarray can clarify whether the loss was likely due to a random chromosome event.
Parental genetics (balanced translocation)
In a small percentage of couples (often 2–5%), one partner carries a balanced translocation. The carrier is typically healthy, but the embryo may inherit an unbalanced set of chromosomes.
Uterine factors: cavity and lining
Possible contributors:
- Congenital uterine anomalies (for example, septate uterus)
- submucosal fibroids
- endometrial polyps
- intrauterine adhesions (Asherman syndrome), sometimes after D&C
Cervical insufficiency
Cervical insufficiency means the cervix opens too early, often with minimal pain, causing second‑trimester loss or very preterm birth.
Endocrine and metabolic causes
- Thyroid dysfunction and autoimmune thyroiditis (anti‑TPO antibodies)
- Diabetes / hyperglycaemia (HbA1c optimisation matters)
- PCOS with insulin resistance
- Hyperprolactinaemia in selected cases
Antiphospholipid syndrome (APS)
Antiphospholipid syndrome (APS) is a treatable cause of recurrent miscarriage. Persistent antibodies can impair placental function and increase clotting tendency.
Inherited thrombophilia: debated
Inherited thrombophilias have a less consistent link with pregnancy loss than APS. Many doctors avoid routine testing unless there is personal thrombosis history or strong family history.
Infection and inflammation (selected cases)
Routine infection screening in symptom‑free parents does not consistently improve outcomes. Chronic endometritis (long‑standing uterine lining inflammation) may be considered in selected fertility pathways.
Lifestyle, environment, and male‑factor contributions
Lifestyle does not explain most recurrent miscarriage, but it can influence risk:
- smoking and obesity
- alcohol (best avoided while trying and during pregnancy)
- caffeine: many teams suggest staying near 200 mg/day
- meaningful exposure to pesticides/solvents/heavy metals or excessive heat
Male evaluation may include semen analysis and, in selected cases, sperm DNA fragmentation.
Unexplained recurrent miscarriage
Around 40–50% of cases remain unexplained after workup. Even so, many couples still have a good chance of success.
What to track after each miscarriage
- gestational age and dating
- ultrasound findings
- bleeding and pain pattern
- fever/chills or foul discharge
- tissue testing reports
- treatments used (misoprostol, D&C, progesterone, aspirin/LMWH)
- uterine imaging already done
When to start evaluation (and when to seek faster care)
Many clinicians start evaluation after two clinical losses.
Seek urgent assessment for heavy bleeding, severe pain, fainting, fever/chills, foul discharge, one‑sided pain (possible ectopic pregnancy), or suspicion of molar pregnancy.
Diagnostic workup commonly offered
- Uterine imaging: transvaginal ultrasound, 3D ultrasound, SIS/HSG, sometimes hysteroscopy
- Blood tests: TSH/free T4, HbA1c/glucose, CBC, prolactin when indicated
- APS panel (with repeat testing to confirm persistence)
- Genetic testing of products of conception when available, parental karyotype when indicated
- Male testing: semen analysis ± sperm DNA fragmentation
Treatments: what may be offered
Preconception steps
- Folic acid (often 400 micrograms daily, higher in selected situations)
- optimise thyroid and blood sugar
- review medicines and supplements
- stop smoking, avoid alcohol, limit caffeine
Treat the cause when found
- uterine cavity correction (septum/polyp/submucosal fibroid/adhesions) when appropriate
- cervical length monitoring and sometimes cerclage
- confirmed APS: low‑dose aspirin plus heparin (often LMWH)
Progesterone: individualised
Routine progesterone for everyone with unexplained recurrent miscarriage has not shown clear benefit in major studies. Some clinicians may still consider vaginal progesterone in specific situations (such as early pregnancy bleeding).
Supportive care when unexplained
Early scans, symptom‑based reviews, and a clear plan can reduce distress.
When to try again
Ovulation can return as early as two weeks after an early miscarriage. Some couples try after bleeding stops, others wait for one period for easier dating. After surgery, timing depends on healing and your doctor’s advice.
Emotional wellbeing
Grief and anxiety are common after recurrent miscarriage. Counselling, couples therapy, and peer support can help. Seek urgent help if there are thoughts of self‑harm.
Key takeaways
- Recurrent miscarriage often prompts evaluation after two clinical losses.
- Common treatable factors include uterine cavity problems, APS, thyroid disorders, and diabetes.
- Many cases remain unexplained, yet many couples still have a good chance of live birth.
- Professionals can support medical evaluation and emotional wellbeing. You can also download the Heloa app for personalised guidance and free child health questionnaires.
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